Managing seminomatous and nonseminomatous germ cell tumors

A Bridge to Nowhere: Enabling Autonomy in a Case of Failed ECMO Rescue of Bleomycin-Induced Pulmonary Toxicity

Extracorporeal membrane oxygenation (ECMO) can be a life-saving intervention in cases of potentially reversible refractory respiratory failure. One such indication can be bleomycin-induced lung injury. However, in some cases, the injury can be so severe that it becomes irreversible and creates complex medical decisions regarding life support and the continuation of care when no additional therapeutic options are feasible, particularly in cases of patients who were young and fully functional prior to an acute illness. In cases of full pulmonary replacement with mechanical support and the degree of functionality that can be attained utilizing modalities such as ECMO can obscure the true severity of illness and make end-of-life decisions significantly harder for families and caregivers.

Somatic-type Malignancies in Testicular Germ Cell Tumors: A Clinicopathologic Study of 63 Cases

The development of somatic-type malignancies (SMs) in testicular germ cell tumors (GCTs) is a rare but well-recognized phenomenon. We studied the pathologic features of 63 GCTs with SMs in the testis (n=22) or metastases (n=41) and correlated these features with clinical outcomes. The patients with SMs in the testis (median age, 26 y) were younger than those with metastatic SMs (median age, 38.5 y). The SMs consisted of carcinomas (n=21), sarcomas (n=21), primitive neuroectodermal tumors (n=15), nephroblastomas (n=3), and mixed tumors (n=3). Sarcoma was the most common SM in the testis (n=11), and most sarcomas were rhabdomyosarcomas (n=9). Carcinoma was the most common SM in metastases (n=20), and most carcinomas were adenocarcinomas (n=12). In metastases, carcinomatous SMs developed after a longer interval from the initial orchiectomy (median times, 213 mo) than sarcomatous SMs (median times, 68 mo). Patients with metastatic SMs had significantly poorer overall survival than those with SMs in the testis (5-y survival rate, 35% vs. 87%; P=0.011). Furthermore, patients with carcinomatous SMs had a significantly worse prognosis than those with sarcomatous or primitive neuroectodermal tumor SMs (5-y survival rates, 17%, 77%, and 73%, respectively; P=0.002), when the whole cohort, including testicular and metastatic SMs, were analyzed. Our results demonstrate that SMs in metastatic GCTs are associated with a significantly worse prognosis than those in the testis. Furthermore, the histologic subtype of SM has a significant effect on the clinical outcome, with the carcinomatous SM carrying the highest risk for mortality.

A phase 1 study of combined guadecitabine and cisplatin in platinum refractory germ cell cancer

Purpose

Germ cell tumors (GCTs) are cured with therapy based on cisplatin, although a clinically significant number of patients are refractory and die of progressive disease. Based on preclinical studies indicating that refractory testicular GCTs are hypersensitive to hypomethylating agents (HMAs), we conducted a phase I trial combining the next‐generation HMA guadecitabine (SGI‐110) with cisplatin in recurrent, cisplatin‐resistant GCT patients.

Methods

Patients with metastatic GCTs were treated for five consecutive days with guadecitabine followed by cisplatin on day 8, for a 28‐day cycle for up to six cycles. The primary endpoint was safety and toxicity including dose‐limiting toxicity (DLT) and maximum tolerated dose (MTD).

Results

The number of patients enrolled was 14. The majority of patients were heavily pretreated. MTD was determined to be 30 mg/m² guadecitabine followed by 100 mg/m² cisplatin. The major DLTs were neutropenia and thrombocytopenia. Three patients had partial responses by RECIST criteria, two of these patients, including one with primary mediastinal disease, completed the study and qualified as complete responses by serum tumor marker criteria with sustained remissions of 5 and 13 months and survival of 16 and 26 months, respectively. The overall response rate was 23%. Three patients also had stable disease indicating a clinical benefit rate of 46%.

Conclusions

The combination of guadecitabine and cisplatin was tolerable and demonstrated activity in patients with platinum refractory germ cell cancer.

Consideraciones en torno a los tumores del mediastino

Introducción. El desarrollo de las imágenes diagnósticas hizo posible el diagnóstico topográfico de los tumores de mediastino; sin embargo, aún con los avances actuales de la cirugía, la anestesiología y la reanimación, el acceso quirúrgico a ese espacio medio de la caja torácica continúa siendo el gran reto que enfrentan los cirujanos torácicos. Objetivo. Profundizar en los diferentes aspectos cognoscitivos actualizados sobre los tumores mediastinales. Métodos. Búsqueda documental digital en bases de datos: Scielo, Lilacs, Web of Science, PubMed, realizada en enero de 2019, de publicaciones sobre el tema en la presente centuria. Resultados. Las neoplasias mediastinales son poco frecuentes, pueden aparecer a cualquier edad, aunque son más frecuentes entre la tercera y quinta décadas, y la mayoría se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Los tumores malignos del mediastino son poco frecuentes, pero los benignos constituyen un desafío diagnóstico para radiólogos y patólogos. En las neoplasias malignas se identifica una amplia gama de variedades histológicas, atribuibles a las características del órgano afectado. Conclusiones. El diagnóstico definitivo generalmente se establece mediante el estudio histopatológico posquirúrgico, si bien la tomografía computarizada, asociada o no a la biopsia percutánea, es el estándar de oro para el diagnóstico preoperatorio. La selección de la vía de entrada al tórax, así como el procedimiento quirúrgico, están condicionados por la localización y el tamaño del tumor en el mediastino.

Clinical characteristics of testicular seminoma in individuals in West China: a 10-year follow-up study

Objective

To assess the clinical characteristics of testicular seminoma (TS).

Patients and methods

A testicular cancer (TC) survey was conducted by the Department of Urology, West China Hospital, between 2008 and 2018. Tumors were classified according to the NCCN criteria such as age, tumor size, tumor marker levels, histopathology, clinical stage, initial treatment, follow-up, and clinical outcomes, were obtained from the database of our center.

Results

Among 155 registered cases of TC with seminomatous element, 127 cases of pure TS were analyzed. All 127 patients with a median age of 37 years were pathologically diagnosed with orchiectomy specimens. Orchiectomy, chemotherapy, and radiotherapy were the main treatments for these patients. Patients with clinical stages I, II, and III testicular cancer of accounted for 81.1% (n=103), 15.7% (n=20), and 3.2% (n=4) of all patients, respectively. After a median follow-up time of 50 months, five patients presented with relapse during follow-up, and one among them died. Of the patients with stage I TS (T1N0M0S0 CS IA), three patients who only underwent orchiectomy relapsed. Among patients with stage II TS (T1N1M0S1 CS IIA), one patient relapsed after orchiectomy, post-surgery chemotherapy and radiotherapy. In four patients with stage III disease (T2N1M1aS1 CS IIIA), one relapsed after orchiectomy and chemotherapy, and died shortly after salvage chemotherapy and radiotherapy due to recurrence. The median overall survival time was 50 months. In all patients, the 2-year overall survival and progression-free survival probabilitis were 98.6% and 98.8%, respectively.

Conclusion

The present study shows that patients with TS have good prognosis even at an advanced stage. Surveillance after orchiectomy was important for patients with CSI seminoma, and we recommend cisplatin-based chemotherapy as salvage therapy for patients with CSI seminoma. In addition, patients with a maximal tumor diameter >4 cm should undergo post-surgery chemotherapy.