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Ayhan A, Tunç M, Akıllı H, Haberal N, Haberal A. Fertility-sparing approach to malignant ovarian germ cell tumors - Oncologic and obstetric outocome: A retrospective study. Int J Gynaecol Obstet 2024; 164:1074-1079. [PMID: 37737565 DOI: 10.1002/ijgo.15141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To evaluate oncologic (such as disease-free and overall survival) and obstetric outcomes in patients diagnosed with malignant ovarian germ cell tumors (MOGCTs). METHODS Patients diagnosed with MOGCTs between March 2007 and February 2022 were evaluated and patients who underwent fertility sparing surgery were included in this retrospective study. The obstetric and oncologic outcomes were evaluated by collecting data up until the patient's last follow-up visit from the hospital records and patient files. The study was approved by Başkent University Institutional Review Board (KA23/124). RESULTS Seventy FSS patients were included in this study. The median age of the patients was 22.5 years (range: 11-37). The median follow-up time was 92.0 months (10-189). Immature teratoma was the most common histological subtype (32.9%). Bilateral involvement was detected in only one patient with immature teratoma (1.4%). The 5-year DFS rates of immature teratoma, dysgerminoma, yolk sac, and mixed germ cell histologic types were 91.1%, 94.1%, 82.4%, and 88.9%, respectively (P: 0.716). The 5-year OS rates of the same histologic types were 95.7%, 100%, 88.2%, and 88.9%, respectively (P = 0.487). All patients (100%) had a regular menstrual cycle after the completion of adjuvant treatment. The mean time between the last chemotherapy and menstruation was 4.38 months. To date, a total of 34 patients tried to conceive after the completion of disease treatment. A total of 23 (67.6%) patients conceived, resulting in 27 live births in 22 (100%) patients. CONCLUSION Fertility preservation should be the first treatment option in MOGCTs in young patients due to the unilateral involvement of the disease and its chemosensitive nature.
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Affiliation(s)
- Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
| | - Mehmet Tunç
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
| | - Hüseyin Akıllı
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
| | - Nihan Haberal
- Department of Pathology, Başkent University Hospital, Ankara, Turkey
| | - Ali Haberal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
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McAvoy C, Fields P, Otto D, Kreimer A, Ellis CS. Incidence of pulmonary toxicity in bleomycin-containing regimens for testicular cancer with and without the use of growth factor. J Oncol Pharm Pract 2024:10781552231225766. [PMID: 38291671 DOI: 10.1177/10781552231225766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
INTRODUCTION The concurrent use of bleomycin and granulocyte colony-stimulating factors (G-CSFs) has historically been debated as a risk factor for bleomycin-induced pulmonary toxicity in patients with both testicular cancer and Hodgkin's lymphoma. The purpose of this study is to evaluate the incidence of pulmonary toxicity in patients with testicular cancer who were treated with bleomycin and pegfilgrastim concurrently. METHODS This is a retrospective study that includes male patients over the age of 18 years old diagnosed with testicular cancer who received bleomycin-containing chemotherapy regimens with and without the use of G-CSF agents. RESULTS There were a total of 33 patients identified as receiving bleomycin, with 30 of those patients having received concurrent G-CSF therapy. Of the patients who received G-CSF therapy, 11 patients (36.6%) experienced pulmonary toxicity leading to discontinuation of bleomycin or changes in chemotherapy regimens altogether. CONCLUSION There were no major differences in patient demographics or risk factors between those who received G-CSF and developed pulmonary toxicity and those who received G-CSF but did not develop pulmonary toxicity. Further studies are needed in order to fully assess the risk of pulmonary toxicity with this chemotherapy regimen.
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Affiliation(s)
- Claire McAvoy
- Department of Pharmacy Services, UK HealthCare Albert B. Chandler Medical Center, Lexington, KY, USA
- Markey Cancer Center, UK HealthCare Albert B. Chandler Medical Center, Lexington, KY, USA
| | - Paige Fields
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Danielle Otto
- Department of Pharmacy Services, UK HealthCare Albert B. Chandler Medical Center, Lexington, KY, USA
- Markey Cancer Center, UK HealthCare Albert B. Chandler Medical Center, Lexington, KY, USA
| | - Alexander Kreimer
- Department of Pharmacy Services, UK HealthCare Albert B. Chandler Medical Center, Lexington, KY, USA
- Markey Cancer Center, UK HealthCare Albert B. Chandler Medical Center, Lexington, KY, USA
| | - Carleton S Ellis
- Department of Pharmacy Services, UK HealthCare Albert B. Chandler Medical Center, Lexington, KY, USA
- Markey Cancer Center, UK HealthCare Albert B. Chandler Medical Center, Lexington, KY, USA
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Ciulei MA, Smith ER, Perumal N, Jakazi CS, Sudfeld CR, Gernand AD. Nutritious Supplemental Foods for Pregnant Women from Food Insecure Settings: Types, Nutritional Composition, and Relationships to Health Outcomes. Curr Dev Nutr 2023; 7:100094. [PMID: 37250388 PMCID: PMC10209485 DOI: 10.1016/j.cdnut.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
There is growing evidence that the provision of nutritious supplemental foods to undernourished pregnant women can improve maternal and infant outcomes. However, comparing and synthesizing the evidence base is complicated by differences in interventions and products and the use of ambiguous terminology. We aimed to define 2 common types of nutritious supplemental foods used in pregnancy, balanced energy-protein (BEP) supplements and lipid-based nutrient supplements (LNS), and to review the evidence supporting each via a narrative review of systematic reviews and meta-analyses (SRMAs). Information about the nutritional composition of the food supplements and their effects on maternal and infant outcomes was abstracted. Five SRMAs (n = 20 trials) evaluated the effect of BEP compared with no BEP/control (comparison group commonly received iron and folic acid [IFA]). BEP foods/products ranged in calories (118-1017 kcals), protein (3-50 g), fat (6-57 g), and micronutrient content. Overall, maternal BEP improved birth weight and reduced the risk of stillbirth and small for gestational age when compared with no BEP/control in pregnancy. Three SRMAs (n = 5 trials) evaluated the effect of LNS compared with IFA or multiple micronutrients (MMNs). The LNS interventions comprised small- and large-quantity LNS that ranged in calories (118-746 kcals), protein (3-21 g), fat (10-53 g), and micronutrient content. LNS compared with IFA increased pregnancy duration, birth weight, and birth length and reduced the risk of small for gestational age and infant stunting; however, no beneficial effect of LNS was identified when compared with MMN. Despite heterogeneity in the nutritional composition of BEP supplements, the evidence suggests that in nutritionally at-risk populations, these products may improve birth outcomes in pregnant women. The evidence is limited but promising when LNS is compared with IFA in improving maternal and infant outcomes. Overall, BEP, compared with MMN or LNS, are key areas that have not been studied and deserve attention.
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Affiliation(s)
- Mihaela A. Ciulei
- Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA, United States
| | - Emily R. Smith
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States
- Department of Exercise and Nutrition Sciences, George Washington University Milken Institute School of Public Health, Washington, DC, United States
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
| | - Nandita Perumal
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
| | - Chioniso S. Jakazi
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States
| | - Alison D. Gernand
- Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA, United States
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Nagasaka H, Takebe S, Yamamoto S, Kondo T, Terao H, Nakaigawa N, Kishida T. Use of Sotrovimab for COVID-19 in a Patient with International Germ Cell Consensus Classification Poor Prognosis Testicular Germ Cell Tumor. Case Rep Oncol 2023; 16:1028-1032. [PMID: 37900855 PMCID: PMC10601775 DOI: 10.1159/000533888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/11/2023] [Indexed: 10/31/2023] Open
Abstract
A 35-year-old man was diagnosed with stage IIIC non-seminoma with paralysis of the lower half of his body due to 8th thoracic spine metastasis. The patient received bleomycin, etoposide, and cisplatin (BEP) therapy. On day 4 of the second course of BEP, the patient developed a fever and was diagnosed with coronavirus disease (COVID-19). COVID-19 was suspected to worsen because of cancer and chemotherapy-induced immunosuppression. However, the benefits of continuing BEP therapy outweighed these risks. After obtaining fully informed consent, BEP therapy was continued from day 5, while sotrovimab (anti-COVID-19 drug) was administered. The second course of BEP was completed without worsening severe COVID-19 or bleomycin-induced lung injury. The patient completed four courses of BEP, with normalization of tumor markers, partial response on imaging, and improvement in lower body paralysis. In this case, we successfully treated a patient with testicular germ cell tumor with chemotherapy while having COVID-19 without treatment delay. During the COVID-19 pandemic, concomitant chemotherapy and COVID-19 treatment are warranted because delaying treatment will decrease the efficacy of highly curative diseases such as germ cell tumors.
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Affiliation(s)
| | - Shinichi Takebe
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Takuya Kondo
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hideyuki Terao
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
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Murez T, Fléchon A, Savoie PH, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Méjean A. [French ccAFU guidelines - update 2020-2022: testicular germ cell tumors]. Prog Urol 2020; 30:S280-S313. [PMID: 33349427 DOI: 10.1016/s1166-7087(20)30754-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE - To update French guidelines concerning testicular germ cell cancer. MATERIALS AND METHODS - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated. RESULTS - Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20%. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3 cm. CONCLUSIONS - A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99% in CSI, 85% in CSII+).
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Affiliation(s)
- T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Cullen M, Huddart R, Joffe J, Gardiner D, Maynard L, Hutton P, Mazhar D, Shamash J, Wheater M, White J, Goubar A, Porta N, Witts S, Lewis R, Hall E. The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis. Eur Urol 2020; 77:344-351. [PMID: 31901440 PMCID: PMC7026695 DOI: 10.1016/j.eururo.2019.11.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/26/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Standard management in the UK for high-risk stage 1 nonseminoma germ cell tumours of the testis (NSGCTT) is two cycles of adjuvant bleomycin, etoposide (360 mg/m2), and cisplatin (BE360P) chemotherapy, or surveillance. OBJECTIVE To test whether one cycle of BE500P achieves similar recurrence rates to two cycles of BE360P. DESIGN, SETTING, AND PARTICIPANTS A total of 246 patients with vascular invasion-positive stage 1 NSGCTT or combined seminoma + NSGCTT were centrally registered in a single-arm prospective study. INTERVENTION One cycle comprising bleomycin 30000 IU on days 1, 8, and 15, etoposide 165 mg/m2 on days 1-3, and cisplatin 50 mg/m2 on days 1-2, plus antibacterial and granulocyte colony stimulating factor prophylaxis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was 2-yr malignant recurrence (MR); the aim was to exclude a rate of ≥5%. Participants had regular imaging and tumour marker (TM) assessment for 5 yr. RESULTS AND LIMITATIONS The median follow-up was 49 mo (interquartile range 37-60). Ten patients with rising TMs at baseline were excluded. Four patients had MR at 6, 7, 13, and 27 mo; all received second-line chemotherapy and surgery and three remained recurrence-free at 5 yr. The 2-yr MR rate was 1.3% (95% confidence interval 0.3-3.7%). Three patients developed nonmalignant recurrences with localised teratoma differentiated, rendered disease-free after surgery. Grade 3-4 febrile neutropenia occurred in 6.8% of participants. CONCLUSIONS BE500P is safe and the 2-yr MR rate is consistent with that seen following two BE360P cycles. The 111 study is the largest prospective trial investigating one cycle of adjuvant BE500P in high-risk stage 1 NSGCTT. Adoption of one cycle of BE500P as standard would reduce overall exposure to chemotherapy in this young population. PATIENT SUMMARY Removing the testicle fails to cure many patients with high-risk primary testicular cancer since undetectable cancers are often present elsewhere. A standard additional treatment in Europe is two cycles of chemotherapy to eradicate these. This trial shows one cycle has few adverse effects and comparable outcomes to those seen with two cycles.
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Affiliation(s)
- Michael Cullen
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robert Huddart
- The Institute Of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | | | - Deborah Gardiner
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Lauren Maynard
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Paul Hutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Danish Mazhar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Matthew Wheater
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jeff White
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Aicha Goubar
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Stephanie Witts
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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Upadhyaya P, Di Serafino A, Sorino L, Ballerini P, Marchisio M, Pierdomenico L, Stuppia L, Antonucci I. Genetic and epigenetic modifications induced by chemotherapeutic drugs: human amniotic fluid stem cells as an in-vitro model. BMC Med Genomics 2019; 12:146. [PMID: 31660974 PMCID: PMC6816179 DOI: 10.1186/s12920-019-0595-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bleomycin, etoposide and cisplatin (BEP) are three chemotherapeutic agents widely used individually or in combination with each other or other chemotherapeutic agents in the treatment of various cancers. These chemotherapeutic agents are cytotoxic; hence, along with killing cancerous cells, they also damage stem cell pools in the body, which causes various negative effects on patients. The epigenetic changes due to the individual action of BEP on stem cells are largely unknown. METHODS Human amniotic fluid stem cells (hAFSCs) were treated with our in-vitro standardized dosages of BEP individually, for seven days. The cells were harvested after the treatment and extraction of DNA and RNA were performed. Real-time PCR and flow cytometry were conducted for cell markers analysis. The global DNA methylation was quantified using 5mC specific kit and promoter and CpG methylation % through bisulfite conversion and pyrosequencing. Micro- RNAs (miRNAs) were quantified with real-time qPCR. RESULTS The cytotoxic nature of BEP was observed even at low dosages throughout the experiment. We also investigated the change in the expression of various pluripotent and germline markers and found a significant change in the properties of the cells after the treatments. The methylation of DNA at global, promoter and individual CpG levels largely get fluctuated due to the BEP treatment. Several tested miRNAs showed differential expression. No positive correlation between mRNA and protein expression was observed for some markers. CONCLUSION Cytotoxic chemotherapeutic agents such as BEP were found to alter stem cell properties of hAFSCs. Different methylation profiles change dynamically, which may explain such changes in cellular properties. Data also suggests that the fate of hAFSCs after treatment may depend upon the interplay between the miRNAs. Finally, our results demonstrate that hAFSCs might prove to be a suitable in-vitro model of stem cells to predict genetic and epigenetic modification due to the action of various drugs.
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Affiliation(s)
- Prabin Upadhyaya
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, "G.d'Annunzio" University, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti, Italy
| | - Alessandra Di Serafino
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, "G.d'Annunzio" University, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti, Italy
| | - Luca Sorino
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, "G.d'Annunzio" University, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti, Italy
| | - Patrizia Ballerini
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, "G.d'Annunzio" University, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti, Italy
- Centre of Aging Science and Translational Medicine (Ce.S.I.-Me.T.), G. d'Annunzio University, Chieti-Pescara, Italy
| | - Marco Marchisio
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, "G.d'Annunzio" University, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti, Italy
- Centre of Aging Science and Translational Medicine (Ce.S.I.-Me.T.), G. d'Annunzio University, Chieti-Pescara, Italy
| | - Laura Pierdomenico
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, "G.d'Annunzio" University, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti, Italy
- Centre of Aging Science and Translational Medicine (Ce.S.I.-Me.T.), G. d'Annunzio University, Chieti-Pescara, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, "G.d'Annunzio" University, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti, Italy
- Centre of Aging Science and Translational Medicine (Ce.S.I.-Me.T.), G. d'Annunzio University, Chieti-Pescara, Italy
| | - Ivana Antonucci
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, "G.d'Annunzio" University, Chieti-Pescara, Via dei Vestini 31, 66013, Chieti, Italy.
- Centre of Aging Science and Translational Medicine (Ce.S.I.-Me.T.), G. d'Annunzio University, Chieti-Pescara, Italy.
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Murez T, Fléchon A, Savoie PH, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Sèbe P, Méjean A. [French ccAFU guidelines - Update 2018-2020: Testicular germ cell tumors]. Prog Urol 2019; 28 Suppl 1:R149-R166. [PMID: 31610870 DOI: 10.1016/j.purol.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To update French guidelines concerning testicular germ cell cancer. METHODS Comprehensive Medline search between 2016 and 2018 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated. RESULTS Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first- line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20 %. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non-seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non-seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3cm. CONCLUSIONS A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99 % in CSI, 85 % in CSII+).
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Affiliation(s)
- T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, CHU Paris Sud, site Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre de pathologie, 51, rue de Jeanne-D'Arc, 80000 Amiens, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud (Pierre Bénite), HCL groupement hospitalier du Sud, 69495 Pierre Bénite cedex, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, BP 50048, 33401 Talence cedex, France
| | - P Sèbe
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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Wang Q, Li Y, Zhou X, Wang T, Qiu L, Gu Y, Chang J. Toughened Poly(lactic acid)/ BEP Composites with Good Biodegradability and Cytocompatibility. Polymers (Basel) 2019; 11:E1413. [PMID: 31466330 PMCID: PMC6780854 DOI: 10.3390/polym11091413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 01/22/2023] Open
Abstract
Using novel biodegradable elastomer particles (BEP) prepared by the technologies of melt polycondensation, emulsification, and irradiation vulcanization, we successfully prepared advanced poly(lactic acid) (PLA)/BEP composites with higher toughness, higher biodegradability, and better cytocompatibility than neat PLA by means of the melt blending technology. The experimental results revealed that the elongation at break of the PLA/BEP composites containing 8 parts per hundred rubber (phr) by weight BEP increased dramatically from 2.9% of neat PLA to 67.1%, and the notched impact strength increased from 3.01 to 7.24 kJ/m2. Meanwhile, the biodegradation rate of the PLA/BEP composites increased dramatically in both soil environment and lipase solution, and the crystallization rate and crystallinity of the PLA/BEP composites increased significantly compared to those of neat PLA. The methyl thiazolyl tetrazolium (MTT) assay also showed that the viability of L929 cells in the presence of extracts of PLA/BEP composites was more than 75%, indicating that the PLA/BEP composites were not cytotoxic and had better cytocompatibility than neat PLA. Research on advanced PLA/BEP composites opens up new potential avenues for preparing advanced PLA products, especially for advanced biomedical materials.
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Affiliation(s)
- Qingguo Wang
- Key Laboratory of Rubber-Plastics of Ministry of Education, Qingdao University of Science and Technology, Qingdao 266042, China.
- Shandong Provincial Key Laboratory of Rubber-Plastics, Qingdao 266042, China.
| | - Yongxuan Li
- Key Laboratory of Rubber-Plastics of Ministry of Education, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Xue Zhou
- Key Laboratory of Rubber-Plastics of Ministry of Education, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Tongyao Wang
- Key Laboratory of Rubber-Plastics of Ministry of Education, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Liyan Qiu
- Key Laboratory of Rubber-Plastics of Ministry of Education, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Yuanchun Gu
- Key Laboratory of Rubber-Plastics of Ministry of Education, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Jiabing Chang
- Key Laboratory of Rubber-Plastics of Ministry of Education, Qingdao University of Science and Technology, Qingdao 266042, China
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Newton C, Murali K, Ahmad A, Hockings H, Graham R, Liberale V, Sarker SJ, Ledermann J, Berney DM, Shamash J, Banerjee S, Stoneham S, Lockley M. A multicentre retrospective cohort study of ovarian germ cell tumours: Evidence for chemotherapy de-escalation and alignment of paediatric and adult practice. Eur J Cancer 2019; 113:19-27. [PMID: 30954883 PMCID: PMC6522056 DOI: 10.1016/j.ejca.2019.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/14/2019] [Accepted: 03/02/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult guidelines recommend BEP (bleomycin, etoposide, cisplatin) for all ovarian germ cell tumours, causing debilitating toxicities in young patients who will survive long term. Paediatricians successfully reduce toxicities by using lower bleomycin doses and substituting carboplatin for cisplatin, while testicular and paediatric immature teratomas (ITs) are safely managed with surgery alone. AIM The aim was to determine whether reduced-toxicity treatment could rationally be extended to patients older than 18 years. METHODS Multicentre cohort study was carried out in four large UK cancer centres over 12 years. RESULTS One hundred thirty-eight patients were enrolled. Overall survival was 93%, and event-free survival (EFS) was 72%. Neoadjuvant/adjuvant chemotherapy (82% BEP) caused 27 potentially chronic toxicities, and one patient subsequently died from acute lymphoblastic leukaemia. There was no difference in histology, stage or grade in patients ≤/>18 years, and EFS was not different in these age groups (≤18:28% and >18:28%; log-rank P = 0.96). Histological subtype powerfully predicted EFS (log-rank P = 4.9 × 10-7). Neoadjuvant/adjuvant chemotherapy reduced future relapse/progression in dysgerminoma (n = 37, chemo:0% vs. no chemo:20%), yolk sac tumour (n = 23, 26.3% vs.75%) and mixed germ cell tumour (n = 32, 40%vs.70%) but not in IT (n = 42, 33% vs.15%). Additionally, we observed no radiological responses to chemotherapy in ITs, pathological IT grade did not predict EFS (univariate hazard ratio 0.82, 95% confidence interval: 0.57-1.19, P = 0.94) and there were no deaths in this subtype. CONCLUSION Survival was excellent but chemotherapy toxicities were severe, implying significant overtreatment. Our data support the extension of reduced-toxicity, paediatric regimens to adults. Our practice-changing findings that IT was chemotherapy resistant and pathological grade uninformative strongly endorse exclusive surgical management of ovarian ITs at all ages.
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Affiliation(s)
- C Newton
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; University College Hospital, 235 Euston Road London, NW1 2BU, UK; University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK; University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - K Murali
- The Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - A Ahmad
- The Wolfson Institute, CRUK Barts Cancer Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK; Cancer Intelligence, Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - H Hockings
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - R Graham
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - V Liberale
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - S-J Sarker
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; Research Department of Medical Education, UCL Medical School, Royal Free Campus, Hampstead, London NW3 2PR, UK
| | - J Ledermann
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - D M Berney
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - J Shamash
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - S Banerjee
- The Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - S Stoneham
- University College Hospital, 235 Euston Road London, NW1 2BU, UK
| | - M Lockley
- Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK; University College Hospital, 235 Euston Road London, NW1 2BU, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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Murez T, Fléchon A, Savoie PH, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Sèbe P, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs germinales du testicule French ccAFU guidelines — Update 2018—2020: Testicular germ cell tumors. Prog Urol 2018; 28:S147-S164. [PMID: 30472999 DOI: 10.1016/j.purol.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.009.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.009.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, CHU Paris Sud, site Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre de pathologie, 51, rue de Jeanne-D'Arc, 80000 Amiens, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud (Pierre Bénite), HCL groupement hospitalier du Sud, 69495 Pierre Bénite cedex, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, BP 50048, 33401 Talence cedex, France
| | - P Sèbe
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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IWAMOTO HIROAKI, IZUMI KOUJI, NATSAGDORJ ARIUNBOLD, MAKINO TOMOYUKI, NOHARA TAKAHIRO, SHIGEHARA KAZUYOSHI, KADONO YOSHIFUMI, MIZOKAMI ATSUSHI. Effectiveness and Safety of Pegfilgrastim in BEP Treatment for Patients with Germ Cell Tumor. In Vivo 2018. [PMID: 29936477 PMCID: PMC6117791 DOI: 10.21873/invivo.112326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The effectiveness and safety of pegfilgrastim during bleomycin, etoposide and cisplatin (BEP) chemotherapy have not yet been investigated. PATIENTS AND METHODS Patients with germ cell tumors (GCTs) who received pegfilgrastim during BEP at the Kanazawa University Hospital between January 2014 and December 2016 were retrospectively analyzed. The frequency of adverse events and effectiveness in inhibiting neutropenia were compared between cycles using pegfilgrastim and those using filgrastim. RESULTS Pegfilgrastim and filgrastim were administered in 13 and 22 cycles, respectively. The absolute neutrophil count at the nadir was significantly lower in patients receiving pegfilgrastim than in those receiving filgrastim (p=0.003). The duration of grade 2-4 neutropenia in cycles using filgrastim was significantly longer than that in those pegfilgrastim (p=0.01). No significant differences in the incidence of febrile neutropenia and serious adverse events were observed. CONCLUSION Pegfilgrastim can be safely and effectively administrated during BEP for patients with GCT.
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Affiliation(s)
- Salmi Narimane
- Service d'Oncologie Médicale, Institut National d'Oncologie, Rabat, Maroc
| | - Hassan Errihani
- Service d'Oncologie Médicale, Institut National d'Oncologie, Rabat, Maroc
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de la Motte Rouge T, Pautier P, Genestie C, Rey A, Gouy S, Leary A, Haie-Meder C, Kerbrat P, Culine S, Fizazi K, Lhommé C. Prognostic significance of an early decline in serum alpha-fetoprotein during chemotherapy for ovarian yolk sac tumors. Gynecol Oncol 2016; 142:452-7. [PMID: 27401840 DOI: 10.1016/j.ygyno.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The ovarian yolk sac tumor (OYST) is a very rare malignancy arising in young women. Our objective was to determine whether an early decline in serum alpha-fetoprotein (AFP) during chemotherapy has a prognostic impact. METHODS This retrospective study is based on prospectively recorded OYST cases at Gustave Roussy (Cancer Treatment Center). Survival curves were estimated using the Kaplan-Meier method. The serum AFP decline was calculated with the formula previously developed and validated in male patients with poor prognosis non-seminomatous germ cell tumors. Univariate and multivariate analyses were performed using the log-rank test and logistic regression, respectively. RESULTS Data on AFP were available to calculate an early AFP decline in 57 patients. All patients had undergone surgery followed by chemotherapy. The 5-year overall survival (OS) and event-free survival (EFS) rates were 86% (95% CI: 74%-93%) and 84% (95% CI: 73%-91%), respectively. The disease stage, presence of ascites at presentation, use of the BEP regimen, serum AFP half-life and an early AFP decline were significantly predictive factors for OS and EFS in the univariate analysis. The OS rate was 100% and 49% (95% CI: 26%-72%) in patients with a favorable AFP decline and in those with an unfavorable decline, respectively (p<0.001). In the multivariate analysis, only the presence of ascites at diagnosis (RR=7.3, p=0.03) and an unfavorable early AFP decline (RR=16.9, p<0.01) were significant negative predictive factors for OS. CONCLUSIONS An early AFP decline during chemotherapy is an independent prognostic factor in patients with OYSTs. CONFLICT OF INTEREST STATEMENT No conflict of interest.
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Affiliation(s)
- Thibault de la Motte Rouge
- Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France
| | - Patricia Pautier
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Catherine Genestie
- Department of Biopathology, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Annie Rey
- Department of Biostatistics, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Sébastien Gouy
- Department of Surgery, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Alexandra Leary
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Christine Haie-Meder
- Department of Radiotherapy, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Pierre Kerbrat
- Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France
| | - Stéphane Culine
- Department of Medical Oncology, CHU Hôpital Saint Louis, 1 avenue Claude-Vellefaux, F-75010 Paris, France
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Catherine Lhommé
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
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Ghezzi M, Berretta M, Bottacin A, Palego P, Sartini B, Cosci I, Finos L, Selice R, Foresta C, Garolla A. Impact of Bep or Carboplatin Chemotherapy on Testicular Function and Sperm Nucleus of Subjects with Testicular Germ Cell Tumor. Front Pharmacol 2016; 7:122. [PMID: 27242529 PMCID: PMC4865517 DOI: 10.3389/fphar.2016.00122] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/27/2016] [Indexed: 01/25/2023] Open
Abstract
Young males have testicular germ cells tumors (TGCT) as the most common malignancy and its incidence is increasing in several countries. Besides unilateral orchiectomy (UO), the treatment of TGCT may include surveillance, radiotherapy, or chemotherapy (CT), basing on tumor histology and stage of disease. It is well known that both radio and CT may have negative effects on testicular function, affecting spermatogenesis, and sex hormones. Many reports investigated these aspects in patients treated with bleomycin, etoposide, and cisplatin (BEP), after UO. In contrast no data are available on the side effects of carboplatin treatment in these patients. We included in this study 212 consecutive subjects who undergone to sperm banking at our Andrology and Human Reproduction Unit after UO for TGCT. Hundred subjects were further treated with one or more BEP cycles (BEP-group), 54 with carboplatin (CARB group), and 58 were just surveilled (S-group). All patients were evaluated for seminal parameters, sperm aneuploidy, sperm DNA, sex hormones, volume of the residual testis at baseline (T0) and after 12 (T1) and 24 months (T2) from UO or end of CT. Seminal parameters, sperm aneuploidies, DNA status, gonadic hormones, and testicular volume at baseline were not different between groups. At T1, we observed a significant reduction of sperm concentration and sperm count in the BEP group versus baseline and versus both Carb and S-group. A significant increase of sperm aneuploidies was present at T1 in the BEP group. Similarly, the same group at 1 had altered sperm DNA integrity and fragmentation compared with baseline, S-group and Carb group. These alterations were persistent after 2 years from the end of BEP treatment. Despite a slight improvement at T2, the BEP group had still higher percentages of sperm aneuploidies than other groups. No impairment of sperm aneuploidies and DNA status were observed in the Carb group both after 1 and 2 years from the end of treatment. Despite preliminary, these data demonstrate that in selected patients with TGCTs CT with carboplatin represents a therapeutic option that that seems to not affect sex hormones, spermatogenesis, and sperm nucleus.
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Affiliation(s)
- Marco Ghezzi
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of PadovaPadova, Italy; Istituto Oncologico Veneto - Istituto di Ricovero e Cura a Carattere ScientificoPadova, Italy
| | - Massimiliano Berretta
- Department of Medical Oncology, CRO Aviano National Cancer Institute IRCCS Aviano, Italy
| | - Alberto Bottacin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova Padova, Italy
| | - Pierfrancesco Palego
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova Padova, Italy
| | - Barbara Sartini
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova Padova, Italy
| | - Ilaria Cosci
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova Padova, Italy
| | - Livio Finos
- Department of Statistical Sciences, University of Padova Padova, Italy
| | - Riccardo Selice
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova Padova, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova Padova, Italy
| | - Andrea Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of PadovaPadova, Italy; Istituto Oncologico Veneto - Istituto di Ricovero e Cura a Carattere ScientificoPadova, Italy
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Aminimoghaddam S, Mohseni I, Afzalzadeh A, Esmaeeli S. Ovarian Malignant Mixed Germ Cell Tumor: A Case of Unusual Presentation as Molar Pregnancy. J Reprod Infertil 2016; 17:133-6. [PMID: 27141469 PMCID: PMC4842235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This research was conducted to introduce a patient with rare ovarian mixed germ cell tumor, presented as molar pregnancy. CASE PRESENTATION The patient was a 16 year old woman admitted with diagnosis of molar pregnancy. Abdominal enlargement was the only complaint. She had a large pelvic mass in physical examination. The first diagnosis was molar pregnancy due to previous ultrasonic reports and positive βeta HCG. Urine pregnancy test was positive. As suction curettage was performed for her, surprisingly, the size of uterus was normal and no molar tissue was found in pathologic examination. At intraoperative ultrasound exam, an extra-uterine heterogeneous mass was found. Extra-uterine mass was confirmed by CT and MRI done after suction curettage. Mixed germ cell tumor was confirmed by histological examination after laparatomy and removing tumoral mass. Finally, she received Bleomycin, Etoposide and Cisplatin (BEP) regimen in four courses and Vincristine, Actinomycin D (Dactinomycin) and Cyclophosphamide (VAC) regimen in two courses and Diphereline for saving the other ovary. CONCLUSION Some young patients misinterpret the early symptoms of an ovarian neoplasm as those of pregnancy which can lead to a delay in the diagnosis.
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Affiliation(s)
- Soheila Aminimoghaddam
- Corresponding Author: Soheila Aminimoghadam, Gynecology Oncology Department, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran, E-mail:
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Boer H, Proost JH, Nuver J, Bunskoek S, Gietema JQ, Geubels BM, Altena R, Zwart N, Oosting SF, Vonk JM, Lefrandt JD, Uges DRA, Meijer C, de Vries EGE, Gietema JA. Long-term exposure to circulating platinum is associated with late effects of treatment in testicular cancer survivors. Ann Oncol 2015; 26:2305-10. [PMID: 26347114 PMCID: PMC4621032 DOI: 10.1093/annonc/mdv369] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/28/2015] [Indexed: 11/17/2022] Open
Abstract
Cisplatin is an essential part of testicular cancer treatment. We investigated whether long-term exposure to circulating platinum (Pt) plays a role in the development of late effects in survivors. We assessed Pt decay in samples collected 1–13 years after chemotherapy. Renal function is a strong determinant of exposure to Pt. Higher exposure to Pt is associated with an increased prevalence of adverse effects hypogonadism and hypertension. Background The success of cisplatin-based (Platinol, Bristol-Myers Squibb Company, New York, NY, USA) chemotherapy for testicular cancer comes at the price of long-term and late effects related to healthy tissue damage. We assessed and modelled serum platinum (Pt) decay after chemotherapy and determined relationships between long-term circulating Pt levels and known late effects. Patients and methods In 99 testicular cancer survivors, treated with cisplatin-based chemotherapy, serum and 24-h urine samples were collected during follow-up (1–13 years after treatment). To build a population pharmacokinetic model, measured Pt data were simultaneously analysed, together with cisplatin dose, age, weight and height using the NONMEM software. Based on this model, area under the curve between 1 and 3 years after treatment (Pt AUC1–3 years) was calculated for each patient. Predicted long-term Pt exposure was related to renal function and to late effects of treatment assessed median 9 (3–15) years after chemotherapy. Results Decay of Pt was best described by a two-compartment model. Mean terminal T1/2 was 3.7 (range 2.5–5.2) years. Pt AUC1–3 years correlated with cumulative cisplatin dose, and creatinine clearance before and 1 year after treatment. Patients with paraesthesia had higher Pt AUC1–3 years (30.9 versus 27.0 µg/l month) compared with those without paraesthesia (P = 0.021). Patients with hypogonadism, elevated LDL-cholesterol levels or hypertension also had higher Pt AUC1–3 years. Conclusions Renal function before and after cisplatin treatment is an important determinant of long-term Pt exposure. Known long-term effects of testicular cancer treatment, such as paraesthesia, hypogonadism, hypercholesterolaemia and hypertension, are associated with long-term circulating Pt exposure.
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Affiliation(s)
- H Boer
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J H Proost
- Department of Hospital Pharmacy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J Nuver
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - S Bunskoek
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J Q Gietema
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B M Geubels
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R Altena
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - N Zwart
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - S F Oosting
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J M Vonk
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J D Lefrandt
- Department of Vascular Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - D R A Uges
- Department of Hospital Pharmacy, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - C Meijer
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J A Gietema
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Lauritsen J, Mortensen MS, Kier MGG, Christensen IJ, Agerbaek M, Gupta R, Daugaard G. Renal impairment and late toxicity in germ-cell cancer survivors. Ann Oncol 2015; 26:173-178. [PMID: 25361985 DOI: 10.1093/annonc/mdu506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment with bleomycin-etoposide-cisplatin (BEP) impairs renal function and increases the risk of late cardiovascular disease (CVD) and death. We investigated the influence of BEP on glomerular filtration rate (GFR) and assessed the importance of GFR changes on CVD and death in a large cohort of germ-cell cancer survivors. PATIENTS AND METHODS BEP-treated patients (N = 1206) were identified in the Danish DaTeCa database, and merged with national registers to identify late toxicity. GFR were measured (51Cr-EDTA clearance) before and after treatment and at 1, 3 and 5-year follow-up. The influence of BEP on GFR was evaluated with a linear mixed model. Risk factors for late toxicity were identified by a landmark analysis adjusting for covariates. The cohort was compared with the background population with standardized hospitalization/mortality rates. RESULTS GFR changed (ΔGFR) -11.3%, -15.4% and -25.9% after three, four and five+ cycles of BEP. For patients with impaired renal function before treatment the changes were 4.3%, 0.0% and -12.8%, respectively. During follow-up a significant rebound of GFR was documented. Compared with the background population, all patients, irrespective of renal function, had an increased risk of CVD and death. This risk depended on chronic kidney disease stage before treatment but not after treatment. ΔGFR had no influence on risk of late toxicity [death: hazard ratio (HR) 1.06, P = 0.50; CVD: HR 0.97, P = 0.61]. CONCLUSIONS Renal function after BEP is closely related to number of cycles, but the changes in GFR are partly reversible and have no impact on risk of CVD or death.
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Affiliation(s)
- J Lauritsen
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen.
| | - M S Mortensen
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - M G G Kier
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - I J Christensen
- Finsen Laboratory, Rigshospitalet and Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen Biocenter, Copenhagen
| | - M Agerbaek
- Department of Oncology, Aarhus University Hospital, Aarhus
| | - R Gupta
- Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Kongens Lyngby, Denmark
| | - G Daugaard
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen
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Sarma D, Barua SK, Rajeev TP, Baruah SJ. Role of primary chemotherapy in management of large tumors of undescended testis: Our experience. Urol Ann 2013; 5:179-82. [PMID: 24049381 PMCID: PMC3764899 DOI: 10.4103/0974-7796.115742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 06/12/2012] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to share our experience with tumors of undescended testis (UDT) and to assess the impact of primary cisplatin-based chemotherapy on such tumors. MATERIALS AND METHODS This study included the cases of tumor in UDT from February 2005 to December 2011. Evaluation of the cases was done with proper clinical examination and laboratory investigations along with tumor markers (alfa-feto protein, beta-human chorionic gonadotropin, lactate dehydrogenase) and contrast-enhanced computed tomography abdomen. Fine needle aspiration cytologywas done in all cases. Primary chemotherapy with three cycles of bleomycin, etoposide, and cisplatin regimen at three weekly intervals started in all cases. Response to treatment was seen after four weeks of the third cycle. RESULTS Fourteen cases (12.5%) of germ cell tumor in UDT out of 112 cases of germ cell tumor of the testis were included. The age ranged from 16-60 years. Histological diagnosis was pure seminoma in all cases. After three cycles of BEP regime, complete response was seen in 11 cases and partial response in three cases where the residual tumor was excised along with retroperitoneal lymph node dissection RPLND. Of the 14 cases, 13 were in regular follow-up and one was lost to follow-up. All on follow-up were doing well without recurrence till now. CONCLUSION Surgical removal of the primary tumor in UDT with or without bulky metastasis is complicated. Primary chemotherapy with cisplatin-based regimen is a good option in such cases.
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Affiliation(s)
- Debanga Sarma
- Department of Urology, Gauhati Medical College, Bhangagarh, Guwahati, Assam, India
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Lerma-Cabrera JM, Carvajal F, Alcaraz-Iborra M, de la Fuente L, Navarro M, Thiele TE, Cubero I. Adolescent binge-like ethanol exposure reduces basal α-MSH expression in the hypothalamus and the amygdala of adult rats. Pharmacol Biochem Behav 2013; 110:66-74. [PMID: 23792540 DOI: 10.1016/j.pbb.2013.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 06/03/2013] [Accepted: 06/09/2013] [Indexed: 01/31/2023]
Abstract
Melanocortins (MC) are central peptides that have been implicated in the modulation of ethanol consumption. There is experimental evidence that chronic ethanol exposure reduces α-MSH expression in the limbic and hypothalamic brain regions and alters central pro-opiomelanocortin (POMC) mRNA activity in adult rats. Adolescence is a critical developmental period of high vulnerability in which ethanol exposure alters corticotropin releasing factor, neuropeptide Y, substance P and neurokinin neuropeptide activities, all of which have key roles in ethanol consumption. Given the involvement of MC and the endogenous inverse agonist AgRP in ethanol drinking, here we evaluate whether a binge-like pattern of ethanol treatment during adolescence has a relevant impact on basal and/or ethanol-stimulated α-MSH and AgRP activities during adulthood. To this end, adolescent Sprague-Dawley rats (beginning at PND25) were pre-treated with either saline (SP group) or binge-like ethanol exposure (BEP group; 3.0 g/kg given in intraperitoneal (i.p.) injections) of one injection per day over two consecutive days, followed by 2 days without injections, repeated for a total of 8 injections. Following 25 ethanol-free days, we evaluated α-MSH and AgRP immunoreactivity (IR) in the limbic and hypothalamic nuclei of adult rats (PND63) in response to ethanol (1.5 or 3.0 g/kgi.p.) and saline. We found that binge-like ethanol exposure during adolescence significantly reduced basal α-MSH IR in the central nucleus of the amygdala (CeA), the arcuate nucleus (Arc) and the paraventricular nucleus of the hypothalamus (PVN) during adulthood. Additionally, acute ethanol elicited AgRP IR in the Arc. Rats given the adolescent ethanol treatment required higher doses of ethanol than saline-treated rats to express AgRP. In light of previous evidence that endogenous MC and AgRP regulate ethanol intake through MC-receptor signaling, we speculate that the α-MSH and AgRP disturbances induced by binge-like ethanol exposure during adolescence may contribute to excessive ethanol consumption during adulthood.
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