Chemotherapy for Advanced Testicular Cancer

Treatment and Survival of Malignant Extracranial Germ Cell Tumours in the Paediatric Population: A Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review and meta-analysis was performed to explore overall survival (OS) and event free survival (EFS) rates internationally over the past two decades and to define specific subgroups with inferior outcomes which may demand different treatment strategies.

METHODS

The search focused on malignant extracranial germ cell tumours (GCTs) in the paediatric population. The initial database search identified 12,556 articles; 32 articles were finally included in this review, comprising a total of 5095 patients.

RESULTS

The studies were heterogeneous, varying from single institution reports to large prospective trials. Older studies, describing eras where non-platinum-based chemotherapy regimens were used, showed clearly worse outcomes. Survival for stage I-II gonadal disease is excellent. On the other hand, patients with an initial alpha-fetoprotein (AFP) > 10,000 ng/mL or kU/L, age > 11 years and stage IV disease confer a survival disadvantage. For testicular disease in particular, lymphovascular invasion and certain histopathological subtypes, such as embryonal carcinoma (EC) and mixed malignant GCTs, survival is poorer. Survival data for sacrococcygeal and mediastinal GCTs show a heterogeneous distribution across studies in this review, independent of year of publication. Patients > 12 years presenting with a mediastinal GCT pose a subpopulation which fares worse than GCTs in other locations or age groups. This is independent of AFP levels, stage of disease or treatment protocol, and these patients may demand a different treatment strategy.

CONCLUSIONS

This review describes the heterogeneous nature of GCTs in different anatomical locations, impacting on stage at presentation, treatment modalities used and survival data. Despite this heterogeneity, in line with the current developmental biology-based classification system, subpopulations can be defined which have an inferior EFS and OS and where future research and more individualised treatment would help to improve survival.

Persistence of cisplatin-induced DNA interstrand crosslinking in peripheral blood mononuclear cells from elderly and young individuals

DNA interstrand crosslinks (ISCL) produced by the incubation of human peripheral blood mononuclear cells (PBMs) with cisplatin (CDDP) were measured in two populations of volunteers, one aged less than 25 years and the other, greater than 72 years. The technique of fluorometric alkaline elution was used to measure DNA interstrand crosslinking with time after a 1-h exposure to drug. The samples from the young group showed a more consistent pattern of crosslink formation and removal, with extensive, or in some cases complete, repair at 48 h. Those from the elderly group showed considerable inter-individual variation and significantly higher mean levels of crosslinking at 24 and 48 h. No samples showed complete repair at 48 h in this population. These results indicate an impaired DNA repair capacity in the cells from the elderly group. This may be a factor in the poor tolerance of chemotherapy in the ageing population.

Testicular cancer

Although testicular cancer accounts for approximately 1% of all male malignancies, it has a significant impact on the social, economic, and emotional status of the young population in which it occurs. TSE is the best available tool for early detection of testicular cancer. Only 15 to 20 years ago, testicular cancer was often fatal because of the rapidity of metastasis to the lungs and other vital organs. Because of progress in surgical technique and chemotherapy, it is today one of the most curable cancers. The use of serum markers and early diagnosis and treatment are of great importance in the management of testicular cancer.