1
|
Arranz Arija JA, Del Muro XG, Caro RL, Méndez-Vidal MJ, Pérez-Valderrama B, Aparicio J, Climent Durán MÁ, Caballero Díaz C, Durán I, González-Billalabeitia E. SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023). Clin Transl Oncol 2024:10.1007/s12094-024-03532-2. [PMID: 38958901 DOI: 10.1007/s12094-024-03532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 07/04/2024]
Abstract
Testicular germ cell tumors are the most common tumors in adolescent and young men. They are curable malignancies that should be treated with curative intent, minimizing acute and long-term side effects. Inguinal orchiectomy is the main diagnostic procedure, and is also curative for most localized tumors, while patients with unfavorable risk factors for recurrence, or those who are unable or unwilling to undergo close follow-up, may require adjuvant treatment. Patients with persistent markers after orchiectomy or advanced disease at diagnosis should be staged and classified according to the IGCCCG prognostic classification. BEP is the most recommended chemotherapy, but other schedules such as EP or VIP may be used to avoid bleomycin in some patients. Efforts should be made to avoid unnecessary delays and dose reductions wherever possible. Insufficient marker decline after each cycle is associated with poor prognosis. Management of residual masses after chemotherapy differs between patients with seminoma and non-seminoma tumors. Patients at high risk of relapse, those with refractory tumors, or those who relapse after chemotherapy should be managed by multidisciplinary teams in experienced centers. Salvage treatment for these patients includes conventional-dose chemotherapy (TIP) and/or high-dose chemotherapy, although the best regimen and strategy for each subgroup of patients is not yet well established. In late recurrences, early complete surgical resection should be performed when feasible. Given the high cure rate of TGCT, oncologists should work with patients to prevent and identify potential long-term side effects of the treatment. The above recommendations also apply to extragonadal retroperitoneal and mediastinal tumors.
Collapse
Affiliation(s)
| | - Xavier García Del Muro
- Hospital Duran I Reynals, Institut Català D'Oncologia L'Hospitalet (ICO), Barcelona, Spain
| | - Raquel Luque Caro
- Hospital Universitario Virgen de Las Nieves, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | | | | | - Jorge Aparicio
- Hospital Universitario I Politècnic La Fe, Valencia, Spain
| | | | | | - Ignacio Durán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | |
Collapse
|
2
|
Paffenholz P. [Venous thromboembolism: risk factors and prophylaxis]. Aktuelle Urol 2024; 55:44-49. [PMID: 37339669 DOI: 10.1055/a-2099-8233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Venous thromboembolism is an important complication in tumour patients as it occurs frequently in these patients and causes relevant morbidity. The risk of thromboembolic complications in tumour patients is 3-9 times higher than in non-tumour patients and is the second most common cause of death in tumour patients. The risk of thrombosis depends on tumour-induced coagulopathy and on individual factors, type and stage of cancer, time since cancer diagnosis as well as type of systemic cancer therapy. Thromboprophylaxis in tumour patients is effective but can be associated with increased bleeding. Even though there are currently no dedicated recommendations for individual tumour entities, international guidelines recommend prophylactic measures in high-risk patients. A thrombosis risk of >8-10% can be considered an indication for thromboprophylaxis, which is indicated by a Khorana score ≥2, and should be calculated individually using nomograms. In particular, patients with a low risk of bleeding should receive thromboprophylaxis. Risk factors and symptoms of a thromboembolic event should also be intensively discussed with the patient and materials for patient information should be handed out.
Collapse
|
3
|
Patrikidou A, Cazzaniga W, Berney D, Boormans J, de Angst I, Di Nardo D, Fankhauser C, Fischer S, Gravina C, Gremmels H, Heidenreich A, Janisch F, Leão R, Nicolai N, Oing C, Oldenburg J, Shepherd R, Tandstad T, Nicol D. European Association of Urology Guidelines on Testicular Cancer: 2023 Update. Eur Urol 2023; 84:289-301. [PMID: 37183161 DOI: 10.1016/j.eururo.2023.04.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023]
Abstract
CONTEXT Each year the European Association of Urology (EAU) produce a document based on the most recent evidence on the diagnosis, therapy, and follow-up of testicular cancer (TC). OBJECTIVE To represent a summarised version of the EAU guidelines on TC for 2023 with a focus on key changes in the 2023 update. EVIDENCE ACQUISITION A multidisciplinary panel of TC experts, comprising urologists, medical and radiation oncologists, and pathologists, reviewed the results from a structured literature search to compile the guidelines document. Each recommendation in the guidelines was assigned a strength rating. EVIDENCE SYNTHESIS For the 2023 EAU guidelines on TC, a review and restructure were undertaken. The key changes incorporated in the 2023 update include: new supporting text regarding venous thromboembolism prophylaxis in males with metastatic germ cell tumours receiving chemotherapy; quality of life after treatment; an update of the histological classifications and inclusion of the World Health Organization 2022 pathological classification; inclusion of the revalidation of the 1997 International Germ Cell Cancer Collaborative Group prognostic risk factors; and a new section covering oncology treatment protocols. CONCLUSIONS The 2023 version of the EAU guidelines on TC include the highest available scientific evidence to standardise the management of TC. Better stratification and optimisation of treatment modalities will continue to improve the high survival rates for patients with TC. PATIENT SUMMARY This article presents a summary of the European Association of Urology guidelines on testicular cancer published in 2023 and includes the latest recommendations for management of this disease. The guidelines are a valuable resource that may help patients in understanding treatment recommendations.
Collapse
Affiliation(s)
- Anna Patrikidou
- Department of Oncology, Institut Gustave Roussy, Villejuif, France
| | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Berney
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Joost Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Isabel de Angst
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Domenico Di Nardo
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Carmen Gravina
- Department of Urology, Sant'Andrea Hospital-Sapienza University, Rome, Italy
| | - Hendrik Gremmels
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Florian Janisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ricardo Leão
- Department of Urology, Faculty of Medicine, University of Coimbra, Clinical Academic Center of Coimbra, Coimbra, Portugal
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Christoph Oing
- Department of Oncology, Freeman Hospital NHS Foundation Trust, London, UK
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - Robert Shepherd
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Torgrim Tandstad
- Department of Oncology, The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway
| | - David Nicol
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer research, London, UK.
| |
Collapse
|
4
|
Clasen SC, Fung C, Sesso HD, Travis LB. Cardiovascular Risks in Testicular Cancer: Assessment, Prevention, and Treatment. Curr Oncol Rep 2023; 25:445-454. [PMID: 36867377 DOI: 10.1007/s11912-023-01375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Testicular cancer (TC) is the leading cancer in men between 18 and 39 years of age. Current treatment involves tumor resection followed by surveillance and/or one or more lines of cisplatin-based chemotherapy (CBCT) and/or bone marrow transplant (BMT). Ten years after treatment, CBCT has been associated with significant atherosclerotic cardiovascular disease (CVD) including myocardial infarction (MI), stroke, and heightened rates of hypertension, dyslipidemia, diabetes mellitus, and metabolic syndrome (MetS). Additionally, low testosterone levels and hypogonadism contribute to MetS and may further drive CVD. RECENT FINDINGS CVD in TCS has been associated with worse physical functioning accompanied by role limitations, decreased energy, and decreased overall health. Exercise may play a role in ameliorating these effects. Systematic CVD screening practices are needed at TC diagnosis and in survivorship. We encourage a multidisciplinary partnership between primary care physicians, cardiologists, cardio-oncologists, medical oncologists, and survivorship providers to address these needs.
Collapse
Affiliation(s)
- Suparna C Clasen
- Division of Cardiovascular Medicine, Department of Medicine, Indiana University School of Medicine, Indiana University, 1800 N. Capitol Ave., E308, Indianapolis, IN, 46202, USA.
| | - Chunkit Fung
- Division of Hematology and Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Howard D Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lois B Travis
- Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Epidemiology, Fairbanks School of Public Health, Indianapolis, IN, USA
| |
Collapse
|
5
|
Terbuch A, Walser G, Stotz M, Gerger A, Posch F, Bauernhofer T. Primary Thromboprophylaxis and the Risk of Venous Thromboembolic Events in Patients With Testicular Germ Cell Tumors Treated With Cisplatinum-Based Chemotherapy. Clin Genitourin Cancer 2023; 21:24-31. [PMID: 36400695 DOI: 10.1016/j.clgc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cisplatinum-based chemotherapy is associated with an increased risk of venous thromboembolism (VTE). We hypothesized that primary thromboprophylaxis in patients with testicular germ cell tumors (GCT) undergoing cisplatinum-based chemotherapy can reduce the risk of VTE. PATIENTS AND METHODS In this single-center retrospective cohort study, we investigated the increased use of primary thromboprophylaxis between January 2000 and December 2021 at our institution and its effect on the risk of VTE. Patients with GCT undergoing adjuvant or curative cisplatinum-based chemotherapy were included. RESULTS Three hundred forty-six patients with GCT initiating a cisplatinum-based therapy were included in the study, of whom 122 (35%) were treated in the adjuvant and 224 (65%) in the curative setting, respectively. VTE events occurred in 49 (14.2%) patients. In univariable competing risk analysis, a higher clinical tumor stage and large retroperitoneal lymphadenopathy (RPLND >5 cm) were the strongest predictors of an elevated VTE risk (SHR for stage IIC - IIIC: 2.6 (95%CI: 5.0-24.7, P < .001), SHR for RPLN: 2.36 (95%CI: 1.27-4.4, P < .007)). The proportion of patients receiving primary thromboprophylaxis strongly increased over time and reached 100% in CS IIC-III patients from 2019 onwards. After adjusting for tumor stage, primary thromboprophylaxis was associated with a 52% relatively lower risk of VTE (SHR = 0.48, 95% CI: 0.24-0.97; P = .032). CONCLUSION In this retrospective cohort study, we showed that TGCT patients undergoing cisplatinum-based chemotherapy have a lower VTE risk when receiving primary thromboprophylaxis. For the duration of chemotherapy, primary thromboprophylaxis should be considered on a risk-benefit ratio.
Collapse
Affiliation(s)
- Angelika Terbuch
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gudrun Walser
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Stotz
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Thomas Bauernhofer
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
6
|
Murez T, Fléchon A, Branger N, Savoie PH, Rocher L, Camparo P, Neuville P, Ferretti L, Van Hove A, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: testicular germ cell cancer. Prog Urol 2022; 32:1066-1101. [DOI: 10.1016/j.purol.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022]
|
7
|
Kadambi S, Clasen SC, Fung C. How to Manage Cisplatin-Based Chemotherapy–Related Cardiovascular Disease in Patients With Testicular Cancer. JACC CardioOncol 2022; 4:409-412. [PMID: 36213350 PMCID: PMC9537082 DOI: 10.1016/j.jaccao.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/01/2022] [Indexed: 11/03/2022] Open
Abstract
Patients with advanced testicular cancer receive cisplatin-based chemotherapy with a high rate of cure. Cisplatin-based chemotherapy increases risks of acute vascular complications among testicular cancer survivors. Cisplatin-based chemotherapy increases cardiovascular disease risk factors and cardiovascular disease among testicular cancer survivors. Long-term management of cardiovascular risk factors and cardiovascular disease in testicular cancer survivors is recommended.
Collapse
|
8
|
Oldenburg J, Berney DM, Bokemeyer C, Climent MA, Daugaard G, Gietema JA, De Giorgi U, Haugnes HS, Huddart RA, Leão R, Sohaib A, Gillessen S, Powles T. Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:362-375. [PMID: 35065204 DOI: 10.1016/j.annonc.2022.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - D M Berney
- Department of Cellular Pathology, Barts Cancer Institute, Queen Mary University of London, London; Barts Health NHS Trust, London, UK
| | - C Bokemeyer
- Department of Oncology, Hematology, Bone Marrow Transplantation with section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M A Climent
- Fundacion Instituto Valenciano de Oncología, València, Spain
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST),'Dino Amadori', Meldola, Italy
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway and UiT-The Arctic University, Tromsoe, Norway
| | - R A Huddart
- Institute of Cancer Research and Royal Marsden Foundation Trust, London, UK
| | - R Leão
- Department of Urology, Hospital de Braga, Hospital CUF Coimbra, Faculty of Medicine University of Coimbra, Coimbra, Portugal
| | - A Sohaib
- Department of Diagnostic Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - S Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona; Faculty of Biomedical Sciences, USI, Lugano, Switzerland; Division of Cancer Medicine, University of Manchester, Manchester
| | - T Powles
- Barts Health NHS Trust, London, UK
| |
Collapse
|
9
|
Haugnes HS, Negaard HF, Jensvoll H, Wilsgaard T, Tandstad T, Solberg A. Thromboembolic Events During Treatment with Cisplatin-based Chemotherapy in Metastatic Testicular Germ-cell Cancer 2000-2014: A Population-based Cohort Study. EUR UROL SUPPL 2021; 32:19-27. [PMID: 34667955 PMCID: PMC8505199 DOI: 10.1016/j.euros.2021.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Cisplatin-based chemotherapy (CBCT) in testicular cancer (TC) is associated with elevated venous thromboembolism (VTE) risk, but trials evaluating the safety and efficacy of thromboprophylaxis are lacking. Objective To evaluate the arterial thromboembolism (ATE) and VTE incidence and risk factors during first-line CBCT for metastatic TC, and the effect of thromboprophylaxis on VTE and bleeding. Design setting and participants In a population-based study, 506 men administered first-line CBCT during 2000-2014 at three university hospitals in Norway were included. Clinical variables were retrieved from medical records. Outcome measurements and statistical analysis Patients with ATE and VTE diagnosed at initiation of or during CBCT until 3 mo after completion were registered. Age-adjusted logistic regression was performed to identify possible VTE risk factors. Results and limitations Overall, 69 men (13.6%) were diagnosed with 70 thromboembolic events. Twelve men (2.4%) experienced ATE. Overall, 58 men (11.5%) experienced VTE, of whom 13 (2.6%) were prevalent at CBCT initiation, while 45 (8.9%) were diagnosed with incident VTE. Age-adjusted logistic regression identified retroperitoneal lymph node metastasis >5 cm (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.01-3.91), central venous access (OR 2.84, 95% CI 1.46-5.50), and elevated C-reactive protein (>5 mg/l; OR 2.38, 95% CI 1.12-5.07) as incident VTE risk factors. Thromboprophylaxis (n = 84) did not influence the risk of VTE (VTE incidence with or without prophylaxis 13% vs 8%, p = 0.16). The incidence of bleeding events was significantly higher among those who received thromboprophylaxis than among those without thromboprophylaxis (14.5% vs 1.1%, p < 0.001). Conclusions We found a high rate of thromboembolism incidence of 13.6%. Thromboprophylaxis did not decrease the risk of VTE but was associated with an increased risk of bleeding. Patient summary We found a high rate of thromboembolism (13.6%) during cisplatin-based chemotherapy for metastatic testicular cancer. Prophylactic treatment against thromboses did not reduce the thrombosis frequency, but it resulted in a high incidence of bleeding events.
Collapse
Affiliation(s)
- Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University, Tromsø, Norway
| | | | - Hilde Jensvoll
- Department of Hematology, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University, Tromsø, Norway
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Solberg
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
10
|
Meng X, Ahmed M, Courtney KD, Arafat W, Ibrahim I, Margulis V, Nichols C, Bagrodia A. Prophylaxis Against Thromboembolic Events During Chemotherapy for Germ Cell Cancer. Front Oncol 2021; 11:724682. [PMID: 34692501 PMCID: PMC8529113 DOI: 10.3389/fonc.2021.724682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Patients with advanced germ cell tumors (GCT) receiving cisplatin-based chemotherapy have high rates of thromboembolic events (TEE) which can negatively affect their overall survival. While primary TEE prophylaxis during chemotherapy may prevent these events, it is unclear which patients will benefit in this setting. MATERIALS AND METHODS A review of PubMed/Medline was conducted in December 2020 and all pertinent articles were evaluated for relevancy and quality of data for inclusion in the review. RESULTS Studies on patients receiving initial cisplatin-based chemotherapy for advanced GCT have reported up to a 19% rate of TEE. This high rate may be associated with multiple factors including retroperitoneal lymphadenopathy, advanced clinical stage, high risk Khorana scores and presence of a central line. Large phase III clinical trials have demonstrated the benefit of low-molecular-weight-heparin and direct oral anticoagulants for primary prophylaxis and against recurrent TEE. However, primary prophylaxis is currently underutilized with GCT patients starting chemotherapy. CONCLUSION Precise models to predict TEE risk and consideration of anticoagulation are difficult to develop owing to the relatively uncommon nature of GCT and lack of representation in primary TEE prophylaxis clinical trials. Despite these limitations, we believe that the benefits of prophylactic anticoagulation outweigh the risk of major bleeding in select GCT patients with higher risk of TEE. We have developed a simple algorithm to help guide TEE prophylaxis selection based on patient factors and route of chemotherapy administration. Given the high rate of TEE in GCT patients, we believe better utilization of primary prophylaxis in patient starting cisplatin-based chemotherapy will have clinical benefit.
Collapse
Affiliation(s)
- Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Murtaza Ahmed
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kevin D Courtney
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Waddah Arafat
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ibrahim Ibrahim
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Craig Nichols
- Testicular Cancer Commons, Portland, OR, United States
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Urology, University of California San Diego, San Diego, CA, United States
| |
Collapse
|
11
|
Testicular cancer with extensive gonadal and renal vein tumor thrombus. Clin Imaging 2021; 79:348-352. [PMID: 34419852 DOI: 10.1016/j.clinimag.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 11/20/2022]
Abstract
Tumor thrombus has been demonstrated to occur with hepatocellular and renal cell carcinoma, however, rarely occurs in testicular germ cell malignancies. Tumor thrombus results from the intravascular invasion of malignant cells, different from the hypercoagulable state induced by malignancy, and has significant implications with regards to prognosis and therapeutic options. We describe a case of an otherwise healthy 30-year-old patient with extensive gonadal and renal vein tumor thrombus from testicular germ cell cancer, as well as discuss the diagnosis and treatment options for this type of metastatic disease.
Collapse
|
12
|
Zraik IM, Heß-Busch Y. [Management of chemotherapy side effects and their long-term sequelae]. Urologe A 2021; 60:862-871. [PMID: 34185118 DOI: 10.1007/s00120-021-01569-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Abstract
Various chemotherapies are used to treat testicular cancer. The most common therapy regimens are BEP (cisplatin, etoposide, bleomycin), carboplatin mono (AUC 7), PEI (cisplatin, etoposide, ifosfamide), TIP (cisplatin, ifosfamide, paclitaxel) and GOP (gemcitabine, oxaliplatin, paclitaxel). This is accompanied by acute and late toxicities. These include general side effects such as anemia, neutropenia, nausea, vomiting, diarrhea, mucositis or paravasation as well as special toxicities like ototoxicity, nephrotoxicity, pulmonary toxicity, neurotoxicity or Raynaud's syndrome. Since young men are usually affected, the possible long-term consequences such as hypogonadism, infertility or the metabolic syndrome are very relevant. Accordingly, adequate management of the possible side effects and long-term consequences in the context of the use of chemotherapy is essential.
Collapse
Affiliation(s)
- Isabella M Zraik
- Klinik für Urologie, Kinderurologie & Urologische Onkologie, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland.
| | - Yasmine Heß-Busch
- Klinik für Internistische Onkologie & Hämatologie mit integrierter Palliativmedizin, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland.
| |
Collapse
|
13
|
Fankhauser CD, Oldenburg J, Albers P, Algaba F, Bokemeyer C, Boormans JL, Fischer S, Fizazi K, Gremmels H, Mayor de Castro J, Janisch F, Muilwijk T, Leão R, Nicol D, Nicolai N, Tandstad T, Pilar Laguna M. Recommendations to Balance Benefits and Risks Of Thromboprophylaxis and to Avoid Central Venous-access Devices During First-line Chemotherapy in Men with Metastatic Germ Cell Tumors: The European Association Of Urology Testicular Cancer Panel Position in 2021. Eur Urol 2021; 80:4-6. [PMID: 33722419 DOI: 10.1016/j.eururo.2021.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
Men with metastatic germ cell tumors undergoing chemotherapy are at high risk of venous thromboembolic events and low risk of bleeding. A central venous-access device should be avoided whenever possible. Thromboprophylaxis may be prescribed after balancing the risks and benefits for each individual patient.
Collapse
Affiliation(s)
| | - Jan Oldenburg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Peter Albers
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Barcelona, Spain
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Pneumology Section, Universitätskliniken Eppendorf, Hamburg, Germany
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
| | - Hendrik Gremmels
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Florian Janisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Ricardo Leão
- Department of Urology, Faculty of Medicine, University of Coimbra, Clinical Academic Center of Coimbra, Coimbra, Portugal
| | - David Nicol
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Torgrim Tandstad
- Department of Oncology, The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway
| | - M Pilar Laguna
- Department of Urology Medipol Mega, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|