Radiotherapy has not been shown to effect the course of non-seminomatous germ cell tumours except for palliative treatments and when there are cranial metastases.
Radiotherapy for Stage I Disease
Radiotherapy has not been used for retroperitoneal radiotherapy for several years. In 1991 a study by Rorth et al  comparing radiotherapy with observation for Stage I non-seminomatous germ cell tumours was released. Although there were no retroperitoneal relapses with radiotherapy, there were still a number of other relapses outside of this region. For the surveillance arm, retroperitoneal relapse had not impact on survival. This study ended the use of radiotherapy for Stage I non-seminomatous germ cell tumour.
Radiotherapy for Brain Metastases 
Brain metastases present in three ways:
- As part of the initial presentation of disease
- As an isolated relapse in otherwise controlled disease
- As part of generalised disease progression
Patients who present with brain metastases have a 25% chance of long term survival if they receive whole brain radiotherapy followed by systemic chemotherapy. Those who develop an isolated recurrence in the brain after a complete response to systemic chemotherapy have an average 5 year survival of 75%; however numbers are very small (8 patients). The dose used in the Spears study was 50 Gy / 25 #.
If brain metastases develop as part of a generalised recurrence of disease then the prognosis is typically grim and high dose radiotherapy is not thought to be appropriate. Palliative radiotherapy (20 Gy / 10 #) may prevent progression of disease in about 40% of patients. Selection of patients is critical; in the study by Spears et al 40% of patients died from systemic disease during or within one month of completing whole brain radiotherapy.
Radiotherapy for Palliation
Palliative radiotherapy can be an effective treatment for non-seminomatous germ cell tumours. Doses from 8 Gy/ 1 # up to 30 Gy/ 10 # are appropriate.
- 3. Non-Seminomatous Germ Cell Tumours