1
|
Abstract
PURPOSE OF REVIEW This review aims to summarize the latest evidence of medical and surgical treatment options for patients with relapsing testicular germ cell tumors. RECENT FINDINGS Depending on International Germ Cell Cancer Classification Group risk classification 10-50% of patients with metastatic TGCT develop relapse which needs further multimodality treatment. With regard to therapy, early relapses are stratified according to their prognostic risk profile which results in a 3-year overall survival between 6% in the very high to 77% in the very low risk group. Prognostic risk score dictates systemic therapy which might be second line chemotherapy (TIP, PEI) or high dose chemotherapy. Any residual masses following salvage chemotherapy need to be completely resected due the presence of viable cancer and/or teratoma in more than 50% of cases. Targeted therapy in men with druggable mutations is for individualized cases only. Patients with late relapses developing more than 2 years after first-line chemotherapy are best managed by surgery. Desperation surgery is reserved for those patients with rising markers during or immediately after chemotherapy and good risk factors such as rising alpha-fetoprotein, <3 metastatic sites and complete resectability. Multimodality treatment will result in long-term cure of 25% to 60%. Due to the complexity of treatment, chemotherapy as well as surgery should be performed in highly experienced centres only. SUMMARY Multimodality treatment to salvage relapsing patients with metastatic testis cancer requires extensive experience for both systemic therapy and surgery. If done properly, it will result in moderate to high cure rates. Personalized therapeutic options are currently evaluated in clinical trials.
Collapse
|
2
|
Yaegashi H, Izumi K, Kadomoto S, Iwamoto H, Iijima M, Kawaguchi S, Nohara T, Shigehara K, Kadono Y, Mizokami A. Treatment at an Inexperienced Center Suggests Worse Prognosis of Metastatic Germ Cell Tumors. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:13-17. [PMID: 35399696 PMCID: PMC8962772 DOI: 10.21873/cdp.10002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM We evaluated the clinical outcomes of patients with metastatic germ cell tumors (GCT) treated at our hospital, which belongs to a regional cancer center. PATIENTS AND METHODS Data pertaining to patients with metastatic GCT were obtained between April 2007-October 2017 and was retrospectively analyzed. Key outcome measures included objective response rates and survival rates. RESULTS All 42 patients received chemotherapy [complete response: eight (19.0%); partial response: 21 (50.0%); stable disease (SD): nine (21.4%); progressive disease: four patients (9.5%)]. Post-chemotherapeutic surgery was performed for seven out of 21 cases of partial response and two out of nine of stable disease. The 5-year survival rates of patients with good, intermediate and poor prognosis (International Germ Cell Consensus Classification) were 100%, 100%, and 71.4%, respectively. Patients who received induction chemotherapy at other hospitals had significantly poorer prognosis than those at our hospital (p=0.0043). CONCLUSION Patients with metastatic GCT should preferably receive chemotherapy at an experienced institution.
Collapse
Affiliation(s)
- Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Masashi Iijima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science,Kanazawa, Japan
| |
Collapse
|
3
|
Speir RW, Cary C, Masterson TA. Surgical salvage in patients with advanced testicular cancer: indications, risks and outcomes. Transl Androl Urol 2020; 9:S83-S90. [PMID: 32055489 DOI: 10.21037/tau.2019.09.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this review is to present a comprehensive and updated review of the literature and summary of the indications, risks and outcomes related to salvage, desperation and late relapse surgery for advanced testicular cancer. After completing a thorough review of the current literature, this review has attempted to provide an overview of the indications for salvage, desperation and late relapse retroperitoneal lymph node dissection (RPLND) followed by a summary of the histopathologic and clinical outcomes regarding each. Recent literature, combined with a significant contribution from historical studies suggest that while testicular cancer is a relatively uncommon malignancy overall, it represents the most common solid organ malignancy for young men. Although a significant number of men are cured with a combination of first-line treatments, the remaining men are a diverse and often challenging cohort who require the benefit of expertise to improve their outcomes. The role of surgical strategies in the salvage, desperation and late relapse settings is unquestionable, although the most important question remains who will benefit. This often requires a multi-disciplinary approach at centers specializing in this disease process in order to recognize who should get surgery, what surgery to do and how to minimize the potential morbidity associated with the operation.
Collapse
Affiliation(s)
- Ryan W Speir
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
4
|
Goldberg H, Klaassen Z, Chandrasekar T, Fleshner N, Hamilton RJ, Jewett MAS. Germ Cell Testicular Tumors-Contemporary Diagnosis, Staging and Management of Localized and Advanced disease. Urology 2018; 125:8-19. [PMID: 30597167 DOI: 10.1016/j.urology.2018.12.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 01/15/2023]
Abstract
Germ cell testicular tumors are the most commonly diagnosed cancer in young men, with cure rates exceeding 95%. Clinical stage 1 disease is the most common manifestation, with radical orchiectomy curing the majority of Clinical stage 1 patients, making active surveillance the treatment of choice, with a cancer specific survival nearing 100% and low relapse rates. However, in metastatic disease, chemotherapy, radiotherapy, and surgery are curative options. Chemotherapy remains the mainstay of therapy for advanced disease with surgical management of residual disease. Patients with advanced disease should be treated in high volume experienced academic centers with multidisciplinary teams. Research exploring refinement of diagnosis and treatment, and lowering treatment burden is underway.
Collapse
Affiliation(s)
- Hanan Goldberg
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada.
| | - Zachary Klaassen
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Thenappan Chandrasekar
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Neil Fleshner
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Robert J Hamilton
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada
| |
Collapse
|
5
|
Oing C, Giannatempo P, Honecker F, Oechsle K, Bokemeyer C, Beyer J. Palliative treatment of germ cell cancer. Cancer Treat Rev 2018; 71:102-107. [DOI: 10.1016/j.ctrv.2018.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/29/2022]
|
6
|
Abstract
PURPOSE OF REVIEW Management of extraretroperitoneal (ERP) germ cell tumor (GCT) is a complex clinical scenario faced by urologic oncologists. This article reviews the indications and approach to management of ERP GCT masses. RECENT FINDINGS ERP GCT management starts with chemotherapy, and for any residual masses, a careful consideration of surgical intervention versus salvage chemotherapy. Decision-making regarding residual ERP masses hinges on tumor markers, and also the anatomical location. These factors should be contextualized by the patient's risk for teratoma or active GCT, which will impact outcome and thus weigh on decision-making conversations with patients who have advanced disease. Technical challenges of surgical management in the postchemotherapy setting also apply in ERP mass resection. The risks of surgical management in the lung and liver, in particular, add special considerations for morbidity. Surgical resection is often the only recourse for a patient who may have chemoresistant disease and may be an important step in achieving cure. SUMMARY Surgical management of ERP GCT requires multidisciplinary input, and the urologic oncologist can help guide management with particular emphasis on the indication, timing, and approach to surgical resection.
Collapse
|
7
|
Abstract
INTRODUCTION Most germ cell cancer patients with metastatic disease are cured by cisplatin-based combination chemotherapy. 30% of metastatic patients will develop relapse or progress despite adequate first-line treatment and will require salvage therapy, with about 10% of metastasized patients ultimately developing platinum-resistant and fatal disease. Areas covered: Based on a comprehensive literature search of MEDLINE, EMBASE and conference proceedings of ESMO, ASCO and EAU meetings, this review provides an overview on current and potential future treatment options for platinum-refractory germ cell cancer patients including cytostatics and molecularly targeted therapies. Expert commentary: Treatment of platinum-refractory disease remains challenging and long-term survival is rarely achieved despite multimodal treatment approaches. Targeted treatment approaches do not yet play a role in the treatment of platinum-refractory disease due to lacking efficacy in small, unselected clinical trials. Inclusion of patients into clinical trials is strongly recommended.
Collapse
Affiliation(s)
- Christoph Oing
- a Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Christoph Seidel
- a Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Carsten Bokemeyer
- a Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| |
Collapse
|
8
|
Abstract
Testicular cancer is a rare urological malignancy with high cure rate. The development of highly effective systemic treatment regimens along with advances in surgical treatment of advanced disease has led to continued improvement in outcomes. Patients with testicular cancer who are treated following the treatment guideline mostly achieved high quality of life and long-term survival. However, patients who were identified as having non-guideline directed care were at significantly higher risk of relapse. In this book chapter, we introduce in depth the modern management of testicular cancer, including diagnosis, staging and risk stratification, treatment strategies of seminoma and non-seminoma germ cell tumors, follow-up protocols, and salvage treatment for disease relapse. We also review new studies and updates on medical and surgical management of advanced testicular cancer.
Collapse
|
9
|
Aparicio J, Terrasa J, Durán I, Germà-Lluch JR, Gironés R, González-Billalabeitia E, Gumà J, Maroto P, Pinto A, García-Del-Muro X. SEOM clinical guidelines for the management of germ cell testicular cancer (2016). Clin Transl Oncol 2016; 18:1187-1196. [PMID: 27815687 PMCID: PMC5138244 DOI: 10.1007/s12094-016-1566-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
Abstract
Testicular cancer represents the most common malignancy in males aged 15-34 years and is considered a model of curable neoplasm. Maintaining success, reducing treatment burden, and focusing on survivorship are then key objectives. Inguinal orchiectomy is the first recommended maneuver that has both diagnostic and therapeutic aims. Most patients are diagnosed with stage I disease (confined to the testicle). Close surveillance and selective, short-course adjuvant chemotherapy are accepted alternatives for these cases. In patients with more advanced disease (stages II and III), 3-4 courses of cisplatin-based chemotherapy (according to IGCCCG risk classification) followed by the judicious surgical removal of residual masses represent the cornerstone of therapy. Poor-risk patients and those failing a first-line therapy should be referred to specialized tertiary centers. Paclitaxel-based conventional chemotherapy and high-dose chemotherapy plus autologous hematopoietic support can cure a proportion of patients with relapsing or refractory disease.
Collapse
Affiliation(s)
- J Aparicio
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Av. Abril Martorell 106, 46026, Valencia, Spain.
| | - J Terrasa
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - I Durán
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - J R Germà-Lluch
- Institut Català d'Oncologia, ICO-IDIBELL L'Hospitalet, Barcelona, Spain
| | - R Gironés
- Hospital Lluis Alcanyis, Xátiva, Spain
| | - E González-Billalabeitia
- Hospital Universitario Morales Meseguer-IMIB, Universidad Católica de Murcia-UCAM, Murcia, Spain
| | - J Gumà
- Hospital Universitario Sant Joan de Reus, URV, IISPV, Reus, Spain
| | - P Maroto
- Hospital de Sant Pau, Barcelona, Spain
| | - A Pinto
- Hospital Universitario La Paz, Madrid, Spain
| | - X García-Del-Muro
- Institut Català d'Oncologia, ICO-IDIBELL L'Hospitalet, Barcelona, Spain
| |
Collapse
|
10
|
Oing C, Alsdorf WH, von Amsberg G, Oechsle K, Bokemeyer C. Platinum-refractory germ cell tumors: an update on current treatment options and developments. World J Urol 2016; 35:1167-1175. [PMID: 27449639 DOI: 10.1007/s00345-016-1898-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 07/13/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE In general, 50 % up to 80 % of metastasized germ cell tumor patients can be cured by platinum-based chemotherapy. However, 3-5 % of patients will still die of platinum-refractory disease and new systemic treatment options are needed to improve treatment success in this difficult setting. This review aims to give an overview on treatment options and current developments in the field of platinum-refractory male germ cell tumors. METHODS A comprehensive literature search was conducted searching PubMed, Medline, Cochrane and Embase to identify clinical trials regarding the treatment of platinum-refractory disease. ASCO, EAU and ESMO conference proceedings were searched to identify unpublished results of relevant trials. Comprehensive review papers were hand searched for additional references. Clinicaltrials.gov was checked for ongoing clinical trials in the field of platinum-refractory germ cell tumors. RESULTS Outcome of platinum-refractory disease remains poor. Single-agents with reasonable activity are gemcitabine, oxaliplatin and paclitaxel, but complete remissions resulting in long-term survival could not be achieved. The triple-combination of gemcitabine, oxaliplatin and paclitaxel followed by resection of residual masses provides the best outcomes with objective responses in 51 % of patients and long-term survival in approximately 10-15 %. To date, no molecularly targeted agent has shown reasonable activity. CONCLUSIONS Treatment options for platinum-refractory disease are limited, but a small subset of patients may achieve long-term disease-free survival by multimodal treatment. The potential of novel targeted agents, i.e. by immune-checkpoint-inhibition remains to be defined.
Collapse
Affiliation(s)
- Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Winfried H Alsdorf
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Gunhild von Amsberg
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
11
|
Daneshmand S. Role of surgical resection for refractory germ cell tumors. Urol Oncol 2015; 33:370-8. [DOI: 10.1016/j.urolonc.2015.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/24/2015] [Accepted: 03/02/2015] [Indexed: 11/15/2022]
|
12
|
Carver BS. Desperation Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Germ Cell Tumors. Urol Clin North Am 2015. [PMID: 26216821 DOI: 10.1016/j.ucl.2015.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with persistently elevated serum tumor markers should be monitored for marker kinetics and evaluated for nonviable cancer causes of marker elevation. Desperation postchemotherapy retroperitoneal lymph node dissection is performed in select patients following second-line chemotherapy. Adjuvant postoperative chemotherapy is not indicated in patients following second-line chemotherapy.
Collapse
Affiliation(s)
- Brett S Carver
- Department of Surgery, Division of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| |
Collapse
|
13
|
Riggs SB, Burgess EF, Gaston KE, Merwarth CA, Raghavan D. Postchemotherapy surgery for germ cell tumors--what have we learned in 35 years? Oncologist 2014; 19:498-506. [PMID: 24718515 DOI: 10.1634/theoncologist.2013-0379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Postchemotherapy surgery for advanced testicular cancer has evolved over the last couple of decades. Patients with nonseminomatous germ cell tumors and residual retroperitoneal mass ≥1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (RPLND). For seminoma, RPLND is considered in those patients with masses ≥3 cm that are also positron emission tomography positive. Masses that occur outside of the retroperitoneum should be completely resected with the possible exception of bilateral lung masses when resection of the first mass shows necrosis. The role of surgery in patients with extragonadal germ cell tumors is most vital in those with primary mediastinal nonseminomatous germ cell tumors. Importantly, patient selection, surgical planning, and consideration of referral to centers with this expertise are important to optimize success.
Collapse
Affiliation(s)
- Stephen B Riggs
- Levine Cancer Institute and McKay Department of Urology, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | | | | | | | | |
Collapse
|
14
|
Daneshmand S, Albers P, Fosså SD, Heidenreich A, Kollmannsberger C, Krege S, Nichols C, Oldenburg J, Wood L. Contemporary management of postchemotherapy testis cancer. Eur Urol 2012; 62:867-76. [PMID: 22938868 DOI: 10.1016/j.eururo.2012.08.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 08/12/2012] [Indexed: 11/17/2022]
Abstract
CONTEXT Some controversy still exists regarding the management of testis cancer following chemotherapy for disseminated disease. OBJECTIVE To review the available literature concerning the management of postchemotherapy testis cancer. EVIDENCE ACQUISITION A Medline search was conducted to identify original and review articles, as well as guidelines addressing the management of testis cancer following first-line chemotherapy. Keywords included germ cell tumor, testis cancer, retroperitoneal lymph node dissection, and chemotherapy. The most relevant articles were critically reviewed with the consensus of all the collaborative authors, who have expertise in the management of germ cell tumors (GCTs). EVIDENCE SYNTHESIS Approximately one-third of patients who undergo chemotherapy for metastatic GCTs have residual retroperitoneal disease. All patients with residual masses ≥1cm after chemotherapy for nonseminomatous GCTs should undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) because of the risk of mature teratoma in 40-45% of cases and of viable GCT in 10-15% of cases. Patients who obtain a complete serologic remission and radiographic residual <1 cm after chemotherapy have a 6-9% risk of relapse. Patients with a completely resected teratoma in only the PC-RPLND specimen have a >90% chance of cure, while patients with viable GCTs should be considered for additional therapy, depending on the percentage of viable tumor. In patients with disseminated seminoma, postchemotherapy masses <3cm may be safely observed, while patients with masses >3 cm should be evaluated with positron emission tomography (PET)/computed tomography 2 mo after completion of chemotherapy, with very selective administration of PC-RPLND. Late relapse occurring >2 yr after chemotherapy is rare, and surgery remains the mainstay of therapy in cases of resectable masses independent of tumor markers. There is still controversy on whether high-dose chemotherapy confers a survival benefit compared with conventional-dose chemotherapy in the salvage setting. Surgery should always be considered for resectable masses following salvage therapies or in chemoresistant disease to maximize chance of cure. CONCLUSIONS Patients with advanced GCTs can achieve long-term disease-free survival when chemotherapy is combined with expert and judicious resection of residual disease. PC-RPLND is recommended for residual masses >1cm identified on postchemotherapy imaging in nonseminomatous GCT and possibly for PET-positive residual disease ≥3cm in treated seminomas.
Collapse
Affiliation(s)
- Siamak Daneshmand
- University of Southern California, Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90089, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Daneshmand S, Djaladat H, Nichols C. Management of residual mass in nonseminomatous germ cell tumors following chemotherapy. Ther Adv Urol 2011; 3:163-71. [PMID: 21969846 DOI: 10.1177/1756287211418721] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Advanced stage nonseminomatous testis cancer is commonly treated with chemotherapy and surgical resection. Patients with retroperitoneal residual masses >1cm following induction chemotherapy with normalized tumor markers should undergo a post-chemotherapy retroperitoneal lymph node dissection. Post chemotherapy retroperitoneal residual mass less than 1 cm with normal markers may be considered as complete response, although the possibility of residual teratoma and viable germ cell tumor are not definitively ruled out. Excellent long term disease free survival following surveillance may justify this option as the treatment of choice in this cohort of patients.
Collapse
Affiliation(s)
- Siamak Daneshmand
- USC Institute of Urology, 1441 East Lake Avenue, Suite 7461, Los Angeles, CA 90033, USA
| | | | | |
Collapse
|
16
|
Tarin T, Carver B, Sheinfeld J. The Role of Lymphadenectomy for Testicular Cancer: Indications, Controversies, and Complications. Urol Clin North Am 2011; 38:439-49, vi. [DOI: 10.1016/j.ucl.2011.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Koychev D, Oechsle K, Bokemeyer C, Honecker F. Treatment of patients with relapsed and/or cisplatin-refractory metastatic germ cell tumours: an update. ACTA ACUST UNITED AC 2011; 34:e266-73. [DOI: 10.1111/j.1365-2605.2011.01145.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
18
|
Abstract
Late relapses of nonseminomatous cell tumours (NSGCTs) are rare and occur by definition at > or =2 years after successful treatment. They represent a major challenge of current treatment and follow-up of the affected patients. We present relevant literature on late-relapsing NSGCTs to provide an overview over the effect of primary treatment, patient and tumour characteristics. Of all patients with NSGCT, 1-6% have a late relapse, with those having extragonadal GCTs being at greatest risk. The predominant site of relapse is the retroperitoneal space. Suboptimal primary treatment, especially insufficient retroperitoneal surgery, increases the risk of late relapses. Radical surgery is probably the most important treatment, with advances in salvage chemotherapy adding to the improved cure rates. Treatment at an experienced institution ensures a 5-year cancer-specific survival of >50%, and this approaches 100% in case of single-site mature teratoma. Diagnosis and proper treatment of patients with late-relapsing NSGCTs is challenging and should be restricted to experienced centres only. Referral of late-relapsing patients to high-volume institutions ensures the best chances of cure and enables increasing understanding of tumour biology and the clinical course of these patients.
Collapse
Affiliation(s)
- Jan Oldenburg
- The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
| | | |
Collapse
|
19
|
Eggener SE. The clinical diversity of postchemotherapy germ cell teratoma. Cancer 2009; 115:1138-41. [PMID: 19165804 DOI: 10.1002/cncr.24146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
20
|
|
21
|
Kollmannsberger C, Honecker F, Bokemeyer C. Pharmacotherapy of relapsed metastatic testicular cancer. Expert Opin Pharmacother 2008; 9:2259-72. [DOI: 10.1517/14656566.9.13.2259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
22
|
Ong TA, Winkler MH, Savage PM, Seckl MJ, Christmas TJ. Retroperitoneal lymph node dissection after chemotherapy in patients with elevated tumour markers: indications, histopathology and outcome. BJU Int 2008; 102:198-202. [DOI: 10.1111/j.1464-410x.2008.07533.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
23
|
Conservative management of testicular germ-cell tumors. ACTA ACUST UNITED AC 2007; 4:550-60. [DOI: 10.1038/ncpuro0905] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 07/10/2007] [Indexed: 11/09/2022]
|
24
|
Oldenburg J, Martin JM, Fosså SD. Late Relapses of Germ Cell Malignancies: Incidence, Management, and Prognosis. J Clin Oncol 2006; 24:5503-11. [PMID: 17158535 DOI: 10.1200/jco.2006.08.1836] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Late relapses of malignant germ cell tumors (MGCTs) are rare and occur, by definition, 2 years or later after successful treatment. They represent a major challenge of today's treatment of MGCTs. Because of the rarity and heterogeneity of late relapses, many aspects of their main characteristics remain obscure. We present relevant literature on relapsing MGCTs to highlight the following issues: incidence, impact of initial treatment on the subsequent risk of late relapse, treatment, and survival. In a pooled analysis, the incidence is 1.4% and 3.2% in seminoma and nonseminoma patients, respectively. The predominant site of relapse is the retroperitoneal space in both histologic types. The initial treatment appears to be important for the risk and localization of late relapses. The treatment of late relapses should be based on a representative presalvage biopsy and includes radical surgery and salvage chemotherapy in most cases. Five-year cancer-specific survival is above 50% in the recent large series and reaches 100% in case of single-site teratoma. Diagnosis and 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 increasing understanding of tumor biology and the clinical course of these patients.
Collapse
Affiliation(s)
- Jan Oldenburg
- Department of Clinical Cancer Research, University of Oslo, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.
| | | | | |
Collapse
|