Relevance of biochemical tumor markers and lymphadenectomy in management of non-seminomatous testis tumors: current perspective

Radioimmunoassay determinations of the biochemical tumor markers, alpha-fetoprotein or human chorionic gonadotropin, revealed elevated serum levels in 94 per cent of the patients with advanced disease. No falsely positive values have been observed. The markers are useful in monitoring the response to therapy and, when persistently elevated after therapy, indicate the presence of residual malignant tumor, usually embryonal carcinoma. However, they have a more limited role in the management and followup of the great majority of new patients with non-seminomatous germ cell tumors of the testis (stages A and B) owing to a falsely negative incidence of 38 per cent in patients found to have retroperitoneal metastases at lymphadenectomy. Furthermore, marker levels obtained during chemotherapy, even in the presence of residual tumor, frequently are normal. Thus, they have a limited role in the early detection of residual disease in patients treated systematically with prophylactic chemotherapy. A meticulous retroperitoneal lymphadenectomy remains the single most important factor in dictating the use of adjuvant chemotherapy, the specific agent and the combination and duration of therapy. The prophylactic use of actinomycin D in stage A and the early aggressive use of vinblastine sulfate and bleomycin in stage B2 have reduced the incidence of recurrence substantially. A prospective plan of management used in 95 consecutive patients since 1974 has resulted in survival free of tumor of 100 per cent for patients with stage A disease, 91 per cent for stage B and 61 per cent for stage C.

13,14-Dihydro-15-keto-prostaglandin F2 alpha in patients with urogenital tumors

13,14-Dihydro-15-keto-prostaglandin F2 alpha (13,14-DHK-PGF2 alpha) represents a stable product of degradation after pulmonary flow and it is shown to be reliably measured by radioimmunoassay. In patients with urogenital tumors, serum levels of 13,14-DHK-PGF2 alpha are distinctly elevated when compared to a control group. The rate of synthesis of this compound in urogenital tumors, however, appears to be different.

Correlation of computed tomography and serum tumor markers in metastatic retroperitoneal testicular tumor

Preliminary findings of an apparently good correlation between computed tomography and serum tumor markers--human chorionic gonadotropin and alpha fetoprotein--are presented. These findings are from an ongoing prospective randomized study evaluating the efficacy of intensive chemotherapy and cytoreductive surgery in metastatic retroperitoneal testicular germ cell tumors.

Association of endodermal sinus tumour, testicular teratoma and alpha1-fetoprotein

An endodermal sinus tumour in the retroperitoneal region was associated with the presence of alpha1-fetoprotein (AFP) in the patient's serum. At autopsy a simple cystic teratoma of the right testicle was also found. The association of these two tumours has been reported before. The classification of these malignant germ-cell tumours and an understanding of their evolution may be aided by the discovery that AFP is often found in the patient's serum.

The value of serial measurement of both human chorionic gonadotropin and alpha-fetoprotein for monitoring germinal cell tumors

Quantitative serial serum measurements of human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) levels using sensitive double-antibody radioimmunoassays were performed in nine patients with germinal cell tumors before and during treatment. The sera of eight of the nine were found to have a hCG marker and five of the nine an AFP marker. The sera of four patients were found to have both. Serial serum levels of hCG, of AFP, or both were useful for monitoring disease activity during therapy in all nine patients. In two patients tumor masses failed to diminish during chemotherapy, but the tumor markers fell appropriately. At surgery one patient had a mature teratoma, the other a mature teratoma with a microscopic focus of an embryonal cell tumor. In one patient tumor reactivation was reflected by the emergence of only one of two previously elevated tumor markers. One patient had a rise in hCG, another a rise in both markers coincident with recurrence of tumor. Serial measurements of AFP and hCG are useful for following the response to therapy of germinal tumors, and can assist in making therapeutic decisions.

The significance of alpha-fetoprotein in the serum of patients with malignant teratomas and related gonadal neoplasms

Sera from eleven patients with gonadal germ cell tumors were tested for alpha-fetoprotein (AFP) by counterelectrophoresis. Ovarian neoplasms containing either the endodermal sinus tumor (EST) or dysgerminoma and half of the testicular embryonal carcinomas elaborated the protein into the serum. The presence of AFP in the serum seemed to correlate with early metastasis or a fatal outcome. That the highest levels of AFP were found in cases of EST was in keeping with the theory that the tumor originates in cells of the yolk sac, a principal embryonic site of AFP synthesis.

Radioimmunoassay for human alpha 1 -fetoprotein

A method of radioimmunoassay has been developed for the quantitation of alpha(1)-fetoprotein in human serum. The assay requires 20 mul of serum, can be completed in 8 hr, and can reproducibly detect concentrations of 20 ng of alpha(1)-fetoprotein per ml of serum. Hence, the method is about 500-fold more sensitive for the detection of alpha(1)-fetoprotein than the Ouchterlony teohnique currently in general use. The procedure is of potential clinical value as an aid in the diagnosis of cancer and a number of noncancerous hepatic diseases.