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Lei N, Lei LL, Wang CH, Mei CR. Pure testicular choriocarcinoma, a rare and highly malignant subtype with challenging treatment: A case report and review of the literature. Mol Clin Oncol 2024; 20:1. [PMID: 38223403 PMCID: PMC10784770 DOI: 10.3892/mco.2023.2699] [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: 06/11/2023] [Accepted: 10/26/2023] [Indexed: 01/16/2024] Open
Abstract
Testicular choriocarcinoma (CC) is the rarest subtype of germ cell tumours (GCTs) of the testis, with a high malignant potential and early haematogenous metastasis. Radical surgical resection should be performed primarily for histological diagnosis, while chemotherapy remains the mainstay of therapy for advanced disease. In the present study, the case of a 65-year-old male patient diagnosed with metastatic testicular CC, who did not fully respond to chemotherapy is reported. This patient underwent surgical removal of the testicular tumour, chemotherapy with etoposide and cisplatin, and radiotherapy of the intracranial lesions. Although the serum human chorionic gonadotropin (HCG) levels of the patient and most of the metastases continued decreasing during chemotherapy, complete response was not achieved after six cycles of chemotherapy. The patient refused high-dose chemotherapy and autologous stem cell transplantation due to severe side effects, and eventually developed respiratory failure on maintenance therapy with oral etoposide. A literature review was then performed, aiming to summarize the characteristics and therapeutic principles of testicular CC. In addition, the emerging therapeutic agents that could be used in maintenance therapy for GCTs, particularly for testicular CC, were also discussed. The limited clinical trials of targeted treatments showed potential benefit for long survival of patients with selected GCTs with fewer side effects. In particular, immunotherapy showed unique potential for testicular CC in preclinical studies, offering new approaches of maintenance therapy for advanced disease. Further studies should shed light on the identification of prognostic factors that predict the response to immune-based therapy in GCTs.
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Affiliation(s)
- Na Lei
- Department of Medical Oncology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital. C. T.), Chengdu, Sichuan 610041, P.R. China
| | - Li-Li Lei
- Department of Medical Oncology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital. C. T.), Chengdu, Sichuan 610041, P.R. China
| | - Chao-Hong Wang
- Department of Medical Oncology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital. C. T.), Chengdu, Sichuan 610041, P.R. China
| | - Chao-Rong Mei
- Department of Medical Oncology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital. C. T.), Chengdu, Sichuan 610041, P.R. China
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Ren C, Zhao J, Kang L, Di Y, Qiu G, Wang Q. Successful treatment of radiotherapy and apatinib in patient with mediastinal mixed non-seminomatous germ cell tumor: A case report. Medicine (Baltimore) 2021; 100:e27617. [PMID: 34713845 PMCID: PMC8556032 DOI: 10.1097/md.0000000000027617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/13/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Mediastinal non-seminomatous germ cell tumors (MNSGCTs) are rare malignancies. Chemotherapy followed by surgical resection has been regarded as the standard management, but treatment options for chemotherapy-refractory patients or those with unresectable tumors are limited, resulting in a very poor prognosis. PATIENT CONCERNS An 18-year-old female presented with symptoms of cough, chest tightness, and shortness of breath for 2 months, and the symptoms gradually worsened. DIAGNOSIS Computed tomography (CT) revealed a large mediastinal mass invading the pericardium and great blood vessels. Serum human chorionic gonadotropin (HCG) and α-fetoprotein (AFP) levels were normal. Histopathological examination of biopsy specimens revealed mixed MNSGCT with embryonal carcinoma and immature teratoma components. INTERVENTIONS The patient achieved complete remission (CR) and long-term survival after multimodal therapy comprising chemotherapy, positron emission tomography/CT (PET/CT)-guided volumetric-modulated arc therapy (VMAT), and anti-angiogenic targeted therapy. OUTCOMES The patient was followed up for more than 4 years without recurrence, metastasis, or treatment-related adverse effects. LESSONS The case presented here highlights the importance of multidisciplinary diagnosis and treatment, providing evidence that radiotherapy and anti-angiogenic therapy may play an important role in unresectable or residual tumors after failure of conventional treatments of MNSGCT. Percutaneous biopsy is necessary for diagnosis if the tumor is unresectable, and serum AFP and HCG levels are normal. Additionally, PET/CT is an effective method for evaluation of efficacy and radiotherapy guidance for patients with MNSGCTs.
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Affiliation(s)
- Congcong Ren
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate School, Hebei North University, Zhangjiakou, Hebei, China
| | - Jing Zhao
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Lin Kang
- Department of Pathology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yan Di
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Gang Qiu
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Qingxue Wang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate School, Hebei North University, Zhangjiakou, Hebei, China
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Francolini G, Trodella LE, Marvaso G, Matrone F, Nicosia L, Timon G, Ognibene L, Vinciguerra A, Franzese C, Borghetti P, Arcangeli S. Radiotherapy role in non-seminomatous germ cell tumors, radiobiological and technical issues of an unexplored scenario. Int J Clin Oncol 2021; 26:1777-1783. [PMID: 34273014 DOI: 10.1007/s10147-021-01989-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/07/2021] [Indexed: 12/01/2022]
Abstract
Historically, non-seminomatous germ cell tumor (NSGCT) has been considered a radio-resistant disease, excluding radiotherapy (RT) from curative strategies. However, case series exploring the use of radiation treatment in this setting are often outdated, and prospective ongoing studies testing new radiotherapeutic approaches in NSGCT are lacking. Considering that tremendous advances in radiotherapy technology have enabled improved precision in RT delivery as well as dose escalation while decreasing treatment-related morbidity, we overviewed the currently available literature to explore the radiobiological basis, the technical issues, and potential strategies for implementation of RT in the management of this clinical entity. The purpose of the present overview is to provide insight for future research in this unexplored scenario. In summary, the biological rationale for RT use and potential implementation with systemic therapies exist, especially considering the advantage of new technologies, which were unavailable in the era of early literature reports. The NSGCT radioresistance paradigm could be based only on the fact that effective treatment schedules were simply undeliverable with older RT techniques due to toxicity issues, but the availability of actual techniques may prompt further exploration to offer treatment alternatives to these patients. Ongoing trials on this issue are lacking, but potential areas of research are platinum-refractory disease and consolidation therapy for residual masses after PST.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
| | - Luca Eolo Trodella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fabio Matrone
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Pordenone, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Giorgia Timon
- Radioterapia Oncologica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Ognibene
- Radiotherapy Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy
| | - Annamaria Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100, Chieti, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Radiotherapy and Radiosurgery Department -Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery-University of Milan Bicocca, Milan, Italy
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Khalifa J, Fléchon A, Chevreau C. Brain metastases from germ cell tumor: time to reconsider radiotherapy? Crit Rev Oncol Hematol 2020; 150:102946. [PMID: 32353705 DOI: 10.1016/j.critrevonc.2020.102946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022] Open
Abstract
The presence of brain metastases (BMs) from germ cell tumor (GCT) remains a rare situation. BMs predominantly occur among patients with testis primary tumor site, and are almost exclusively associated with non-seminomatous (NS) histologies. Two situations must be distinguished, which differ in terms of clinical presentation, overall prognostic and management. At diagnosis, BMs are almost systematically associated with extra-cerebral metastases and the cornerstone of treatment is chemotherapy, while the role of local treatment remains controversial. In the metachronous setting, BMs more frequently constitute an isolated site of relapse, the outcome is poorer, and the role of local treatment is more consensual. However, all these data widely come from old reports, with outdated radiation techniques. The recent advances in radiation oncology, especially the rising use of stereotactic radiotherapy, could lead to the reconsideration of ancient dogmas regarding the "radiosensitivity" of (NS)GCT and the role of radiotherapy among patients with BMs.
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Affiliation(s)
- Jonathan Khalifa
- Department of Radiation Oncology, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopole, 1 avenue Irène Joliot-Curie, 31000, Toulouse, France.
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon-Bérard, 28 rue Laennec, 69008, Lyon, France.
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud / Institut Universitaire du Cancer de Toulouse - Oncopole, 1 avenue Irène Joliot-Curie, 31000, Toulouse, France.
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Satyanarayan A, Mooney R, Bhanvadia RR, Iyengar P, Margulis V, Desai NB, Bagrodia A. Stereotactic Ablative Radiotherapy (SAbR) in the Setting of Metastatic Nonseminomatous Germ Cell Tumor of Testis. Clin Genitourin Cancer 2019; 17:e768-e771. [PMID: 31109801 DOI: 10.1016/j.clgc.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Arthi Satyanarayan
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Ryan Mooney
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Puneeth Iyengar
- Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
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