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Stoehr B, Zangerl F, Steiner E, Leonhartsberger N, Fritzer A, Bartsch G, Steiner H. Routine scrotal ultrasonography during the follow-up of patients with testicular cancer leads to earlier detection of asynchronous tumours and a high rate of organ preservation. BJU Int 2010; 105:1118-20. [DOI: 10.1111/j.1464-410x.2009.08906.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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152
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Nicolai N, Necchi A, Piva L, Stagni S, Catanzaro M, Biasoni D, Milani A, Torelli T, Salvioni R. Retroperitoneal Surgery in the Treatment of Germ-Cell Tumors of the Testis: Retroperitoneal Lymph Node Dissection (RPLND). Urologia 2010. [DOI: 10.1177/039156031007700202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Germ-cell tumors of the testis (GCTT) are rare, but have a high social impact. In fact they represent no more than 1% of male tumors (about 700 new cases per year in Italy), but electively occur in young patients, 20 to 40 years old, during their fully mature social and working life. More than 80% of patients are cured and return to a normal social, sexual, and working life. Improvements achieved both in diagnosis, with the use of scans (CT, MRI, US and recently PET) and of serum tumor markers alpha-fetoprotein (AFP), beta-fraction of human chorionic gonadotropin (β-HCG) and lactate dehydrogenase (LDH), and mainly in treatment, through the amelioration of radiotherapy and surgical techniques and, especially, with the introduction of Cisplatin, Etoposide and Ifosfamide in Chemotherapic regimens, have made germ-cell tumor a model of “curable disease”. Retroperitoneal lymph node dissection (RPLND) has indications in patients with clinical stage I (CS1) as well as in advanced disease, where it is integrated in the multimodality treatment. Anatomical studies, as well as a long-term experience, have gradually but consistently modified the surgical techniques of RPLND. Currently, “nerve sparing” RPLND represents a safe management of CS1 nonseminomatous germ cell testicular tumor with minimal morbidity and excellent outcomes. Nonetheless, surveillance and adjuvant chemotherapy are as effective as RPLND, but, in our opinion, associated with some discomforts for the patients. Laparoscopic retroperitoneal lymph node dissection (Lap-RPLND) is gaining popularity as a minimally invasive staging procedure for clinical stage I nonseminomatous testicular carcinoma, but its therapeutic role is still under investigation.
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Affiliation(s)
- N. Nicolai
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - A. Necchi
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - L Piva
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - S. Stagni
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - M.A. Catanzaro
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - D. Biasoni
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - A. Milani
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - T. Torelli
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - R. Salvioni
- SC Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
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153
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Challenging the EAU 2009 Guidelines on Testis Cancer: The Risk-Adapted Management of Stage I Nonseminomatous Germ Cell Tumours: Surveillance Yields Equal Results With Less Toxicity. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.eursup.2010.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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154
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van Vledder MG, van der Hage JA, Kirkels WJ, Oosterhuis JW, Verhoef C, de Wilt JHW. Cervical Lymph Node Dissection for Metastatic Testicular Cancer. Ann Surg Oncol 2010; 17:1682-7. [DOI: 10.1245/s10434-010-1036-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Indexed: 11/18/2022]
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155
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Bevacizumab in combination with sequential high-dose chemotherapy in solid cancer, a feasibility study. Bone Marrow Transplant 2010; 45:1704-9. [PMID: 20228848 DOI: 10.1038/bmt.2010.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We evaluated the feasibility and toxicity of bevacizumab in combination with sequential high-dose (HD) ifosfamide, carboplatin and etoposide refractory to standard chemotherapy in patients with sarcoma and germ cell cancer (GCC). Sixteen patients (13 sarcomas, 3 GCC) received SD-ICE followed by 4 cycles of HD-ICE, qd22 with stem cell support in combination with bevacizumab. All 16 patients were evaluable for toxicity and efficacy, and received 51 cycles (median 3.3). There was no increase in toxicity except of a relatively high incidence of ifosfamide encephalopathy in 17 cycles when compared with previous HD-ICE protocols. One almost complete response in the patient with GCC, previously progressive with three preceding protocols, was observed. Six patients had a partial response (sarcoma 4/13 patients; GCC 2/3 patients), and five patients stable disease (sarcoma 5/13 patients). The median PFS/OS for sarcoma was 5 months (confidence interval (CI): 3.1-6.9) and 13 months (CI: 3.6-24.4), respectively. To our knowledge, this is the first report of the addition of bevacizumab to HD-ICE. This combination did not show new unexpected toxicities except for a relatively high rate of ifosfamide encephalopathy. The efficacy in these heavily pretreated patients including possible reversal of chemotherapy resistance by the addition of bevacizumab indicates a possible potential of bevacizumab in this combination.
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156
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Seitz M, Bader M, Strittmatter F, Gratzke C, Tilki D, Roosen A, Schlenker B, Reich O, Stief C. [Diagnostic work-up for lymph node metastases of urological tumors]. Urologe A 2010; 49:356-63. [PMID: 20213349 DOI: 10.1007/s00120-010-2271-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Both CT and MRI are currently the most frequently used and recommended modalities for lymph node staging of uro-oncological diseases. Their diagnostic usefulness is limited particularly for recognition of micrometastases and lymph nodes <10 mm. FDG- and choline-based PET/CT procedures also do not offer much improvement in these cases. Meanwhile however PET/CT has been included in the EAU guidelines for seminomas and is recommended for further management of residual tumors after chemotherapy. Magnetic resonance imaging with lymphotropic monocrystalline iron oxide nanoparticles appears to exhibit great potential and can detect smaller metastases and micrometastases even in normal-sized lymph nodes in uro-oncological diseases. Nevertheless, Guerbet has withdrawn its application to the EMEA for marketing authorization of its product Sinerem (superparamagnetic iron oxide nanoparticles). In the meantime diffusion-weighted MRI represents a promising technique and is already being evaluated in fields outside the realm of urology.
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Affiliation(s)
- M Seitz
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 München.
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157
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Piulats JM, Jiménez L, García del Muro X, Villanueva A, Viñals F, Germà-Lluch JR. Molecular mechanisms behind the resistance of cisplatin in germ cell tumours. Clin Transl Oncol 2010; 11:780-6. [PMID: 20045784 DOI: 10.1007/s12094-009-0446-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cisplatin has been one of the principal chemotherapy agents for the last 30 years and is still used widely in the treatment of testicular, ovarian, lung, head and neck, bladder and several other tumours. Resistance to chemotherapeutic agents is a major obstacle for successful treatment. Treatment effect on germ cell tumours (GCTs) is more successful than in adults suffering from almost any other solid tumour, but resistance still appears in 20% of patients with metastatic disease. However, because of the young age of patients and few data regarding the process of becoming resistant, this situation is still a challenge. In this review we are going to analyse the published literature on cisplatin resistance in GCTs and explain the initiatives that the Spanish Germ Cell Cancer Group (GG) is taking to try to elucidate the molecular mechanisms behind this process.
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Affiliation(s)
- Josep Ma Piulats
- Medical Oncology Department, IDIBELL Institut Català d'Oncologia, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, Spain
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158
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No Role for Routine Chest Radiography in Stage I Seminoma Surveillance. Eur Urol 2010; 57:474-9. [DOI: 10.1016/j.eururo.2009.06.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 06/17/2009] [Indexed: 11/24/2022]
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159
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Karadimou A, Dimopoulos MA, Bamias A. The role of high-dose chemotherapy in the treatment of testicular cancer. Open Access J Urol 2010; 2:25-30. [PMID: 24198610 PMCID: PMC3818874 DOI: 10.2147/rru.s6571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Testicular cancer is a highly curable neoplasm, even in the case of extragonadal disease. Nevertheless, patients with adverse prognostic features or relapsing after first-line cisplatin-based chemotherapy have a worse prognosis with a death rate greater than 50%. High-dose chemotherapy (HDC) has long been used in this group of patients. The introduction of stem cells, instead of bone marrow, as the source of hemopoietic cells and the use of leukocyte growth factors have substantially reduced the mortality and morbidity of this procedure although the role of HDC is not well defined. This review summarizes the available data, focusing on published randomized studies. The problems associated with the design of these studies and the interpretation of data are discussed. Currently this HDC approach is mainly used in patients who relapse after first-line chemotherapy. Nevertheless, selection of patients likely to benefit from this treatment remains an issue of intense clinical research.
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Affiliation(s)
- Alexandra Karadimou
- Dept of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | | | - Aristotle Bamias
- Dept of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
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160
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Kollmannsberger C, Daneshmand S, So A, Chi KN, Murray N, Moore C, Hayes-Lattin B, Nichols C. Management of Disseminated Nonseminomatous Germ Cell Tumors With Risk-Based Chemotherapy Followed by Response-Guided Postchemotherapy Surgery. J Clin Oncol 2010; 28:537-42. [DOI: 10.1200/jco.2009.23.0755] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The management of patients with a radiographic complete response after chemotherapy remains controversial. The current study assesses the outcome for a modern, unselected patient population with disseminated testicular cancer with particular emphasis on those achieving a radiographic complete remission to combination chemotherapy. Patients and Methods All patients with disseminated nonseminoma seen between 1999 and 2007 at the British Columbia Cancer Agency (BCCA) as well as through the Oregon Testis Cancer Program were retrospectively reviewed. A total of 276 patients treated with combination chemotherapy were identified. A radiographic complete remission (CR) was defined as disappearance of all metastatic lesions or minimal residual tissue ≤ 1 cm. Results One hundred sixty-one patients achieved a CR. Results for the total population and CR subset were as follows: International Germ Cell Cancer Consensus Group stage good/intermediate/poor 84%/5%/11% (CR subset, 94%/3%/3%), presence of teratoma in the primary tumor 40% (CR subset, 55%), relapses 13%, death from disease 3% (CR subset, 6% and 0%, respectively). Two of the total 10 relapses in the CR group occurred beyond 2 years. Eight of the 10 relapses in the CR group were treated surgically for teratoma alone, whereas two required salvage chemotherapy. Disease-specific survival for the CR group was 100% after a median follow-up of 52 months (range, 3 to 135 months). Conclusion Modern risk-adapted systemic chemotherapy with or without surgery for current populations of patients with disseminated testicular nonseminoma results in superb outcomes. Patients with disseminated germ cell tumors who obtain a complete serologic remission and no or minimal radiographic residual can be safely observed without adjunctive regional surgery.
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Affiliation(s)
- Christian Kollmannsberger
- From the Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre; Department of Urological Sciences, University of British Columbia, The Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; Section of Urologic Oncology, Divisions of Urology and Renal Transplantation and Hematology and Medical Oncology, Oregon Health & Science University; and the Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR
| | - Siamak Daneshmand
- From the Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre; Department of Urological Sciences, University of British Columbia, The Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; Section of Urologic Oncology, Divisions of Urology and Renal Transplantation and Hematology and Medical Oncology, Oregon Health & Science University; and the Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR
| | - Alan So
- From the Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre; Department of Urological Sciences, University of British Columbia, The Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; Section of Urologic Oncology, Divisions of Urology and Renal Transplantation and Hematology and Medical Oncology, Oregon Health & Science University; and the Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR
| | - Kim N. Chi
- From the Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre; Department of Urological Sciences, University of British Columbia, The Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; Section of Urologic Oncology, Divisions of Urology and Renal Transplantation and Hematology and Medical Oncology, Oregon Health & Science University; and the Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR
| | - Nevin Murray
- From the Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre; Department of Urological Sciences, University of British Columbia, The Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; Section of Urologic Oncology, Divisions of Urology and Renal Transplantation and Hematology and Medical Oncology, Oregon Health & Science University; and the Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR
| | - Christie Moore
- From the Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre; Department of Urological Sciences, University of British Columbia, The Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; Section of Urologic Oncology, Divisions of Urology and Renal Transplantation and Hematology and Medical Oncology, Oregon Health & Science University; and the Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR
| | - Brandon Hayes-Lattin
- From the Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre; Department of Urological Sciences, University of British Columbia, The Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; Section of Urologic Oncology, Divisions of Urology and Renal Transplantation and Hematology and Medical Oncology, Oregon Health & Science University; and the Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR
| | - Craig Nichols
- From the Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre; Department of Urological Sciences, University of British Columbia, The Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; Section of Urologic Oncology, Divisions of Urology and Renal Transplantation and Hematology and Medical Oncology, Oregon Health & Science University; and the Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR
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161
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162
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Stang A, Katalinic A, Dieckmann KP, Pritzkuleit R, Stabenow R. A novel approach to estimate the German-wide incidence of testicular cancer. Cancer Epidemiol 2010; 34:13-9. [DOI: 10.1016/j.canep.2009.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 11/26/2022]
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163
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Dieckmann KP, Gerl A, Witt J, Hartmann JT. Myocardial infarction and other major vascular events during chemotherapy for testicular cancer. Ann Oncol 2010; 21:1607-1611. [PMID: 20067918 DOI: 10.1093/annonc/mdp597] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic vascular morbidity resulting from chemotherapy for testicular germ-cell cancer (TGCC) is recognized. Cardiovascular events (CVEs) occurring early during chemotherapy are less understood. We evaluated the incidence and clinical features of CVEs associated with chemotherapy of TGCC. PATIENTS AND METHODS A questionnaire was sent to 355 institutions in Germany to explore for early CVEs occurring during 1996-2008. To assess the relative incidence of CVEs, the number of events was put into relation to the total number of patients treated during the time span (n = 8233, calculated from national database). The response rate was 79%. RESULTS Twenty cases with myocardial infarction (MI), 3 with cerebral stroke, and 2 with arterial thrombosis were recorded. The estimated incidence of MI and of all CVEs during chemotherapy is 0.24% [95% confidence intervals (CIs) 0.137% to 0.349%] and 0.30% (95% CI 0.188% to 0.423%), respectively. This estimate represents a minimum figure because the calculation is on the basis of simplifications. Six MI patients had no risk factors. Coronary angiography was indicative of thromboembolic rather than atherosclerotic origin of MI. CONCLUSIONS There is a small but definite risk of major early CVE associated with chemotherapy of TGCC. Physicians caring for TGCC patients must be aware of this hazard.
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Affiliation(s)
- K-P Dieckmann
- Department of Urology, Albertinen-Krankenhaus Hamburg, Hamburg.
| | - A Gerl
- Onkologische Schwerpunktpraxis München, Munich
| | - J Witt
- Department of Cardiology, Albertinen-Krankenhaus Hamburg, Hamburg
| | - J-T Hartmann
- Department of Medical Oncology, II. Medizinische Klinik und Poliklinik, Universitätsklinik Tübingen, Tübingen, Germany
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164
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Kawai K, Akaza H. Current status of chemotherapy in risk-adapted management for metastatic testicular germ cell cancer. Cancer Sci 2010; 101:22-8. [PMID: 19922501 PMCID: PMC11159163 DOI: 10.1111/j.1349-7006.2009.01373.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Today, approximately 80% of men with metastatic testicular cancer can be cured with chemotherapy combined with the appropriate surgery. The improved treatment outcome has led to the stratification of patients with metastatic disease by the consensus prognostic index; the International Germ Cell Cancer Consensus Group classification. Currently, the first-line chemotherapy with bleomycin, etoposide, and cisplatin (BEP) remains the standard management of metastatic testicular cancer. Three cycles of BEP for good-prognosis patients and four cycles of BEP for intermediate- and poor-prognosis patients are the standard first-line chemotherapy. To achieve the optimal outcome, BEP should be given with appropriate supportive care and risk assessment for toxicity. Although no universal prognostic criteria have been defined for the recurrent or refractory disease, the risk-adapted approach may clarify the role of ifosfamide- and paclitaxel-containing conventional-dose chemotherapy or high-dose chemotherapy in the second-line setting. Several investigators reported recent improvement of treatment outcome of testicular cancer patients, especially those with poor prognosis. Along with the progress in chemotherapy, the risk-adapted management at experienced hospitals seems to be responsible for the recent progress in treatment outcome.
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Affiliation(s)
- Koji Kawai
- Department of Urology, Institute of Clinical Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki, Japan.
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165
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Lee SC, Kim KH, Kim SH, Lee NS, Park HS, Won JH. Mixed testicular germ cell tumor presenting as metastatic pure choriocarcinoma involving multiple lung metastases that was effectively treated with high-dose chemotherapy. Cancer Res Treat 2009; 41:229-32. [PMID: 20057969 DOI: 10.4143/crt.2009.41.4.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 06/28/2009] [Indexed: 11/21/2022] Open
Abstract
Choriocarcinoma in the testis is very rare, and it represents less than 1% (0.3%) of all the testicular germ cell tumors. It is a particularly aggressive variant of non-seminoma tumor, which is characterized by a high serum beta-HCG level and multiple lung metastases. The optimal management for this disease remains undefined. We report here on a case of choriocarcinoma with multiple lung metastases, and the patient has achieved continuous remission for 2 years after combination chemotherapy of BEP (bleomycin, etoposide and cisplatin) and sequential high-dose chemotherapy with autologous peripheral stem cell rescue.
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Affiliation(s)
- Sang-Cheol Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
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166
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Brydøy M, Oldenburg J, Klepp O, Bremnes RM, Wist EA, Wentzel-Larsen T, Hauge ER, Dahl O, Fosså SD. Observational study of prevalence of long-term Raynaud-like phenomena and neurological side effects in testicular cancer survivors. J Natl Cancer Inst 2009; 101:1682-95. [PMID: 19940282 PMCID: PMC2794301 DOI: 10.1093/jnci/djp413] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Sensory neuropathy (paresthesias), tinnitus, hearing impairment, and Raynaud phenomena are side effects of cisplatin-based chemotherapy used to treat testicular cancer patients. We assessed the long-term occurrence of these side effects among testicular cancer survivors according to the treatment they received. Methods A total of 1814 men who were treated for unilateral testicular cancer in Norway during 1980–1994 were invited to participate in a national multicenter follow-up survey conducted during 1998–2002. The men were allocated to six groups according to the treatment they had received. Self-reported symptoms were assessed by a mailed questionnaire that included the Scale for Chemotherapy-Induced Neurotoxicity. A total of 1409 participants who responded to the questionnaire and/or underwent audiometry were assessable in this study. Respondents to the questionnaire (n = 1402) scored the relevant symptoms according to how troubled they were by each (not at all, a little, quite a bit, or very much). Hearing impairment was objectively assessed by audiometry at 4000 Hz in 755 men (seven of whom did not respond to the questionnaire). Group comparisons of symptom assessments were performed with χ2 or Kruskal–Wallis tests. Associations between relevant factors and self-reported symptoms or hearing impairment measured by audiometry were assessed using proportional odds ordinal logistic regression models and linear regression models, respectively. All statistical tests were two-sided. Results The median follow-up for the 1409 assessable men was 10.7 years (range = 4–21 years). All chemotherapy groups had statistically significantly higher odds for increasing severity of all assessed symptoms and inferior audiometric results compared with men who did not receive chemotherapy. Among chemotherapy-treated men, 39% (95% confidence interval [CI] = 35% to 43%) reported Raynaud-like phenomena (defined as white or cold hands or fingers [or feet or toes] on cold exposure), 29% (95% CI = 25% to 33%) reported paresthesias in the hands or feet, 21% (95% CI = 18% to 25%) reported hearing impairment, and 22% (95% CI = 19% to 26%) reported tinnitus as major symptoms troubling them quite a bit or very much. Hearing impairment (odds ratio [OR] = 5.3, 95% CI = 3.0 to 9.2) and tinnitus (OR = 7.1, 95% CI = 4.1 to 12.4) were particularly common in the dose-intensive chemotherapy group compared with the no chemotherapy group. Men who were treated with radiotherapy had higher odds of self-reported paresthesias in feet compared with those not treated with radiotherapy (OR = 1.5, 95% CI = 1.01 to 2.1, P = .04). Conclusion Long-term survivors of testicular cancer who were treated with cisplatin-based chemotherapy were more often troubled by dose-dependent neurological side effects and Raynaud-like phenomena compared with those who were not treated with chemotherapy.
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Affiliation(s)
- Marianne Brydøy
- Department of Oncology, Haukeland University Hospital, N-5021 Bergen, Norway.
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167
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Nichols CR, Kollmannsberger C. Clinical Claims From Claims-Based Data. J Clin Oncol 2009; 27:e282-3; author reply e284-5. [DOI: 10.1200/jco.2009.25.8319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Craig R. Nichols
- Providence Cancer Center, Earle A. Chiles Research Institute, Portland, OR
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, British Columbia, Canada
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168
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Breaking down barriers: improving outcomes for teenagers and young adults with germ cell tumours. Oncol Rev 2009. [DOI: 10.1007/s12156-009-0030-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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169
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Salvioni R, Nicolai N, Necchi A, Torelli T, Piva L, Stagni S, Catanzaro MA, Biasoni D, Milani A. State of the Art and Controversies in the Treatment of Testis Germ-Cell Tumors (TGT). Urologia 2009. [DOI: 10.1177/039156030907600401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many different, intersecting strategies are available for managing germ-cell cancers, particularly in early-stage disease. Which is ‘right’ remains a matter of debate, and requires balancing efficacy against late effects, bearing in mind the complexity of treatment strategies and the available expertise.
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Affiliation(s)
- R. Salvioni
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - N. Nicolai
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - A. Necchi
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - T. Torelli
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - L. Piva
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - S. Stagni
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - M. A. Catanzaro
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - D. Biasoni
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
| | - A. Milani
- SC di Chirurgia Urologica, Fondazione IRCCS Istituto Tumori, Milano
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170
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Ellinger J, Albers P, Müller SC, von Ruecker A, Bastian PJ. Circulating mitochondrial DNA in the serum of patients with testicular germ cell cancer as a novel noninvasive diagnostic biomarker. BJU Int 2009; 104:48-52. [PMID: 19154496 DOI: 10.1111/j.1464-410x.2008.08289.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the diagnostic and prognostic value of cell-free mitochondrial (mt)DNA in patients with testicular cancer, as increased levels of cell-free circulating mtDNA have been reported in patients with cancer. PATIENTS, SUBJECTS AND METHODS In all, 74 patients with testicular cancer (seminoma in 39, nonseminoma in 35) and 35 healthy individuals were included in the study. Circulating DNA was isolated from 1 mL of serum. A quantitative real-time polymerase chain reaction was used to analyse the levels of a 79-bp (mtDNA-79) and 220 bp (mtDNA-220) fragment of the mitochondrial specific 16S-RNA. The mtDNA integrity was expressed as the ratio of mtDNA-220 to mtDNA-79. RESULTS mtDNA-79 and mtDNA-220 levels were significantly (P < 0.001) greater in patients with testicular cancer than in healthy individuals. The mtDNA integrity was similar in patients and healthy controls (P = 0.435). Receiver operator characteristic curve analysis showed that cell-free mtDNA (mtDNA-79) levels distinguished, with a sensitivity of 59.5% and a specificity of 94.3%, between patients and healthy individuals (area under curve, 0.787). Also, mtDNA-79 levels could be used to distinguish between patients (31) with conventional markers (alpha-fetoprotein, human chorionic gonadotrophin, placental alkaline phosphatase and lactate dehydrogenase) within normal ranges and healthy individuals, with a sensitivity of 64.5% and specificity of 91.4% (area under curve 0.797). Cell-free mtDNA levels were not correlated with any clinicopathological variable (pT stage, lymph node invasion, vascular invasion, clinical stage, International Germ Cell Cancer Collaborative Group classification, tumour markers; all P > 0.05). CONCLUSION Cell-free mtDNA levels are greater in patients with testicular cancer and might provide valuable information for managing patients with testicular anomalies, especially those with normal levels of established tumour markers.
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Affiliation(s)
- Jörg Ellinger
- Klinik und Poliklinik für Urologie, Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
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171
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Posttreatment surveillance after paraaortic radiotherapy for stage I seminoma: a systematic analysis. J Cancer Res Clin Oncol 2009; 136:227-32. [PMID: 19680688 DOI: 10.1007/s00432-009-0653-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
Abstract
CONTEXT The extent and duration of routine follow-up after paraaortic (PA) radiotherapy for stage I seminoma remain controversial in terms of efficacy, costs of technical investigations and long-term morbidity. OBJECTIVE To analyze the current literature assessing routine follow-up after PA radiotherapy for stage I seminoma. EVIDENCE ACQUISITION We identified all published reports on PA radiotherapy for stage I seminoma (1986-2005). We analyzed time patterns of recurrence, sites and methods of detection of relapse, and follow-up programs used. EVIDENCE SYNTHESIS We identified 11 publications reporting outcome in 2,280 patients. Median time to recurrence in 80 relapsing patients was 15.5 months. Less than 10% of recurrences were diagnosed beyond the third year of follow-up. Isolated locoregional or distant recurrence was observed in 52 and 20 patients, respectively, without significant difference in median time to relapse. 19 out of 43 recurrences with reported method of detection of relapse were diagnosed by routine technical investigations. There was no significant difference in time to relapse between those patients followed with low volume as compared to high-volume imaging protocols. CONCLUSIONS Our data suggest that technical investigations in posttreatment surveillance should be restricted to the first 3 years of follow-up. Furthermore, surveillance programs with a high volume of imaging apparently do not lead to earlier detection or less advanced stage at the time of relapse as compared to protocols with low volume imaging.
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172
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Beck SDW, Foster RS. Management of the post chemotherapy subcentimeter residual mass: the case for observation. World J Urol 2009; 27:485-8. [DOI: 10.1007/s00345-009-0452-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022] Open
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173
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Calestroupat JP, Sanchez-Salas R, Cathelineau X, Rozet F, Galiano M, Smyth G, Kasraeian A, Barret E, Vallancien G. Postchemotherapy laparoscopic retroperitoneal lymph node dissection in nonseminomatous germ-cell tumor. J Endourol 2009; 23:645-50. [PMID: 19335332 DOI: 10.1089/end.2008.0423] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Postchemotherapy retroperitoneal lymph node dissection (RPLND) remains essential in the management of metastatic testicular carcinoma and represents a surgical challenge. We determined to assess the feasibility and complications of laparoscopic RPLND in patients who were treated with induction chemotherapy for testis cancer. PATIENTS AND METHODS We performed a retrospective analysis of data that was prospectively recorded from 26 patients who underwent laparoscopic RPLND postplatinum-based chemotherapy between 2000 and 2006. The surgical technique consisted of excision of the residual mass plus unilateral template dissection. A transperitoneal technique was used in 24 patients, and an extraperitoneal approach was used in 2 patients. Operative details, perioperative morbidity data, and histologic findings were assessed for the study. RESULTS Primary pathologic evaluation of the testis tumor revealed pure embryonal carcinoma in 4 patients, teratocarcinoma in 1 patient, and mixed nonseminomatous germ-cell tumors in 21 patients. All patients had residual disease in the retroperitoneum on a preoperative CT scan, with a median size of 3.4 cm (range 2-6 cm). Procedures in three (11.5%) patients were converted to open surgery. Median operative time was 183 minutes (range 120-260 min). Median estimated blood loss was 400 mL (range 100-600 mL), and blood transfusion was necessary in one patient. Median hospital stay was 5 days (range 2-6 d). Median number of lymph nodes obtained on final histologic examination was 7 (range 4-13). Perioperative complications included eight lymphovascular and one intestinal. At a mean follow-up of 27 months (range 14-36 mos), no recurrences have been observed and no patient was lost to follow-up. CONCLUSIONS Postchemotherapy laparoscopic RPLND is technically feasible. The most frequent complications and causes of conversion are lymphovascular.
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174
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Clinical stage I seminoma: the case for surveillance. World J Urol 2009; 27:433-9. [DOI: 10.1007/s00345-009-0430-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 05/19/2009] [Indexed: 10/20/2022] Open
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175
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Nichols CR, Kollmannsberger C. Vox Populi: Using Community-Based Studies to Determine Best Management of Early-Stage Nonseminoma. J Clin Oncol 2009; 27:2114-6. [DOI: 10.1200/jco.2008.21.1524] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Craig R. Nichols
- Providence Cancer Center, Earle A. Chiles Research Institute, Portland, Oregon
| | - Christian Kollmannsberger
- British Columbia Cancer Agency-Vancouver Cancer Centre, University of British Columbia, Vancouver, British Columbia, Canada
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176
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Schmoll HJ, Jordan K, Huddart R, Laguna M, Horwich A, Fizazi K, Kataja V. Testicular non-seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 Suppl 4:89-96. [DOI: 10.1093/annonc/mdp139] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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177
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Schmoll HJ, Jordan K, Huddart R, Laguna M, Horwich A, Fizazi K, Kataja V. Testicular seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 Suppl 4:83-8. [DOI: 10.1093/annonc/mdp138] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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178
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Eberhard J, Ståhl O, Cohn-Cedermark G, Cavallin-Ståhl E, Giwercman Y, Rylander L, Eberhard-Gran M, Kvist U, Fugl-Meyer KS, Giwercman A. Sexual function in men treated for testicular cancer. J Sex Med 2009; 6:1979-89. [PMID: 19453896 DOI: 10.1111/j.1743-6109.2009.01298.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Testicular germ cell cancer (TGCC) patients may be at risk of developing sexual dysfunction after treatment. AIM The aim of this study was to assess the prevalence of sexual dysfunctions in TGCC patients 3 to 5 years after treatment, and relate findings to biochemical hypogonadism, treatment intensity, and the expected prevalence in the Swedish male population. METHODS A questionnaire study on 129 consecutive TGCC patients 3 to 5 years post-treatment was performed. Comparators were an age-matched nationally representative group of men (N = 916) included in a study on sexual life in Sweden. MAIN OUTCOME MEASURES Sexual functions (including erectile dysfunctional distress), time since last intercourse, sexual satisfaction, and experience of sexological treatment seeking were assessed using the same questions used in the epidemiological study on sexual life in Sweden. The findings in TGCC patients were correlated to biochemical signs of hypogonadism and type of oncological treatment: Surveillance, adjuvant chemotherapy, adjuvant radiotherapy, or standard doses of chemotherapy. RESULTS A higher proportion of TGCC patients than comparators were likely to report low sexual desire (odds ratio [OR] 6.7 [95% confidence interval {CI} 2.1-21]) as well as erectile dysfunction (OR 3.8 [95% CI 1.4-10]). No significant differences were observed regarding erectile dysfunctional distress, change of desire over time, interest in sex, premature or delayed ejaculation, time since last intercourse, need for or receiving sexual advice, or sexual satisfaction. Hypogonadism did not predict erectile dysfunction (OR 1.1 [95% CI 0.26-4.5]) or low sexual desire (OR 1.2 [95% CI 0.11-14]). Treatment modality had no obvious impact on sexual function. CONCLUSION Men treated for testicular cancer had higher risk of having low sexual desire and erectile dysfunction 3 to 5 years after completion of therapy than comparators. These sexual dysfunctions were not significantly associated with treatment intensity or hypogonadism.
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Affiliation(s)
- Jakob Eberhard
- Department of Oncology, Lund University Hospital, Lund, Sweden.
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179
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Skliarenko J, Vesprini D, Warde P. Stage I seminoma: What should a practicing uro-oncologist do in 2009? Int J Urol 2009; 16:544-51. [DOI: 10.1111/j.1442-2042.2009.02296.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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180
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Oldenburg J, Wahlqvist R, Fosså SD. Late relapse of germ cell tumors. World J Urol 2009; 27:493-500. [PMID: 19373473 DOI: 10.1007/s00345-009-0411-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 03/26/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the main characteristics of late relapsing malignant germ cell tumors (MGCTs). These tumors are rare and occur by definition 2 years or later after successful treatment. METHODS We present relevant literature on relapsing MGCT in order to highlight the following issues: incidence, impact of initial treatment on the subsequent risk of late relapse, treatment, and survival. RESULTS A pooled analysis of 5,880 patients with MGCT revealed late relapses in 119 of 3,704 (3.2%) and in 31 of 2,176 (1.4%) patients with non-seminoma and seminoma, respectively. The retroperitoneal space is the predominant site of relapse in both histological types. The initial treatment is important for the risk and localization of late relapses. Patients with single site teratoma are usually cured by surgery alone, whereas viable MGCT or teratoma with malignant transformation may require multimodal treatment with chemo- and/or radiotherapy as well as surgery. Surgery is the most important part in the treatment of late relapses. Salvage chemotherapy should, if feasible, be based on a representative biopsy. Five-year cancer-specific survival is above 50% in the recent large series and reaches 100% in case of single site teratoma. CONCLUSIONS Treatment of late relapsing MGCT patients is challenging and should be performed in experienced centers only. Referral of late relapsing patients to high-volume institutions ensures the best chances of cure and enables multimodal treatment, and contributes to increased knowledge of tumor biology as well experience with the clinical course of these patients.
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Affiliation(s)
- Jan Oldenburg
- Department of Medical Oncology, The Norwegian Radium Hospital, Oslo, Norway,
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181
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Consequences of Missed Nodes during Retroperitoneal Lymph Node Dissection and How to Avoid Them. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eursup.2009.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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182
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Abstract
Cancer patients frequently report cognitive complaints following chemotherapy, but the results from the available studies, mainly of women with breast cancer, are inconsistent. Our aim was to compare cognitive function of men with testicular cancer (TC) who had orchiectomy and chemotherapy (bleomycin, etoposide, cisplatin) with men who had orchiectomy only or orchiectomy and radiotherapy. Thirty-six chemotherapy patients and 36 nonchemotherapy patients were tested 2-7 years after treatment for TC with standardized neuropsychological tests. Chemotherapy and nonchemotherapy patients displayed similar performances on cognitive tests (p values adjusted for multiple comparisons: .63-1.00). Moreover, there was no difference in the proportion of cognitively impaired patients in the chemotherapy group (5.6%) compared to the nonchemotherapy group (8.3%) (chi2 = 0.22, p = .64). Our results are discordant with previous findings indicating cognitive impairment following chemotherapy and suggest that TC patients do not need to fear long-term cognitive consequences following chemotherapy.
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183
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184
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185
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[Value of retroperitoneal lymphadenectomy for germ cell cancer]. Urologe A 2008; 48:32-6. [PMID: 19066838 DOI: 10.1007/s00120-008-1757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Retroperitoneal lymph node dissection (RPLND) is an integral part in the therapy of nonseminomatous germ cell tumors. However, there has been a shift concerning the indication. For a long period RPLND was the primary choice in clinical stage I nonseminoma. Nowadays a risk-adapted strategy is preferred. RPLND is obligatory after finishing chemotherapy in metastasized patients if residual tumor is seen. In cases of a late relapse surgery is much more important than chemotherapy independent of increased tumor markers. RPLND can also be a salvage strategy in chemoresistant patients. About 25% of these patients have a long-term benefit. Open or laparoscopic surgery can be performed, though the indications for laparoscopy are small.
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186
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Affiliation(s)
- Carmel J. Pezaro
- Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Girish Mallesara
- Department of Medical Oncology, Calvary Mater Newcastle, New South Wales, Australia
| | - Guy C. Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne; University of Melbourne, Melbourne, Victoria, Australia
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187
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Pectasides D, Pectasides E, Constantinidou A, Aravantinos G. Stage I testicular seminoma: management and controversies. Crit Rev Oncol Hematol 2008; 71:22-8. [PMID: 19046898 DOI: 10.1016/j.critrevonc.2008.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 09/28/2008] [Accepted: 10/09/2008] [Indexed: 11/20/2022] Open
Abstract
Seminomas constitute more than half of testicular germ-cell tumours and 70-80% of patients with seminoma present with clinical stage I disease. Post-orchiectomy, management options include irradiation, surveillance or chemotherapy. Adjuvant irradiation to the infradiaphragmatic lymph nodes is the standard of care with relapse rates of 3-4%. Long-term follow-up data have shown association with late complications (cardiotoxicity, second malignancy, fertility impairment). Surveillance is an attractive alternative but relapse rates are higher ranging between 15 and 20%. Single agent carboplatin chemotherapy has demonstrated survival data equivalent to radiotherapy but long-term relapse and toxicity data are yet to be confirmed. Routine follow-up after irradiation and the role of risk stratification also remain unclear. Highly curative rates can be attained by all three modalities. Standard treatment with radiotherapy is challenged by surveillance and chemotherapy. Toxicity issues and patients' preferences are considered when management decisions are made.
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Affiliation(s)
- D Pectasides
- 2nd Department of Internal Medicine, Propaedeutic, Oncology Section, Attikon University General Hospital, Haidari, Athens, Greece.
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188
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False‐Positive Serum Human Chorionic Gonadotropin (hCG) in a Male Patient with a Malignant Germ Cell Tumor of the Testis: A Case Report and Review of the Literature. Oncologist 2008; 13:1149-54. [DOI: 10.1634/theoncologist.2008-0159] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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189
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Ansell W, Shamash J. Testicular cancer before and after cisplatin: a 30-year view. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2008. [DOI: 10.1111/j.1749-771x.2008.00060.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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190
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Heidenreich A, Pfister D, Witthuhn R, Thüer D, Albers P. Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection. Eur Urol 2008; 55:217-24. [PMID: 18926622 DOI: 10.1016/j.eururo.2008.09.027] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The anatomical extent of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) has been discussed controversially for many years. OBJECTIVE To evaluate the necessity of PC-RPLND with modified or radical template resection in patients with advanced nonseminomatous germ-cell tumors (NSGCT) and residual masses following systemic chemotherapy. DESIGN, SETTING, AND PARTICIPANTS The charts of 152 consecutive patients who were treated at two tertiary referral centers were retrospectively reviewed. INTERVENTION All patients underwent PC-RPLND, with 54 and 98 patients undergoing a radical template resection and 98 patients undergoing a modified template resection. Modified template resection was performed if the location of the residual mass corresponded to the primary landing zone of testis cancer and the residual mass measured < or = 5 cm in diameter. In all other cases a full bilateral PC-RPLND was chosen. MEASUREMENTS The following data were analyzed: location of the residual mass, extent of surgery, length of surgery, treatment-associated complications, nerve-sparing approach, adjunctive surgical procedures, postoperative morbidity, duration of hospital stay, early and late complications, relapse rates, cancer-specific survival rates, and overall survival rates. RESULTS AND LIMITATIONS Overall, 84 patients (55.2%) had necrosis/fibrosis, 45 (29.6%) had mature teratoma, and 23 (15.1%) had vital cancer in the surgical specimens. Antegrade ejaculation was preserved in 85% and 25% of patients undergoing modified and bilateral PC-RPLND (p=0.02), respectively. Eight recurrences (5.2%) were observed after a mean follow-up of 39 mo (range 6-105 mo): one patient had an in-field relapse following modified PC-RPLND, and seven patients had recurrences outside the boundaries of full bilateral PC-RPLNDs. The 2-yr disease-free survival rates were 78.6% and 92.8% for bilateral and modified PC-RPLND, respectively. The limitations of this study were a short follow-up, a limited number of patients, and the retrospective nature of the study. CONCLUSIONS Full bilateral PC-RPLND is the standard approach to extensive residual masses. In well-defined masses a modified template PC-RPLND does not interfere with oncologic outcome but decreases treatment-associated morbidity.
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Affiliation(s)
- Axel Heidenreich
- Department of Urology, Division of Oncological Urology, University of Cologne, Cologne, Germany.
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191
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Salvage chemotherapy after failure of first-line chemotherapy in patients with metastatic testicular cancer. Curr Opin Support Palliat Care 2008; 2:167-72. [PMID: 18685416 DOI: 10.1097/spc.0b013e328309c741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Because of the small number of relapsed patients, their prognostic variability and the complexity of second-line therapy, randomized studies are largely lacking and treatment recommendations for patients with relapse after first-line chemotherapy are derived from retrospective series or phase II studies. This review summarizes the existing evidence including several recently published larger studies on the use of high-dose chemotherapy in these patients. RECENT FINDINGS Patients with unfavorable features such as incomplete response to first-line therapy, cisplatin refractoriness, multiple relapses or advanced stage at initial diagnosis have been shown to benefit from salvage high-dose chemotherapy with autologous stem cell support. Long-term survival rates of up to 60% have been reported after salvage high-dose chemotherapy for these patients. The treatment for patients relapsing after complete remission to first-line therapy, cisplatin-sensitive disease and gonadal primary remains controversial. Excellent long-term event-free survival rates of up to 80% have been reported after both conventional and high-dose chemotherapy. Surgery remains an important part of any salvage strategy. SUMMARY The prognosis of patients relapsing after first-line cisplatin-based chemotherapy has improved with multimodality therapy including conventional and high-dose chemotherapy, surgery and radiation. The treatment of these patients requires a close cooperation of experienced medical oncologists, urologists and radiation oncologists.
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192
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[Value of targeted treatment for testicular cancer: from molecular approaches to clinical possibilities]. Urologe A 2008; 47:1328-33. [PMID: 18587552 DOI: 10.1007/s00120-008-1750-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Due to the introduction of tyrosine kinase-inhibitors in the treatment of metastatic renal cell cancer, targeted therapy raises hopes for other urological tumors as well. Even if excellent cure rates, achieved by standardization of diagnosis und therapy, have made testicular cancer a curable disease, up to 6% of young patients still die from tumors refractory to therapy. The quality of life of patients in advanced stages needing aggressive treatment should be improved by new therapies with reduced side effects. The role of tyrosine kinase inhibitors and angiogenesis inhibitors as well as intervention in the cell cycle and induction of apoptosis are discussed.
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