1
|
Beati F, Persano G, De Pasquale MD, Martucci C, Madafferi S, Miele E, Stracuzzi A, Di Paolo PL, Natali GL, Alaggio R, Crocoli A, Inserra A. Growing teratoma syndrome in children and adolescents: Prevalence and surgical outcome. Pediatr Blood Cancer 2024:e31126. [PMID: 38837659 DOI: 10.1002/pbc.31126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Patients affected by metastatic germ cell tumors may occasionally experience enlargement of masses with concurrent normalization of tumor markers during or after chemotherapy. This phenomenon is described as growing teratoma syndrome (GTS). The aim of the pre sent study is to assess the prevalence of GTS in the pediatric population and its implications in terms of surgical outcome. PATIENTS AND METHODS The clinical notes of patients diagnosed with stage III and IV malignant germ cell tumors from January 2010 until December 2020 at our Institution were retrospectively reviewed. The prevalence of GTS, treatment strategies, survival, and outcome were analyzed. RESULTS Thirty-three patients with high-stage malignant germ cell tumors were diagnosed in our institution in the analyzed period. Nine patients (28%) had radiologic evidence of enlargement of persistent masses with normal markers after chemotherapy; these patients were classified as GTS patients. All nine patients underwent resection of metastatic lymph nodes, and six had surgery on visceral metastases. In six patients, radical excision of all metastatic sites was achieved; five patients are alive and in complete remission, while one died because of peri-operative complications. Out of the three patients who could not achieve radical excision of the metastases, two died of progressive disease, and one is alive with progressive disease. CONCLUSIONS Patients affected by GTS have a risk of progression of chemotherapy-resistant disease and death. Radical surgical excision is essential to achieve disease control and long-term survival.
Collapse
Affiliation(s)
- Federico Beati
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giorgio Persano
- Surgical Oncology - General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maria Debora De Pasquale
- Onco-Hematology Unit, Department of Onco-Hematology and Gene Therapy, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Cristina Martucci
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Silvia Madafferi
- Surgical Oncology - General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Evelina Miele
- Onco-Hematology Unit, Department of Onco-Hematology and Gene Therapy, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandra Stracuzzi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Pier Luigi Di Paolo
- Radiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Gian Luigi Natali
- Radiology Unit, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology - General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Inserra
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| |
Collapse
|
2
|
Liang C, Sekler J, Gückel B, Pfannenberg C, Dittmann H, Seith F, Amend B, Nikolaou K, Reinert CP. How [18F]-FDG-PET/CT Affects Clinical Management of Patients with Germ Cell Tumors in the Real World. Cancers (Basel) 2023; 15:3652. [PMID: 37509313 PMCID: PMC10377569 DOI: 10.3390/cancers15143652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of PET/CT on clinical management of patients with germ cell tumors (GCTs) conducted in a real-world setting, including avoidance of invasive procedures, additional diagnostic imaging, and changes in treatment. METHODS Patients with GCTs were prospectively enrolled into a PET/CT registry study between May 2013 and April 2021. Intended patient management prior and after PET/CT was documented using standardized questionnaires. Changes in oncologic staging and clinical management after PET/CT were recorded, including planned treatment and planned additional diagnostics. RESULTS Forty-three male patients with GCTs were included consecutively in this study. After PET/CT, oncologic staging changed in 22/43 patients (51%), with upstaging in seven cases (16%), downstaging in ten cases (23%), and cancer relapse in five cases (11%). The number of patients with intended curative treatment remained stable, while a considerable change in intended therapeutic intervention was noted after PET/CT, with an increase in planned chemotherapy from three to eleven patients and a decrease in planned surgical resection from eleven to two patients. In addition, PET/CT contributed to preventing patients from intended invasive procedures including biopsy and surgery in 8/43 (19%) cases and from additional diagnostic procedures in 25 (58%) cases. CONCLUSION With the use of FDG-PET/CT as a tool to guide patient management in GCTs, we observed a notable impact on clinical staging and a consequent reduction in the need for additional invasive and diagnostic procedures. These findings are expected to be even more consequential in the future as treatment modalities improve and the life expectancy of GCT patients further increases. KEY POINTS PET/CT considerably influences the clinical stage of GCT patients. PET/CT has remarkable influence on the choice of therapeutic interventions and reduces additional diagnostic procedures.
Collapse
Affiliation(s)
- Cecilia Liang
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Julia Sekler
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tübingen, Germany
| | - Brigitte Gückel
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tübingen, Germany
| | - Christina Pfannenberg
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Helmut Dittmann
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tübingen, Germany
| | - Ferdinand Seith
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Bastian Amend
- Department of Urology, Tübingen University Hospital, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, 72076 Tübingen, Germany
| | - Christian Philipp Reinert
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| |
Collapse
|
3
|
Conduit C, Hong W, Martin F, Thomas B, Lawrentschuk N, Goad J, Grimison P, Ahmadi N, Tran B, Lewin J. A meta-analysis of clinicopathologic features that predict necrosis or fibrosis at post-chemotherapy retroperitoneal lymph node dissection in individuals receiving treatment for non-seminoma germ cell tumours. Front Oncol 2022; 12:931509. [PMID: 36059636 PMCID: PMC9428700 DOI: 10.3389/fonc.2022.931509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Post-chemotherapy retroperitoneal lymph node dissection (pcRPLND) for residual nodal masses is a critical component of care in metastatic testicular germ cell tumour (GCT). However, the procedure is not of therapeutic value in up to 50% of individuals in whom histopathology demonstrates post-treatment necrosis or fibrosis alone. Improved diagnostic tools and clinicopathologic features are needed to separate individuals who benefit from pcRPLND and avoid surgery in those who do not. Methods A prospectively registered meta-analysis of studies reporting clinicopathologic features associated with teratoma, GCT and/or necrosis/fibrosis at pcRPLND for metastatic non-seminoma GCT (NSGCT) was undertaken. We examined the effect of various clinicopathologic factors on the finding of necrosis/fibrosis at pcRPLND. The log odds ratios (ORs) of each association were pooled using random-effects models. Results Using the initial search strategy, 4,178 potentially eligible abstracts were identified. We included studies providing OR relating to clinicopathologic factors predicting pcRPLND histopathology, or where individual patient-level data were available to permit the calculation of OR. A total of 31 studies evaluating pcRPLND histopathology in 3,390 patients were eligible for inclusion, including two identified through hand-searching the reference lists of eligible studies. The following were associated with the presence of necrosis/fibrosis at pcRPLND: absence of teratomatous elements in orchidectomy (OR 3.45, 95% confidence interval [CI] 2.94-4.17); presence of seminomatous elements at orchidectomy (OR 2.71, 95% CI 1.37-5.37); normal pre-chemotherapy serum bHCG (OR 1.96, 95% CI 1.62-2.36); normal AFP (OR 3.22, 95% CI 2.49–4.15); elevated LDH (OR 1.72, 95% CI 1.37-2.17); >50% change in mass during chemotherapy (OR 4.84, 95% CI 3.94-5.94); and smaller residual mass size (<2 cm versus >2 cm: OR 3.93, 95% CI 3.23-4.77; <5 cm versus >5 cm: OR 4.13, 95% CI 3.26-5.23). Conclusions In this meta-analysis, clinicopathologic features helped predict the presence of pcRPLND necrosis/fibrosis. Collaboration between centres that provide individual patient-level data is required to develop and validate clinical models and inform routine care to direct pcRPLND to individuals most likely to derive benefits. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021279699
Collapse
Affiliation(s)
- Ciara Conduit
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Wei Hong
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Felicity Martin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Benjamin Thomas
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jeremy Goad
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Peter Grimison
- Department of Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Nariman Ahmadi
- Department of Urology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jeremy Lewin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- ONTrac at Peter Mac, Victorian Adolescence and Young Adult Cancer Service, Melbourne, VIC, Australia
- *Correspondence: Jeremy Lewin,
| |
Collapse
|
4
|
Liu Y, Zhang Q, Li J, Guo L, Wang L, Sun Q, Liu N. Laparoscopic resection of giant retroperitoneal mature cystic teratoma with diaphragm invasion in a 3-month-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
5
|
Ruf CG, Krampe S, Matthies C, Anheuser P, Nestler T, Simon J, Isbarn H, Dieckmann KP. Major complications of post-chemotherapy retroperitoneal lymph node dissection in a contemporary cohort of patients with testicular cancer and a review of the literature. World J Surg Oncol 2020; 18:253. [PMID: 32972425 PMCID: PMC7517823 DOI: 10.1186/s12957-020-02032-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background Post-chemotherapy retroperitoneal lymph node dissection (pc-RPLND) is one cornerstone in the clinical management of patients with nonseminomatous testicular germ cell tumours (GCT). A wide range of complication rates in this type of surgery is reported so far. We retrospectively evaluated the frequency of major complications by using the Clavien-Dindo classification and analysed the influence of various clinical factors on complication rates in pc-RPLND. Methods We retrospectively analysed 146 GCT patients undergoing pc-RPLND. Complications of grade III–V according to the Clavien-Dindo classification occurring within 30 days after surgery were registered along with the following clinical factors: age, body mass index (BMI), duration of surgery, number of anatomic fields resected, side of primary tumour, histology of surgical specimen, histology of primary tumour, and total dose of cisplatin applied prior to surgery. For comparison, we also evaluated 35 chemotherapy-naïve patients with primary RPLND and 19 with laparoscopic RPLND. We analysed types and frequencies of the various complications as well as associations with clinical factors using descriptive statistical methods. Results A total of 14.4% grade III–IV complications were observed in pc-RPLND, and 8.6% and 5.3% in primary and in laparoscopic RPLND, respectively. There was no perioperative mortality. Lymphocele was the most frequent adverse event (16% of grade III–IV complications). Operation time > 270 min (p = 0.001) and vital cancer in the resected specimen (p = 0.02) were significantly associated with higher complication rates. Left-sided resection fields involved two-fold higher complication rates, barely missing statistical significance (p = 0.06). Conclusions Pc-RPLND involves a grade III–V complication rate of 14.4%. Prolonged operation time and vital cancer in the residual mass are significantly associated with higher complication rates. The Clavien-Dindo classification system may allow inter-observer variation in rating complication grades, which may represent one reason for the wide range of reported RPLND complication rates. RPLND represents major surgery and surgeons active in this field must be competent to manage adverse events.
Collapse
Affiliation(s)
- Christian Guido Ruf
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Germany.,Department of Urology, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Simon Krampe
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Germany
| | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Germany
| | - Petra Anheuser
- Department of Urology, Albertinen Krankenhaus Hamburg, Suentelstrasse 11a, 22457, Hamburg, Germany
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Jörg Simon
- Department of Urology, Ortenau-Klinikum, Ebertplatz 12, 77654, Offenburg, Germany
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Klaus Peter Dieckmann
- Department of Urology, Albertinen Krankenhaus Hamburg, Suentelstrasse 11a, 22457, Hamburg, Germany. .,Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany.
| |
Collapse
|
6
|
Justo I, Rodríguez-Gil Y, Villar R, Kadaoui SD, Rodríguez de la Calle J. Pancreas Sparing Duodenectomy for the Treatment of Mature Teratoma Infiltrating Duodenum. Cir Esp 2020; 99:392-394. [PMID: 32600644 DOI: 10.1016/j.ciresp.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/10/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Iago Justo
- Servicio de Cirugía General, Hospital Universitario Doce de Octubre, Madrid, España.
| | - Yolanda Rodríguez-Gil
- Servicio de Anatomía Patológica, Hospital Universitario Doce de Octubre, Madrid, España
| | - Roberto Villar
- Servicio de Radiodiagnóstico, Hospital Universitario Doce de Octubre, Madrid, España
| | - Salah-Din Kadaoui
- Servicio de Anestesia y Reanimación, Hospital Universitario Doce de Octubre, Madrid, España
| | | |
Collapse
|
7
|
Blok JM, Meijer RP, van der Poel HG, Bex A, van Vooren J, van Urk JJ, Horenblas S, Bosch JLHR. Additional surgical procedures and perioperative morbidity in post-chemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer in two intermediate volume hospitals. World J Urol 2020; 39:839-846. [PMID: 32372160 PMCID: PMC7969692 DOI: 10.1007/s00345-020-03229-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the perioperative morbidity of PC-RPLND in two intermediate volume centers and to identify predictors of high morbidity. Methods Retrospective analysis of 124 patients treated with open PC-RPLND at two tertiary referral centers between 2001 and 2018. Perioperative morbidity was determined by analyzing additional surgical procedures, intra-operative blood loss, and postoperative complications. Results An additional procedure was necessary for 33 patients (26.6%). The risk was higher in patients with IGCCCG intermediate/poor prognosis (OR 3.56; 95% CI 1.33–9.52) and residual tumor size > 5 cm (OR 3.53; 95% CI 1.39–8.93). Blood loss was higher in patients with IGCCCG intermediate/poor prognosis (β = 0.177; p = 0.029), large residual tumor (β = 0.570; p < 0.001), an additional intervention (β = 0.342; p < 0.001) and teratoma on retroperitoneal histology (β = − 0.19; p = 0.014). Thirty-one patients had a postoperative complication Clavien-Dindo Grade ≥ 2 (25.0%). Complication risk was highest in patients undergoing an additional intervention (OR 3.46; 95% CI 1.03–11.60; p = 0.044). Conclusions The rate of additional interventions in our series is comparable to what has been reported in high-volume centers. IGCCCG intermediate/poor prognosis patients with high-volume disease and patients undergoing an additional surgical procedure can be classified as high-risk patients. Electronic supplementary material The online version of this article (10.1007/s00345-020-03229-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Joost M Blok
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeanette van Vooren
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Japke J van Urk
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J L H Ruud Bosch
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
8
|
Diagnosis and management of the growing teratoma syndrome: A single-center experience and review of the literature. Urol Oncol 2018; 36:529.e23-529.e30. [PMID: 30446456 DOI: 10.1016/j.urolonc.2018.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/06/2018] [Accepted: 09/22/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the diagnostic, surgical as well as oncological outcome of patients with a growing teratoma syndrome. MATERIAL AND METHODS We performed a retrospective analysis including 680 patients with advanced nonseminomatous germ cell tumors who underwent a postchemotherapy retroperitoneal lymph node dissection. The peri- and postoperative outcome of 22 patients (3%) that fulfilled the criteria of a growing teratoma syndrome were analyzed: nonseminomatous germ cell tumors with increasing tumor size during or after chemotherapy despite normalized or decreasing tumor markers. RESULTS The median tumor diameter at time of surgery was 6 cm (4-12.2). For a complete resection of the residual masses, adjunctive surgery had to be performed in 4 (18%) patients: resection of the abdominal aorta, inferior vena cava or renal vein with graft replacement, nephrectomy and resection of parts of the intestine. Eight postoperative complications occurred in 5 (23%) patients, with 4/8 of these complications affecting only one patient. Fifty percent of all complications were classified as Clavien-Dindo grade III or IV. After a median follow-up of 25 months, relapse occurred in 2 patients (9%); all but one patient is alive resulting in an overall survival of 95.5%. CONCLUSIONS The growing teratoma syndrome is a rare phenomenon among patients with advanced nonseminomatous germ cell tumors and necessitates complete surgical resection of the masses with curative intention. Due to its complexity and potential adjunctive surgery, the treatment should be performed in tertiary referral centers only.
Collapse
|
9
|
Michalski W, Jonska-Gmyrek J, Poniatowska G, Kucharz J, Stelmasiak P, Nietupski K, Sadowska M, Demkow T, Wiechno P. Testicular teratomas: a growing problem? Med Oncol 2018; 35:153. [PMID: 30367327 DOI: 10.1007/s12032-018-1215-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/24/2018] [Indexed: 01/05/2023]
Abstract
Testicular teratomas represent a specific entity within the group of germ-cell tumours. They may comprise elements of all three germ layers. In contrast to prepubertal benign teratomas observed in infants and adolescents, postpubertal teratomas originate from the malignant germ-cell precursor. Given the good prognosis and curability of most patients with germ-cell tumour, medical oncologists and urological surgeons must be well acquainted with the principles of teratomas management. Surgery plays the decisive part in teratomas treatment, as these tumours are resistant to radio- and, to some extent, chemotherapy. In this article we concentrate on the management of post-chemotherapy resection of teratomatous masses, with special attention to the phenomenon of 'growing teratoma syndrome' and somatic-type transformation of teratomas. To understand the nature of teratomas better, we begin with a glimpse of their biological, molecular and immunohistochemical features. Managing germ-cell tumours, teratomas in particular, in high-volume reference centres is of utmost importance to maintain and increase the survivorship rate in these patients.
Collapse
Affiliation(s)
- Wojciech Michalski
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Joanna Jonska-Gmyrek
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Grazyna Poniatowska
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Jakub Kucharz
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland.
| | - Pawel Stelmasiak
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Karol Nietupski
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Malgorzata Sadowska
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Tomasz Demkow
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Pawel Wiechno
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| |
Collapse
|
10
|
Heidenreich A, Paffenholz P, Haidl F, Pfister D. [When is surgical resection of metastases in testicular germ cell tumors indicated and is there a scientific basis?]. Urologe A 2018; 56:627-636. [PMID: 28432399 DOI: 10.1007/s00120-017-0385-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Surgical resection of metastases represents an integral part of curative management in patients with testicular germ cell tumors (GCT). Primary nerve-sparing retroperitoneal lymph node dissection (nsRPLND) for low volume metastases in clinical stages I-IIB has to be differentiated from the more complex and more extensive postchemotherapeutic procedures. In Europe, primary nerve-sparing retroperitoneal lymph node dissection (nsRPLND) for clinical stage I nonseminomatous GCT (NSGCT) plays a subordinate. In clinical stage IIA/B, nsRPLND is indicated for patients with marker-negative metastases in whom cure rates of about 65% can be achieved with surgery alone. For clinical stage IIA/B seminomas, nsRPLND represents an individual, still experimental procedure with high cure rates. Postchemotherapy residual tumor resection (pRTR) for advanced seminomas is only indicated in the context of a FDG-PET/CT-positive residual mass >3 cm in diameter. For NSGCT, pRTR is indicated in patients with residual masses >1 cm and negative or plateauing tumor markers to resect persisting teratoma or vital cancer. Complete resection of all masses including resection of adjacent vascular, visceral or skeletal metastases is mandatory to achieving the highest cure rate possible. Due to the complexity and the lower rate of significant morbidity and mortality, these procedures should be done at tertiary referral centers.
Collapse
Affiliation(s)
- A Heidenreich
- Klinik für Urologie, Uro - Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - P Paffenholz
- Klinik für Urologie, Uro - Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - F Haidl
- Klinik für Urologie, Uro - Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - D Pfister
- Klinik für Urologie, Uro - Onkologie, Roboter-assistierte und Spezielle Urologische Chirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| |
Collapse
|
11
|
Wei Z, Ye X, Yang X, Zheng A, Huang G, Dong S, Li W, Wang J, Han X, Meng M, Ni Y. The efficacy and safety of microwave ablation in patients with retroperitoneal metastases. Int J Hyperthermia 2017; 34:1053-1060. [PMID: 29082799 DOI: 10.1080/02656736.2017.1390788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Retroperitoneal metastases are common, and most present with symptoms; however, treatments for this condition are limited. This retrospective study verified the efficacy and safety of microwave ablation (MWA) in retroperitoneal metastases patients. METHODS Patients with pathologically confirmed malignant carcinoma and imaging showing retroperitoneal metastases were enrolled and underwent MWA. The end-points included objective response rate, time to local progression (TTLP), overall survival, visual analogue scale (VAS) score, dose of morphine pre- and post-ablation and complications. RESULTS Twenty-three patients were enrolled. The mean tumour diameter was 3.6 cm. Altogether, 29 tumour sites in 23 patients were ablated during 23 procedures; technical success was achieved in all 23 patients. The objective response and disease control rates were 95.7% and 100.0%, respectively. The mean TTLP and median OS were 22.8 months (95% CI: 16.1-29.6 months) and 10.6 months (95% CI: 7.4-13.8 months), respectively. In 13 patients with symptoms, the VAS values before ablation and 48 h, 1 month, 2 months, 3 months and 6 months after ablation were 5.38, 2.77 (p = 0.015), 2.15 (p = 0.001), 2.17 (p = 0.001), 1.40 (p = 0.000) and 1.71 (p = 0.006), respectively. The corresponding morphine doses were 76.9 mg, 70.7 mg (p = 0.584), 50.7 mg (p = 0.031), 55.0 mg (p = 0.097), 46.0 mg (p = 0.057) and 40.0 mg (p = 0.363), respectively. No ablation-associated mortality was observed. Major complications, minor complications and adverse events were observed in eight (34.8%), five (21.7%) and four (17.4%) patients, respectively. CONCLUSION MWA for the treatment of retroperitoneal metastases was effective and the complications were common.
Collapse
Affiliation(s)
- Zhigang Wei
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Xin Ye
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Xia Yang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Aimin Zheng
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Guanghui Huang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Shenming Dong
- b Department of Oncology , Pingyuan People's Hospital , Shandong Province , China
| | - Wenhong Li
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Jiao Wang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Xiaoying Han
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Min Meng
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| | - Yang Ni
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Shandong Province , China
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW In the present review, we summarize the recent developments in the management of germ cell tumors (GCTs). RECENT FINDINGS Treatment-related acute and late-onset toxicity remains a key challenge in the management of GCTs. Recent data show that patients with large retroperitoneal lymph node metastases are at increased risk of venous thromboembolism and may benefit from prophylactic anticoagulation. Predictive models have been developed to identify patients with residual retroperitoneal lymph node masses who are more likely to benefit from surgical resection. However, their clinical use remains hampered by relatively low accuracy. There are currently multiple conventional-dose chemotherapy (CDCT) options for salvage therapy in patients with refractory or recurrent disease. In addition, more efficacious high-dose chemotherapy (HDCT) regimens continue to be developed. The role of salvage CDCT versus HDCT is currently being prospectively investigated.Finally, intratumoral heterogeneity is a common finding in cancer and an obvious observation in GCTs. Despite intratumoral heterogeneity, recent studies on nonseminomatous GCT have identified distinct histological subgroups and a potentially lethal clinical phenotype. Importantly, comprehensive molecular profiling so far has not elucidated the biologic basis or the clinical underpinnings of intratumoral heterogeneity in GCTs. SUMMARY Remaining challenges to be addressed include minimizing therapeutic toxicity and improving outcomes in patients with refractory/recurrent GCTs or malignant transformation of teratomas.
Collapse
|