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Hendricks M, Cois A, Geel J, du Plessis J, Bassingthwaighte M, Naidu G, Rowe B, Büchner A, Omar F, Thomas K, Uys R, van Zyl A, van Heerden J, Mahlachana N, Vermeulen J, Davidson A, Frazier AL, Donald K, Kruger M. Malignant extracranial germ cell tumours: A first national report by the South African Children's Cancer Study Group. Pediatr Blood Cancer 2022; 69:e29543. [PMID: 34971072 DOI: 10.1002/pbc.29543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the overall survival (OS) and prognostic factors influencing outcomes in children and adolescents with malignant extracranial germ cell tumours (MEGCTs) in preparation for the development of a harmonised national treatment protocol. METHODS A retrospective folder review was undertaken at nine South African paediatric oncology units to document patient profiles, tumour and treatment-related data and outcomes for all children with biopsy-proven MEGCTs from birth up to and including 16 years of age. RESULTS Between 1 January 2000 and 31 December 2015, 218 patients were diagnosed with MEGCTs. Female sex (hazard ratio [HR] 0.284, p = .037) and higher socio-economic status (SES) (HR 0.071, p = .039) were associated with a significantly lower risk of death. Advanced clinical stage at diagnosis significantly affected 5-year OS: stage I: 96%; stage II: 94.3%; stage III: 75.5% (p = .017) and stage IV (60.1%; p < .001). There was a significant association between earlier stage at presentation and higher SES (p = .03). Patients with a serum alpha-fetoprotein (AFP) level of more than 33,000 ng/ml at diagnosis had significantly poorer outcomes (p = .002). The use of chemotherapy significantly improved survival, irrespective of the regimen used (p < .001). CONCLUSIONS The cohort demonstrated a 5-year OS of 80.3% with an event-free survival (EFS) of 75.3%. Stage, the use of chemotherapy and an elevated serum AFP level of more than 33,000 ng/ml were independently predictive of outcome. The relationship between SES and outcome is important as the implementation of the new national protocol hopes to standardise care across the socio-economic divide.
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Affiliation(s)
- Marc Hendricks
- Haematology Oncology Service, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Annibale Cois
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Geel
- Division of Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Johan du Plessis
- Division of Paediatric Haematology Oncology, Department of Paediatrics, Universitas Hospital, University of the Free State, Bloemfontein, South Africa
| | - Mairi Bassingthwaighte
- Division of Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Soweto, South Africa
| | - Gita Naidu
- Division of Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Soweto, South Africa
| | - Biance Rowe
- Division of Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Soweto, South Africa
| | - Ané Büchner
- Paediatric Haematology Oncology, Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Tshwane, South Africa
| | - Fareed Omar
- Paediatric Haematology Oncology, Department of Paediatrics, Steve Biko Academic Hospital, University of Pretoria, Tshwane, South Africa
| | - Karla Thomas
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Frere Hospital, East London, South Africa
| | - Ronelle Uys
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Anel van Zyl
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Jaques van Heerden
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Ngoakoana Mahlachana
- Division of Paediatric Haematology Oncology, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Soweto, South Africa
| | - Johani Vermeulen
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Port Elizabeth Provincial Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - Alan Davidson
- Haematology Oncology Service, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - A Lindsay Frazier
- Paediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorder Centre, Harvard University, Boston, Massachusetts, USA
| | - Kirsty Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mariana Kruger
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
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Murthy V, Karmakar S, Carlton J, Joshi A, Krishnatry R, Prabhash K, Noronha V, Bakshi G, Prakash G, Pal M, Menon S, Agrawal A, Rangarajan V. Radiotherapy for Post-Chemotherapy Residual Mass in Advanced Seminoma: A Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography-Based Risk-adapted Approach. Clin Oncol (R Coll Radiol) 2021; 33:e315-e321. [PMID: 33608206 DOI: 10.1016/j.clon.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 01/07/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
AIMS There is a lack of consensus regarding the management of post-chemotherapy residual mass in classical seminoma. The use of fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) may aid the detection of residual masses harbouring viable disease and help to tailor therapy. The aim of this study was to evaluate if PET-CT could identify patients who will benefit from locoregional radiotherapy. MATERIALS AND METHODS This ethics-approved study included patients with advanced classical seminoma primarily treated with standard platinum-based first-line chemotherapy. Patients were either observed or given adjuvant radiotherapy based on the clinician's preference and followed up. For this study, patients were stratified into two groups based on FDG PET-CT residual nodal maximum standardised uptake value (SUVmax): low risk (SUVmax <3) and high risk (SUVmax ≥3). Further subgroup analysis was carried out for patients with residual nodal size ≥3 cm and SUVmax ≥3, and this was considered as the very high risk group. The diagnostic accuracy of FDG PET-CT was assessed and survival was compared between the different groups. RESULTS Sixty-nine patients were included in the study: 48 patients were observed and 21 received radiotherapy. The low and high risk groups contained 50.7% and 49.3% of the patients, respectively. The very high risk subgroup had 24 patients. At a median follow-up of 44 months, locoregional failures in the radiotherapy and observation cohorts were 0% and 30% (P = 0.059) in the very high risk subgroup and 5.8% and 29.4% (P = 0.078) in the high risk group. The positive predictive value for the very high risk and high risk groups was 30% and 17.1%, respectively. The benefit of locoregional control failed to translate into overall survival benefit. CONCLUSION A tailored, FDG PET-based risk-adapted treatment approach can refine the management of post-chemotherapy residual masses in seminoma. In this study, with the largest cohort of advanced seminoma patients treated with radiotherapy reported to date, radiotherapy seems to benefit patients with post-chemotherapy residual mass SUVmax ≥3.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
| | - S Karmakar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - J Carlton
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - R Krishnatry
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - G Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - G Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - M Pal
- Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Menon
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, India
| | - A Agrawal
- Department of Bio-imaging, Tata Memorial Hospital, Parel, Mumbai, India
| | - V Rangarajan
- Department of Bio-imaging, Tata Memorial Hospital, Parel, Mumbai, India
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Murthy V, Johnny C, Huddart R. Positron Emission Tomography-Positive Post-Chemotherapy Seminoma Masses: Time to Reevaluate the Role of Radiotherapy? J Clin Oncol 2019; 37:937-938. [PMID: 30811289 DOI: 10.1200/jco.18.01991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vedang Murthy
- Vedang Murthy, MD, and Carlton Johnny, MBBS, Tata Memorial Centre, Mumbai, India; and Robert Huddart, PhD, Institute of Cancer Research and Royal Marsden Hospital NHS, London, United Kingdom
| | - Carlton Johnny
- Vedang Murthy, MD, and Carlton Johnny, MBBS, Tata Memorial Centre, Mumbai, India; and Robert Huddart, PhD, Institute of Cancer Research and Royal Marsden Hospital NHS, London, United Kingdom
| | - Robert Huddart
- Vedang Murthy, MD, and Carlton Johnny, MBBS, Tata Memorial Centre, Mumbai, India; and Robert Huddart, PhD, Institute of Cancer Research and Royal Marsden Hospital NHS, London, United Kingdom
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Cathomas R, Klingbiel D, Bernard B, Lorch A, Garcia Del Muro X, Morelli F, De Giorgi U, Fedyanin M, Oing C, Haugnes HS, Hentrich M, Fankhauser C, Gillessen S, Beyer J. Questioning the Value of Fluorodeoxyglucose Positron Emission Tomography for Residual Lesions After Chemotherapy for Metastatic Seminoma: Results of an International Global Germ Cell Cancer Group Registry. J Clin Oncol 2018; 36:JCO1800210. [PMID: 30285559 DOI: 10.1200/jco.18.00210] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Residual lesions after chemotherapy are frequent in metastatic seminoma. Watchful waiting is recommended for lesions < 3 cm as well as for fluorodeoxyglucose (FDG) positron emission tomography (PET)-negative lesions ≥ 3 cm. Information on the optimal management of PET-positive residual lesions ≥ 3 cm is lacking. PATIENTS AND METHODS We retrospectively identified 90 patients with metastatic seminoma with PET-positive residual lesions after chemotherapy. Patients with elevated α-fetoprotein or nonseminomatous histology were excluded. We analyzed the post-PET management and its impact on relapse and survival and calculated the positive predictive value (PPV) for PET. RESULTS Median follow-up time was 29 months (interquartile range [IQR], 10 to 62 months). Median diameter of the largest residual mass was 4.9 cm (range, 1.1 to 14 cm), with masses located in the retroperitoneum (77%), pelvis (16%), mediastinum (17%), and/or lung (3%). Median time from the last day of chemotherapy to PET was 6.9 weeks (IQR, 4.4 to 9.9 weeks). Post-PET management included repeated imaging in 51 patients (57%), resection in 26 patients (29%), biopsy in nine patients (10%) and radiotherapy in four patients (4%). Histology of the resected specimen was necrosis in 21 patients (81%) and vital seminoma in five patients (19%). No biopsy revealed vital seminoma. Relapse or progression occurred in 15 patients (17%) after a median of 3.7 months (IQR, 2.5 to 4.9 months) and was found in 11 (22%) of 51 patients on repeated imaging, in two (8%) of 26 patients after resection, and in two (22%) of nine patients after biopsy. All but one patient who experienced relapse were successfully treated with salvage therapy. The PPV for FDG-PET was 23%. CONCLUSION FDG-PET has a low PPV for vital tumor in residual lesions after chemotherapy in patients with metastatic seminoma. This cautions against clinical decisions based on PET positivity alone.
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Affiliation(s)
- Richard Cathomas
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Dirk Klingbiel
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Brandon Bernard
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Anja Lorch
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Xavier Garcia Del Muro
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Franco Morelli
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Ugo De Giorgi
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Mikhail Fedyanin
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Christoph Oing
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Hege Sagstuen Haugnes
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Marcus Hentrich
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Christian Fankhauser
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Silke Gillessen
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Jörg Beyer
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
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5
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Pak JS, Shapiro E, Margolskee EM, McKiernan JM. Hypermetabolic residual retroperitoneal mass after chemotherapy for primary seminoma. Urology 2015; 85:987-990. [PMID: 25769778 DOI: 10.1016/j.urology.2015.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 12/12/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Jamie Sungmin Pak
- Department of Urology, Columbia University Medical Center, New York, NY.
| | - Edan Shapiro
- Department of Urology, Columbia University Medical Center, New York, NY
| | | | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY
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6
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Pfister D, Porres D, Matveev V, Heidenreich A. Reduzierte Morbidität bei der Resektion von Residualtumoren nach Chemotherapie beim Seminom. Urologe A 2015; 54:1402-6. [DOI: 10.1007/s00120-014-3708-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Decoene J, Winter C, Albers P. False-positive fluorodeoxyglucose positron emission tomography results after chemotherapy in patients with metastatic seminoma. Urol Oncol 2015; 33:23.e15-23.e21. [DOI: 10.1016/j.urolonc.2014.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/16/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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8
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Jeong Y, Cheon J, Kim TO, Lim DH, Lee S, Cho YM, Hong JH, Lee JL. Conventional Cisplatin-Based Combination Chemotherapy Is Effective in the Treatment of Metastatic Spermatocytic Seminoma with Extensive Rhabdomyosarcomatous Transformation. Cancer Res Treat 2014; 47:931-6. [PMID: 25381827 PMCID: PMC4614201 DOI: 10.4143/crt.2014.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/15/2014] [Indexed: 11/21/2022] Open
Abstract
A 52-year-old man was presented with a huge left testicular mass and palpable cervical lymphadenopathy with retroperitoneal lymph node enlargement on an abdominal computed tomography. A left radical orchiectomy and an ultrasound-guided neck node biopsy were performed. A pathological examination revealed spermatocytic seminoma with extensive rhabdomyosarcomatous transformation, a condition known to be highly resistant to platinum-based chemotherapy. The patient received four cycles of etoposide, ifosfamide and cisplatin (VIP) chemotherapy. A repeat computed tomography revealed a substantial regression consistent with a partial response. Retroperitoneal lymph node dissection was attempted, which revealed rhabdomyosarcoma; however, complete microscopic resection was not achieved. After surgery, the residual abdominal lymph node progressed and salvage paclitaxel, ifosfamide and cisplatin (TIP) chemotherapy was employed, which again achieved a partial response. Here, we present a first case report of a spermatocytic seminoma with extensive rhabdomyosarcomatous transformation and multiple metastatic lymphadenopathies that showed a favorable response to platinum-based systemic chemotherapy.
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Affiliation(s)
- Yumun Jeong
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaekyung Cheon
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Oh Kim
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Doo-Ho Lim
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sunpyo Lee
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Mi Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Lyun Lee
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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9
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Positive FDG-PET/CT scans of a residual seminoma after chemotherapy and radiotherapy: case report and review of the literature. Clin Genitourin Cancer 2014; 12:e147-50. [PMID: 24674785 DOI: 10.1016/j.clgc.2014.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 11/21/2022]
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10
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Stein ME, Drumea K, Charas T, Gershuny A, Ben-Yosef R. Platinum-based Chemotherapy in Primary Advanced Seminoma-a Retrospective Analysis: Treatment Results at the Northern Israel Oncology Center (1989-2010). Rambam Maimonides Med J 2014; 5:e0005. [PMID: 24498512 PMCID: PMC3904480 DOI: 10.5041/rmmj.10139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Over the past 30 years, great strides have been made in the treatment of disseminated testicular tumors. Despite the low number of patients and the rarity of studies concerning primary advanced seminoma, the efficacy of chemotherapy is clear, mainly 3-4-cisplatin-based chemotherapy. Aiming to contribute to the understanding and implementation of proper chemotherapeutic management in advanced seminoma patients, we retrospectively summarized our experience with 26 patients who were referred for platinum-based chemotherapy, post-orchiectomy to the Northern Israel Oncology Center between 1989 and 2010. Response rate, side effects, and long-term outcome were investigated. METHODS Before chemotherapy, meticulous staging was done, including tumor markers (B-human chorionic gonadotropin (B-HCG), alpha-fetoprotein (AFP), and lactic dehydrogenase (LDH)), and abdominal and pelvic computerized tomography (CT) scans were carried out. RESULTS All 26 treated patients achieved complete remission, clinically and symptomatically, with normalization of their CT scans. At a median follow-up of 120 months (range, 24-268 months) all patients are alive, without evidence of recurrent disease. One patient whose disease recurred twice achieved a third complete remission following salvage treatment with high-dose chemotherapy and autologous peripheral stem cell transplantation. Another patient, who preferred surveillance, relapsed abdominally after 9 months but achieved long-standing complete remission with cisplatin-based chemotherapy. Both these patients are alive with no evidence of disease. Three patients recovered uneventfully from bleomycin-induced pneumonitis. CONCLUSIONS Advanced seminoma is a highly curable disease using platinum-based chemotherapy. Our study confirms the efficacy and safety of cisplatin-based chemotherapy in the treatment of advanced seminoma.
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Affiliation(s)
- Moshe E. Stein
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
- To whom correspondence should be addressed. E-mail:
| | - Karen Drumea
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
| | - Tomer Charas
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
| | - Anthony Gershuny
- Department of Clinical Oncology & Radiation Therapy, Queen’s Hospital, Romford, Essex, UK
| | - Rahamim Ben-Yosef
- Northern Israel Oncology Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and
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11
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12
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Domont J, Massard C, Patrikidou A, Bossi A, de Crevoisier R, Rose M, Wibault P, Fizazi K. A risk-adapted strategy of radiotherapy or cisplatin-based chemotherapy in stage II seminoma. Urol Oncol 2013; 31:697-705. [DOI: 10.1016/j.urolonc.2011.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/11/2011] [Accepted: 04/13/2011] [Indexed: 11/29/2022]
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13
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Wagner M, Bellmunt J, Boutros C, Bonardel G, Loriot Y, Albiges L, Massard C, Fizazi K. False Positive 2-18Fluroro-deoxy-D-Glucose Positron Emission Tomography (FDG-PET) in Patients With Disseminated Seminoma and Post-Chemotherapy Residual Masses. Clin Genitourin Cancer 2013; 11:66-9. [DOI: 10.1016/j.clgc.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 11/25/2022]
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14
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Bachner M, Loriot Y, Gross-Goupil M, Zucali PA, Horwich A, Germa-Lluch JR, Kollmannsberger C, Stoiber F, Fléchon A, Oechsle K, Gillessen S, Oldenburg J, Cohn-Cedermark G, Daugaard G, Morelli F, Sella A, Harland S, Kerst M, Gampe J, Dittrich C, Fizazi K, De Santis M. 2-¹⁸fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) for postchemotherapy seminoma residual lesions: a retrospective validation of the SEMPET trial. Ann Oncol 2012; 23:59-64. [PMID: 21460378 DOI: 10.1093/annonc/mdr052] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 2-¹⁸fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) has been recommended in international guidelines in the evaluation of postchemotherapy seminoma residuals. Our trial was designed to validate these recommendations in a larger group of patients. PATIENTS AND METHODS FDG-PET studies in patients with metastatic seminoma and residual masses after platinum-containing chemotherapy were correlated with either the histology of the resected lesion(s) or the clinical outcome. RESULTS One hundred and seventy seven FDG-PET results were contributed. Of 127 eligible PET studies, 69% were true negative, 11% true positive, 6% false negative, and 15% false positive. We compared PET scans carried out before and after a cut-off level of 6 weeks after the end of the last chemotherapy cycle. PET sensitivity, specificity, negative predictive value (NPV), and positive predictive value were 50%, 77%, 91%, and 25%, respectively, before the cut-off and 82%, 90%, 95%, and 69% after the cut-off. PET accuracy significantly improved from 73% before to 88% after the cut-off (P=0.032). CONCLUSION Our study confirms the high specificity, sensitivity, and NPV of FDG-PET for evaluating postchemotherapy seminoma residuals. When carried out at an adequate time point, FDG-PET remains a valuable tool for clinical decision-making in this clinical setting and spares patients unnecessary therapy.
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Affiliation(s)
- M Bachner
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria
| | - Y Loriot
- Institut Gustave Roussy, Villejuif, France
| | | | - P A Zucali
- Istituto Clinico Humanitas IRCCS, Rozzano (Milan), Italian Germ Cell Cancer Group
| | - A Horwich
- The Royal Marsden Hospital, London and Surrey, UK
| | | | | | - F Stoiber
- Krankenhaus der Barmherzigen Schwestern, Linz, Austria
| | | | - K Oechsle
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - S Gillessen
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, 5073 Rigshospitalet, Copenhagen, Denmark
| | - F Morelli
- Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - A Sella
- Assaf Harofeh Medical Center, Zerifin, Israel
| | - S Harland
- University College Hospital London, London, UK
| | - M Kerst
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Gampe
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - C Dittrich
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria
| | - K Fizazi
- Institut Gustave Roussy, Villejuif, France
| | - M De Santis
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria.
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15
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Lavery HJ, Bahnson RR, Sharp DS, Pohar KS. Management of the residual post-chemotherapy retroperitoneal mass in germ cell tumors. Ther Adv Urol 2011; 1:199-207. [PMID: 21789067 DOI: 10.1177/1756287209350315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The management of the residual mass in the retroperitoneum following induction chemotherapy for metastatic testicular cancer has evolved over the past three decades. A multidisciplinary approach involving cisplatin-based chemotherapy and postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) has increased long-term survival rates above 80%. Advances into the appropriate patient selection and timing of surgery have lowered morbidity while improving oncologic outcomes. However, areas of controversy still exist within the field. Management of the small residual mass, predictors of the histology of the residual mass, the extent of PC-RPLND, the role of PC-RPLND in the setting of elevated serum tumor markers, and the role of positron-emission tomography are all topics of ongoing research and debate. We will discuss these issues and review the current guidelines for the management of the residual postchemotherapy retroperitoneal mass in this review.
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Affiliation(s)
- Hugh J Lavery
- Department of Urology, Ohio State University Medical Center, 456 West 10th Ave, Columbus, Ohio, OH 43210, USA
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16
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Warde P, Huddart R, Bolton D, Heidenreich A, Gilligan T, Fossa S. Management of Localized Seminoma, Stage I-II: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology 2011; 78:S435-43. [PMID: 21986223 DOI: 10.1016/j.urology.2011.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 01/04/2011] [Accepted: 02/14/2011] [Indexed: 10/16/2022]
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17
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Müller J, Schrader AJ, Jentzmik F, Schrader M. [Assessment of residual tumours after systemic treatment of metastatic seminoma: ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography - meta-analysis of diagnostic value]. Urologe A 2011; 50:322-7. [PMID: 21161157 DOI: 10.1007/s00120-010-2469-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Meta-analysis evaluating the accuracy and sensitivity of FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) positron emission tomography (PET) to predict viable residual tumours in patients with metastatic seminoma. MATERIAL AND METHODS Altogether 5 studies with 130 patients were identified. Both FDG PET and the size of the residual lesions on conventional computed tomography (CT; lesions either ≤ or > 3 cm) were correlated with the presence or absence of viable residual tumour. RESULTS The specificity (92 vs 59%), sensitivity (72 vs 63%), positive (70 vs 28%) and negative (93 vs 86%) predictive value of FDG PET were superior to data obtained by assessing residual tumour size (either ≤ or > 3 cm) applying CT scans alone. CONCLUSION In view of the data currently available, FDG PET seems to be a clinically useful predictor of viable tumour in post-chemotherapy residuals of pure seminoma.
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Affiliation(s)
- J Müller
- Klinik für Urologie, Universitätsklinikum Ulm, Pritzwitzstraße 43, 89075 Ulm, Deutschland.
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18
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Boujelbene N, Cosinschi A, Boujelbene N, Khanfir K, Bhagwati S, Herrmann E, Mirimanoff RO, Ozsahin M, Zouhair A. Pure seminoma: a review and update. Radiat Oncol 2011; 6:90. [PMID: 21819630 PMCID: PMC3163197 DOI: 10.1186/1748-717x-6-90] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/08/2011] [Indexed: 03/27/2023] Open
Abstract
Pure seminoma is a rare pathology of the young adult, often discovered in the early stages. Its prognosis is generally excellent and many therapeutic options are available, especially in stage I tumors. High cure rates can be achieved in several ways: standard treatment with radiotherapy is challenged by surveillance and chemotherapy. Toxicity issues and the patients' preferences should be considered when management decisions are made. This paper describes firstly the management of primary seminoma and its nodal involvement and, secondly, the various therapeutic options according to stage.
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Affiliation(s)
- Noureddine Boujelbene
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
- Department of Radiation Oncology, Centre Hospitalier Universitaire Habib Bourguiba, 3000 Sfax, Tunisia
- Department of Radiation Oncology, Hôpital de Sion-CHCVs, CH-1950 Sion, Switzerland
| | - Adrien Cosinschi
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Nadia Boujelbene
- Department of Pathology, Institut Gustave-Roussy, 94805 Villejuif, France
- Department of Pathology, Hôpital HabibThameur, 1089 Tunis, Tunisia
| | - Kaouthar Khanfir
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
- Department of Radiation Oncology, Hôpital de Sion-CHCVs, CH-1950 Sion, Switzerland
| | - Shushila Bhagwati
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Eveleyn Herrmann
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Rene-Olivier Mirimanoff
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Abderrahim Zouhair
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
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20
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Abstract
Testicular germ cell tumors and, in particular, seminomas are exquisitely radiation and chemotherapy-sensitive and most presentations are highly curable. In recent years the management focus has been on reducing late sequelae of treatment. For Stage I disease surveillance and adjuvant carboplatin, chemotherapy has become an option. The efficacy of combination chemotherapy has been established for advanced metastatic disease. Through a review of the available literature this article outlines the recent changes in the management of seminoma.
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Affiliation(s)
- Emma J Alexander
- Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, United Kingdom
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21
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Mueller J, Schnoeller T, Zengerling F, Waalkes S, Ghazal AA, Jentzmik F, Schrader M, Schrader AJ. Meta-Analysis to Determine the Diagnostic Value of 2-<sup>18</sup>Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography in Assessing Residual Tumors after Systemic Therapy for Metastatic Seminoma. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/oju.2011.13011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Choo R, Quevedo F, Choo CS, Blute M. Can radiotherapy be a viable salvage treatment option for the relapsed seminoma confined to the infra-diaphragm region recurring after primary chemotherapy for bulky stage II seminoma? Can Urol Assoc J 2010; 4:E137-40. [PMID: 20944793 DOI: 10.5489/cuaj.937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There has been a paucity of research describing a potential role of radiotherapy as salvage treatment for recurrent seminoma following primary chemotherapy for bulky stage IIC seminoma. We report a case of a bulky stage IIC seminoma relapsed in the pelvis after primary chemotherapy and surgery for post-chemotherapy residual mass, which was subsequently salvaged with radiotherapy. The patient has remained free of relapse at 3.7 years post-salvage radiotherapy. This case demonstrates that radiotherapy can be a salvage therapeutic option for recurrent seminoma following primary chemotherapy for bulky stage IIC seminoma, provided that the recurrent tumour is confined to a limited area of the infradiaphragmatic region. There is a need for further study to examine the potential role of radiotherapy as a salvage therapeutic tool for post-chemotherapy recurrent seminoma.
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Affiliation(s)
- Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Wood L, Kollmannsberger C, Jewett M, Chung P, Hotte S, O'Malley M, Sweet J, Anson-Cartwright L, Winquist E, North S, Tyldesley S, Sturgeon J, Gospodarowicz M, Segal R, Cheng T, Venner P, Moore M, Albers P, Huddart R, Nichols C, Warde P. Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J 2010; 4:e19-38. [PMID: 20368885 PMCID: PMC2845668 DOI: 10.5489/cuaj.815] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
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Cai JY, Tang JY, Pan C, Xu M, Xue HL, Zhou M, Dong L, Ye QD, Jiang H, Shen SH, Chen J. Results of RS-99 protocol for childhood solid tumors. World J Pediatr 2010; 6:43-9. [PMID: 20143210 DOI: 10.1007/s12519-010-0005-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 05/29/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Little was known about the therapeutic result of rhabdomyosarcomas (RMSs) and other malignant tumors until the end of the last century in China. Very few prospective clinical research results have been reported. We designed a RS-99 protocol under close cooperation of a multidisciplinary team including surgeons, radiologists, pathologists, and pediatric oncologists at Shanghai Children's Medical Center. This study aimed to improve the prognosis of childhood solid tumors and analyze the results of different tumors with the same protocol, including RMSs, the Ewing sarcoma family of tumors (ESFTs), and ex-cranial germ cell tumors (GCTs). METHODS Sixty-six patients with malignant solid tumors [RMS (n=30), GCT (n=22), and ESFT (n=14)] were enrolled on the RS-99 protocol from October 1998 to October 2006. They were 34 girls and 32 boys aged 9 to 194 months. The protocol involved surgery, radiotherapy and chemotherapy which included VCP (vincristine, cisdiaminedichloroplatinum, and cyclophosphamide) and IEV (etoposide, vincristine and ifosfamide) for the low-risk group, AVCP (adriamycin, vincristine, cisdiaminedichloroplatinum, and cyclophosphamide) and IEV for the intermediate-risk group and high-risk group. Peripheral blood stem cell transplantation was suggested for the high-risk group. Radiotherapy was only given for RMS and ESFT. Differences in survival between the groups were determined by comparison of entire survival curves and tested by the Kaplan-Meier method and the log-rank tests. RESULTS The 5-year event-free survival (EFS) for the whole group (RMS, ESFT and GCT) was 60%. The 5-year EFS for children with RMS was 35% (95% CI 16-54), GCT was 79% (95% CI 70-88) and ESFT was 72% (95% CI 58-86). The 5-year EFS showed that the patients with RMS in the retroperitoneum-pelvis did not have a better result than those with tumors in other sites (P=0.604). The histological classification of RMS exerted prognostic influence on the estimated 5-year EFS (P=0.04). Tumor stage and risk group were also contributive to prognosis (P=0.008). For GCT patients, the primary sites of tumors and their histological classification did not influence the therapeutic result (P=0.814). The 5-year EFS was 100% in stage I and II versus 62% in stage III and IV patients (P=0.02). Because of the small number of patients, we did not analyze the prognostic factors for patients with ESFT. No organ failure or functional impairment occurred in the patients enrolled in the RS-99 protocol. One ESFT patient developed a second cancer. CONCLUSIONS The RS-99 protocol is well tolerated and is reasonable for the 3 different tumors. Risk-based grouping protocol design is needed and the protocol for high risk RMS should be revised.
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Affiliation(s)
- Jiao-Yang Cai
- Department of Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz-Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part II. Eur Urol 2008; 53:497-513. [PMID: 18191015 DOI: 10.1016/j.eururo.2007.12.025] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Iborra F, Avances C, Culine S, Houlgatte A, Mottete N. [What about lombo-aortic curage in the treatment of testicle cancer?]. ACTA ACUST UNITED AC 2008; 41:116-26. [PMID: 18260272 DOI: 10.1016/j.anuro.2007.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The indications and techniques of retroperitoneal lymphadenectomy in stage I non seminomatous germ cell tumours have markedly evolved over the past ten years. A literature review allows noticing that historical radical retroperitoneal dissection has been replaced by more limited techniques, known as nerve sparing and nerve preserving lymph node dissection. Stage I non seminomatous germ cell tumours are classified according to the risk of retroperitoneat lymph node involvement; they constitute three groups: low, intermediate and high risk tumours. Retroperitoneal lymph node dissection is considered for low risk patients in case of non compliance or difficult follow-up, and for intermediate risk patients (vascular invasion with presence of high percentage of teratomatous component).
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Affiliation(s)
- F Iborra
- Service d'urologie, CHU Lapeyronie, 34000 Montpellier, France.
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Hinz S, Schrader M, Kempkensteffen C, Bares R, Brenner W, Krege S, Franzius C, Kliesch S, Heicappel R, Miller K, de Wit M. The role of positron emission tomography in the evaluation of residual masses after chemotherapy for advanced stage seminoma. J Urol 2008; 179:936-40; discussion 940. [PMID: 18207171 DOI: 10.1016/j.juro.2007.10.054] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE Treatment in patients with seminoma who have residual or recurrent masses following chemotherapy is still a matter of debate. Surgical resection is currently the most common recommendation for masses greater than 3 cm, resulting in overtreatment in up to 70% of those affected. We analyzed the accuracy of preoperative positron emission tomography for predicting viable tumor residuals in patients with seminoma. MATERIALS AND METHODS In a prospective, multicenter trial computerized tomography and FDG (2-(F-18)-fluoro-2-deoxy-D-glucose) positron emission tomography were performed before surgical resection for residual or recurrent masses in 20 patients who had undergone chemotherapy for stage IIb, IIc or III seminoma. Histopathological findings were directly correlated with positron emission tomography results. RESULTS Of the patients 18 presented with residual masses and 2 had recurrent masses following chemotherapy. Histopathological assessment revealed viable tumor in 3 patients and benign lesions in 17. All patients with viable tumor were identified correctly by positron emission tomography. No false-negative results were observed but 9 patients had false-positive positron emission tomography results. This resulted in a negative predictive value of 1 (95% CI 0.63-1) and a positive predictive value of 0.25 (95% CI 0.05-0.57) for FDG-positron emission tomography in our patient cohort. CONCLUSIONS Our data indicate that FDG-positron emission tomography is capable of excluding viable disease in residual masses, even those exceeding 3 cm. Therefore, it may be considered an additional tool to improve patient counseling. However, the decision to perform surgical resection of the residual mass should not be based exclusively on a positive positron emission tomography image since false-positive results appear to be common.
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Affiliation(s)
- Stefan Hinz
- Department of Urology, Charité Campus Benjamin Franklin, Universitaetsmedizin Berlin, Berlin, Germany.
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Gilligan T, Kantoff PW. Testis Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Testicular germ-cell tumours (TGCTs) represent the model of a curable malignancy; sensitive tumour markers, accurate prognostic classification, logical series of management trials, and high cure rates in both seminomas and non-seminomas have enabled a framework of effective cancer therapy. Understanding the molecular biology of TGCT could help improve treatment of other cancers. The typical presentation in young adults means that issues of long-term toxicity become especially important in judging appropriate management. A focus of recent developments has been to tailor aggressiveness of treatment to the severity of the prognosis. Recent changes affect the most common subtypes and include the reduction of chemotherapy for patients who have metastastic non-seminomas and a good prognosis, and alternatives to adjuvant radiotherapy in stage I seminomas. We summarise advances in the understanding and management of TGCT during the past decade.
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Affiliation(s)
- Alan Horwich
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey SM2 5PT, UK.
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Quek ML, Simma-Chiang V, Stein JP, Pinski J, Quinn DI, Skinner DG. Postchemotherapy residual masses in advanced seminoma: current management and outcomes. Expert Rev Anticancer Ther 2006; 5:869-74. [PMID: 16221056 DOI: 10.1586/14737140.5.5.869] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although pure testicular seminoma is most often confined to the testis, it can present with advanced-stage bulky retroperitoneal metastases in nearly a quarter of cases. While highly treatable with cisplatin-based chemotherapy, up to 80% of patients with advanced disease are found to have a radiographically detectable residual mass after chemotherapy. The management of these postchemotherapy residual masses remains controversial. Surgical resection is technically challenging due to a desmoplastic reaction resulting from seminoma treatment and regression. In addition, these residual masses often demonstrate a protracted period of regression that can span several months to years. Surveillance protocols, therefore, may be appropriate for most patients. Several retrospective studies have supported surgical resection only for discrete, well-delineated masses over 3 cm in size. Despite the highly radiosensitive nature of seminoma, radiation therapy in this setting has not been shown to provide significant benefit, and may limit the tolerability of subsequent salvage chemotherapy. The incorporation of noninvasive imaging modalities, such as positron emission tomography, into the management algorithm may better delineate the presence of viable residual tumor and thus allow better risk stratification.
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Affiliation(s)
- Marcus L Quek
- Department of Urology, Loyola University Stritch School of Medicine, IL 60153, USA.
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Abstract
Testicular cancer is remarkable because it is curable by combination cytotoxic chemotherapy even when widely disseminated. Treatment is defined by widely accepted staging and prognostic factors. Three cycles of bleomycin, etoposide and cisplatin has been defined as the current optimum treatment in good prognosis metastatic disease, curing 90-95% of patients. Outcomes are less impressive for patients in intermediate and poor prognostic categories. A number of different approaches, including introduction of new agents and dose intensification, are being investigated to improve outcomes in these patients. Data developed over the last few years have identified increased risks of second malignancy and cardiovascular disease in long-term survivors. This has led to re-evaluation of strategies to manage Stage I patients. In particular, the use of radiotherapy in Stage I seminoma and the need for adjuvant therapy in Stage I nonseminoma are being re-examined. It is anticipated that advances in imaging and prognostic factors will facilitate this process.
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Affiliation(s)
- Robert A Huddart
- The Royal Marsden NHS Foundation Trust & The Institute of Cancer Research, The Academic Unit of Radiotherapy & Oncology, Downs Road, Sutton, Surrey, SM2 5PT, UK.
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Gori S, Porrozzi S, Roila F, Gatta G, De Giorgi U, Marangolo M. Germ cell tumours of the testis. Crit Rev Oncol Hematol 2005; 53:141-64. [PMID: 15661565 DOI: 10.1016/j.critrevonc.2004.05.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2004] [Indexed: 11/27/2022] Open
Abstract
Cancer of the testis is a relatively rare disease, accounting for about 1% of all cancers in men. Cryptorchidism is the only confirmed risk factor for testicular germ cell tumour. The majority of GCT are clinically detectable at initial presentation. Any nodular, hard, or fixed area discovered in the testis, must be considered neoplastic until proved otherwise. The appropriate surgical procedure to make the diagnosis is a radical orchidectomy through an inguinal incision. Many GCT produce tumoural markers (AFP, HCG, LDH), who are useful in the diagnosis and staging of disease; to monitor the therapeutic response and to detect tumour recurrence. In 1997 a prognostic factor-based classification for the metastatic germ cell tumours was developed by the IGCCCG: good, intermediate and poor prognosis, with 5-year survival of 91, 79 and 48%, respectively. GCT of the testis is a highly table, often curable, cancer. Germ cell testicular cancers are divided into seminoma and non-seminoma types for treatment planning because seminomatous testicular cancers are more sensitive to radiotherapy. Seminoma (all stages combined) has a cure rate of greater than 90%. For patients with low-stage disease, the cure approaches 100%. For patients with non-seminoma tumours, the cure rate is >95% in stages I and II; it is approximately 70% with standard chemotherapy and resection of residual disease, if necessary, in stages III and IV. Minimum guidelines for clinical, biochemical, and radiological follow-up have been reported by ESMO in 2001.
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Abstract
Positron emission tomography (PET) in uro-oncology has been one of the slowest areas to develop. There are problems because of the excretion of tracer through the renal tract. Its use in prostate cancer has generally being disappointing, with PET being unable to differentiate malignancy from benign prostatic hypertrophy. In more advanced disease and in the search for the site of recurrence, PET can be of more use. Also, new tracers may prove to be more effective. PET has been shown to be of value in testicular cancer, particularly in defining recurrent disease in residual masses and in patients with raised markers. There is a clear place for PET in some of these cases. Early studies at staging are promising but more work is required to define its exact place. In renal and bladder cancer, PET may be a useful adjunct to conventional imaging in difficult cases and may assist in local staging. In all tumours it is valuable to differentiate fibrosis from recurrent disease in the treatment bed, an area of difficulty for CT/MR.
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Affiliation(s)
- S F Hain
- Department of Nuclear Medicine, Charing Cross Hospital, London, UK.
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Delaney G, Jacob S, Barton M. Estimating the optimal external-beam radiotherapy utilization rate for genitourinary malignancies. Cancer 2005; 103:462-73. [PMID: 15612081 DOI: 10.1002/cncr.20789] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Benchmark radiotherapy utilization rates for genitourinary malignancies are largely unknown, despite the finding that genitourinary cancers comprise approximately 19% of all registered malignancies in Australia. METHODS To develop an evidence-based benchmark of the optimal proportion of patients with genitourinary malignancies who should receive at least one course of radiotherapy at some time during their illness, the authors studied treatment guidelines and treatment reviews regarding genitourinary malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes that indicated possible benefit from radiotherapy based on evidence. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with genitourinary cancer for whom radiotherapy was considered appropriate. RESULTS The proportion of patients with genitourinary malignancies for whom radiotherapy was indicated at some point in their illness, according to the best available evidence, was estimated to be 27% of patients with renal cancer, 58% of patients with bladder cancer, 60% of patients with prostate cancer, and 49% of patients with testicular cancer. The occurrence of ureteric and penile cancers among patients was too rare, and, therefore, these patients were not included in the current study. CONCLUSIONS There was a large discrepancy between actual radiotherapy utilization and the evidence-based optimal rate. The authors recommended strategies to implement the evidence-based guidelines. Evidence-based benchmarks for radiotherapy utilization rates such as the ones described in the current study were important in the evaluation of the appropriate use of radiotherapy.
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Affiliation(s)
- Geoff Delaney
- Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, Australia.
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Schmoll HJ, Souchon R, Krege S, Albers P, Beyer J, Kollmannsberger C, Fossa SD, Skakkebaek NE, de Wit R, Fizazi K, Droz JP, Pizzocaro G, Daugaard G, de Mulder PHM, Horwich A, Oliver T, Huddart R, Rosti G, Paz Ares L, Pont O, Hartmann JT, Aass N, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Classen J, Clemm S, Culine S, de Wit M, Derigs HG, Dieckmann KP, Flasshove M, Garcia del Muro X, Gerl A, Germa-Lluch JR, Hartmann M, Heidenreich A, Hoeltl W, Joffe J, Jones W, Kaiser G, Klepp O, Kliesch S, Kisbenedek L, Koehrmann KU, Kuczyk M, Laguna MP, Leiva O, Loy V, Mason MD, Mead GM, Mueller RP, Nicolai N, Oosterhof GON, Pottek T, Rick O, Schmidberger H, Sedlmayer F, Siegert W, Studer U, Tjulandin S, von der Maase H, Walz P, Weinknecht S, Weissbach L, Winter E, Wittekind C. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15:1377-99. [PMID: 15319245 DOI: 10.1093/annonc/mdh301] [Citation(s) in RCA: 380] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception.
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Affiliation(s)
- H J Schmoll
- European Germ Cell Cancer Consensus Group, Martin-Luther-University, Department of Hematology/Oncology, Halle, Germany.
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De Santis M, Becherer A, Bokemeyer C, Stoiber F, Oechsle K, Sellner F, Lang A, Kletter K, Dohmen BM, Dittrich C, Pont J. 2-18fluoro-deoxy-D-glucose Positron Emission Tomography Is a Reliable Predictor for Viable Tumor in Postchemotherapy Seminoma: An Update of the Prospective Multicentric SEMPET Trial. J Clin Oncol 2004; 22:1034-9. [PMID: 15020605 DOI: 10.1200/jco.2004.07.188] [Citation(s) in RCA: 347] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To define the clinical value of 2-18fluoro-deoxy-D-glucose positron emission tomography (FDG PET) as a predictor for viable residual tumor in postchemotherapy seminoma residuals in a prospective multicentric trial. Patients and Methods FDG PET studies in patients with metastatic pure seminoma who had radiographically defined postchemotherapy residual masses were correlated with either the histology of the resected lesion or the clinical outcome documented by computer tomography (CT), tumor markers, and/or physical examination during follow-up. The size of the residual lesions on CT, either > 3 cm or ≤ 3 cm, was correlated with the presence or absence of viable residual tumor. Results Fifty-six FDG PET scans of 51 patients were assessable. All 19 cases with residual lesions > 3 cm and 35 (95%) of 37 with residual lesions ≤ 3 cm were correctly predicted by FDG PET. The specificity, sensitivity, positive predictive value, and negative predictive value of FDG PET were 100% (95% CI, 92% to 100%), 80% (95% CI, 44% to 95%), 100%, and 96%, respectively, versus 74% (95% CI, 58% to 85%), 70% (95% CI, 34% to 90%), 37%, and 92%, respectively, for CT discrimination of the residual tumor by size (> 3 cm/≤ 3 cm). Conclusion This investigation confirms that FDG PET is the best predictor of viable residual tumor in postchemotherapy seminoma residuals and should be used as a standard tool for clinical decision making in this patient group.
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Affiliation(s)
- Maria De Santis
- Department of Medical Oncology, Kaiser Franz Josef Spital, Kundratstrasse 3, A-1100 Wien, Austria
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Abstract
The pronounced radiosensitivity of renal tissue limits the total radiotherapeutic dose that can be applied safely to treatment volumes that include the kidneys. The incidence of clinical radiation nephropathy has increased with the use of total-body irradiation (TBI) in preparation for bone marrow transplantation and as a consequence of radionuclide therapies. The clinical presentation is azotemia, hypertension, and, disproportionately, severe anemia seen several months to years after irradiation that, if untreated, leads to renal failure. Structural features include mesangiolysis, sclerosis, tubular atrophy, and tubulointerstitial scarring. Similar changes are seen in a variety of experimental animal models. The classic view of radiation nephropathy being inevitable, progressive, and untreatable because of DNA damage-mediated cell loss at division has been replaced by a new paradigm in which radiation-induced injury involves not only direct cell kill but also involves complex and dynamic interactions between glomerular, tubular, and interstitial cells. These serve both as autocrine and as paracrine, if not endocrine, targets of biologic mediators that mediate nephron injury and repair. The renin angiotensin system (RAS) clearly is involved; multiple experimental studies have shown that antagonism of the RAS is beneficial, even when not initiated until weeks after irradiation. Recent findings suggest a similar benefit in clinical radiation nephropathy.
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Affiliation(s)
- Eric P Cohen
- Medical College of Wisconsin, Milwaukee, WI, USA
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Patel MI, Motzer RJ, Sheinfeld J. Management of recurrence and follow-up strategies for patients with seminoma and selected high-risk groups. Urol Clin North Am 2004; 30:803-17. [PMID: 14680316 DOI: 10.1016/s0094-0143(03)00063-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Seminoma is characterized by high sensitivity to both radiation and chemotherapy. Localized recurrences in the retroperitoneum after surveillance for stage I can be treated with radiotherapy; however, multiple or large bulky retroperitoneal recurrences or systemic metastasis requires cisplatin-based chemotherapy. Salvage chemotherapy for those who recur after initial CR to induction chemotherapy is based on ifosfamide- and cisplatin-containing regimens. Incomplete response or failure after induction chemotherapy requires high-dose chemotherapy and stem cell rescue. Patients with seminoma need long-term follow-up because of the possibility of late recurrence and the risk of a second primary tumor.
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Affiliation(s)
- Manish I Patel
- Department of Urology, Memorial Sloan-Kettering Cancer Center, 353 E. 68th Street, New York, NY 10021, USA
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Abstract
Up to 80% of metastatic germ-cell tumours are curable with conventional chemotherapy. The combination of cisplatin, bleomycin, and etoposide has become the gold standard in this disease. Patients can be divided into good, intermediate, and poor prognosis groups. For those patients with good prognostic features, cure rates reach 90% and attempts have been made to reduce toxic effects of treatment while maintaining efficacy. Patients that relapse require salvage treatment. This can involve the incorporation of drugs such as ifosfamide and taxol into conventional protocols or the use of high-dose chemotherapy with stem-cell transplants. Patients with poor prognosis disease are much more likely to fail conventional chemotherapy and are candidates for dose-intensive protocols or transplants as first-line treatment. Although the results obtained in treating metastatic germ-cell tumours are superior to those with other solid tumour types, there are still many areas that require further improvement.
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Affiliation(s)
- Robert H Jones
- Cancer Research UK Molecular Oncology Group, Department of Pathology and Microbiology, School of Medical Sciences, University Walk, Bristol, UK.
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Management of Post-Chemotherapy Residual Masses in Advanced Seminoma. J Urol 2002. [DOI: 10.1097/00005392-200211000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Flechon A, Bompas E, Biron P, Droz JP. Management of post-chemotherapy residual masses in advanced seminoma. J Urol 2002; 168:1975-9. [PMID: 12394688 DOI: 10.1016/s0022-5347(05)64275-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We studied the resection of post-chemotherapy residual masses (20% to 80%) of advanced seminoma complicated by extensive fibrosis, in which active disease appears in 10% to 20% of cases. MATERIALS AND METHODS We retrospectively analyzed (1986 to 2000) residual mass evolution according to size in 79 platinum treated patients. RESULTS There was an evaluable response in 78 patients, including toxic death in 1 after 1 chemotherapy cycle, a complete response in 34 (after chemotherapy in 15 and after complete residual mass resection in 19), a marker negative partial response in 42 (incomplete residual mass resection in 8), stable and progressive disease in 1 each. In 15 of 31 patients the resected residual mass was 3 cm. or greater, whereas in 12 of 29 it was less than 3 cm. No surgery was performed for 3 residual masses of unknown size. Of the 42 residual masses 21 disappeared at a median of 12.5 months. Progression occurred at the initial tumor site in 11 of 13 patients after a median of 3.5 months, including 3 with a complete response, 8 with a marker negative partial response (residual mass 3 cm. or greater in 3, less than 3 cm. in 4 and unknown size in 1) and treatment failure in 2 (residual mass 3 cm. or greater). At a median followup of 36.4 months 67 patients survived (no disease progression in 56 and nonevolving residual masses in 11), while 12 had died including 9 of progressive disease 1 of toxicity and 2 of other causes. CONCLUSIONS In our study there was incomplete surgical resection in 30% of cases. Relapse in 16.6% of cases occurred rapidly after the end of chemotherapy. Viable cells were only noted in residual masses 3 cm. or greater (13%) and 50% of residual masses disappeared during surveillance. We intend to perform a prospective cohort study with close followup of patients with residual masses less than 3 cm. using an indication for surgery tailored to positron emission tomography findings in those with residual masses 3 cm. or greater.
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Affiliation(s)
- Aude Flechon
- Department of Medical Oncology, Centre Léon Bérnard, Lyon, France
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Abstract
We present the case of a 42-year-old male who presented with a hot, tender swelling in the left supraclavicular fossa. He was pyrexial on presentation with a mildly elevated leucocyte count of 12.4x10(9)/l. Clinical examination, including full ear, nose and throat assessment, proved unremarkable. The medical history revealed that 2 years earlier the patient had been diagnosed with a testicular seminoma for which he underwent a right inguinal orchidectomy and abdominal radiotherapy. CT scan highlighted a 6 cm para-laryngeal mass, of mixed attenuation, with an adjacent region of inflammation. Overall appearance was suggestive of an infective mass. Ultrasound-guided fine needle aspiration cytology revealed a metastatic seminomatous deposit. Imaging of the chest and abdomen revealed this as the only site of metastasis. He is currently undergoing chemotherapy, and is responding well. We review the pathology of testicular seminoma. This case highlights the myriad of pathologies that may present as a lump in the neck.
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Affiliation(s)
- Rajiv K Bhalla
- Department of Otolaryngology, University Hospital Aintree, Lower Lane, L9 7AL, Liverpool, UK.
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44
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De Santis M, Bokemeyer C, Becherer A, Stoiber F, Oechsle K, Kletter K, Dohmen BM, Dittrich C, Pont J. Predictive impact of 2-18fluoro-2-deoxy-D-glucose positron emission tomography for residual postchemotherapy masses in patients with bulky seminoma. J Clin Oncol 2001; 19:3740-4. [PMID: 11533096 DOI: 10.1200/jco.2001.19.17.3740] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To establish the predictive potential of 2-18fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) for detecting viable tumor tissue in residual postchemotherapy masses of seminoma patients. PATIENTS AND METHODS In this prospective multicenter trial, results of FDG PET studies in seminoma patients with postchemotherapy masses > or = 1 cm were correlated with either the histology of the resected lesion or the clinical outcome on follow-up without resection. Negative PET scans of residual lesions that were devoid of viable tumor tissue on resection or disappeared, shrunk, or remained stable in size for at least 2 years were rated as true-negative (TN). Positive scans without histologic or clinical evidence of tumor tissue were classified as false-positive. In patients with histologically positive or progressive lesions, positive PET scans were defined as true-positive (TP) and negative scans, false-negative (FN). RESULTS Thirty-seven PET scans of 33 patients were assessable at a median follow-up time of 23 months (range, 2 to 46 months). Histologic data were available from nine patients who had undergone resection. Twenty-eight patients were followed-up clinically and radiologically. Twenty-eight scans were TN, eight were TP, and one was FN. All 14 residual lesions more than 3 cm and 22 (96%) of the 23 < or = 3 cm were correctly predicted by FDG PET. The specificity (100%; 95% confidence interval [CI], 87.7% to 100%), sensitivity (89%; 95% CI, 51.7% to 99.7%), positive predictive value (100%), and the negative predictive value (97%) of FDG PET were superior to data obtained by assessing residual tumor size (< or = or > 3 cm). CONCLUSION FDG PET is a clinically useful predictor of viable tumor in postchemotherapy residuals of pure seminoma, especially those greater than 3 cm.
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Affiliation(s)
- M De Santis
- Department of Medical Oncology and Luwdig Boltzmann Institute for Applied Cancer Research, Kaiser Franz Josef Spital, Wien, Austria
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45
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Parkinson MC, Harland SJ, Harnden P, Sandison A. The role of the histopathologist in the management of testicular germ cell tumour in adults. Histopathology 2001; 38:183-94. [PMID: 11260297 DOI: 10.1046/j.1365-2559.2001.01071.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the last 20--30 years the availability of effective chemotherapy and more accurate clinical staging has greatly improved the prognosis for patients with testicular germ cell tumours. Initially, such treatment appeared to diminish the role of histopathology to the distinction between seminoma and nonseminomatous germ cell tumour (NSGCT) in the primary specimen. However, histopathology has evolved as a prognostic tool indicating the risk of relapse in various defined clinical contexts thereby facilitating therapeutic decisions. The clinical emphasis has been on quality of life and reduction of therapy both in terms of the number of patients treated and the number of chemotherapy courses given to each patient. The treatment of adult testicular germ cell tumours may differ between countries but protocols are established. Therefore it is appropriate to discuss the role of histopathology during this era of relative therapeutic stability.
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Affiliation(s)
- M C Parkinson
- UCL Hospitals Trust and Institute of Urology, UCL London, UK
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46
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Horwich A, Oliver RT, Wilkinson PM, Mead GM, Harland SJ, Cullen MH, Roberts JT, Fossa SD, Dearnaley DP, Lallemand E, Stenning SP. A medical research council randomized trial of single agent carboplatin versus etoposide and cisplatin for advanced metastatic seminoma. MRC Testicular Tumour Working Party. Br J Cancer 2000; 83:1623-9. [PMID: 11104556 PMCID: PMC2363456 DOI: 10.1054/bjoc.2000.1498] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The UK Medical Research Council conducted this trial of carboplatin chemotherapy in advanced seminoma to compare single agent carboplatin with a standard combination of etoposide with cisplatin. The use of single agent carboplatin was expected to be associated with reduced toxicity. A total of 130 patients with advanced seminoma were randomly assigned to treatment with either single agent carboplatin (C) at a dose of 400 mg/m(2)to be corrected for glomerular filtration rate outside the range 81-120 ml min(-1)and to be administered on day 1 of a 21 day cycle to a total of 4 cycles or to etoposide + platinum (EP). The trial was designed as an equivalence study aiming to exclude a reduction in the 3-year progression-free survival in patients allocated to carboplatin of between 10 and 15%, requiring initially a target accrual of 250 patients (90% power significance level 5% (one-sided)). The trial closed after 130 patients had been randomized following recommendation by an independent data monitoring committee. At a median follow-up time of 4.5 years, 81% of patients had been followed up for at least 3 years and 19 patients have died. The estimated PFS rate (95% Confidence Intervals (CI)) at 3 years was 71% (60-82%) in patients allocated C and 81% (71-90%) in those allocated EP; the 95% CI for the difference in 3 year PFS was - 6% to +19%. The hazard ratio of 0.64 (95% CI 0.32-1.28) favoured EP but the difference was not statistically significant (log rank chi-squared = 1.59 P = 0.21). The 3-year survival rate was 84% (75-92%) in those allocated C, and 89% (81-96%) in those allocated EP. The hazard ratio for survival was 0.85 with 95% CI, 0.35-2.10, log rank chi-squared = 0.12, P = 0.73. The trial has not demonstrated statistically significant differences in the major survival endpoints comparing single agent carboplatin with a combination of etoposide + cisplatin. This cannot be taken as an indication of equivalence since the limited size of this trial rendered it unable to exclude a 19% lower progression-free survival and survival in those treated with single agent carboplatin which would be important clinically. Standard initial chemotherapy for advanced seminoma should be based on cisplatin combinations and the role of carboplatin awaits the outcome of further studies.
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Affiliation(s)
- A Horwich
- Radiotherapy Unit, Royal Marsden Hospital, Downs Rd, Sutton, Surrey, UK
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47
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Fléchon A, Droz JP. [Germ cell tumors of the testes: state of the art]. Cancer Radiother 2000; 4:27-31. [PMID: 10742806 DOI: 10.1016/s1278-3218(00)88649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Germ cell tumors of the testes are rare tumors occurring in young men, the incidence of which increases continuously. They are curable in more than 80% of the cases. The treatment of stage I seminoma is lomboaortic radiotherapy, and that of stage I non-seminomatous tumors is either surveillance, retroperitoneal lymph node dissection or adjuvant chemotherapy according to the risk factors of extra-testicular involvement (pure embryonal carcinoma, vascular invasion). For advanced diseases, the standard treatment is three cycles of bleomycin, etoposide, cisplatin (BEP regimen) or four cycles of the same association without bleomycin (EP regimen) and four cycles of the BEP regimen for patients with good risk and poor risk prognostic characteristics, respectively. The five-year overall survival rates are 90% and 50% for patients with good risk and poor risk factors respectively. It is recommended to resect all residual masses after chemotherapy. The standard salvage treatment is four cycles of vinblastin, ifosfamide, cisplatin (VelP regimen). New associations of drugs are under study in order to improve the overall survival rate for the poor-risk and relapsed-tumors patients.
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Affiliation(s)
- A Fléchon
- Département de cancérologie médicale, Centre Léon-Bérard, Lyon, France
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48
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Abstract
Testicular seminoma is highly curable with currently available treatments. Today, there is good evidence that patients with Stage I disease can be treated equally well with either immediate adjuvant para-aortic and ipsilateral pelvic radiotherapy or close surveillance with treatment at the time of relapse. The decision as to which of these management strategies is adopted in an individual case is a complex function of physician preference, and the emotional, social, and economic circumstances of the patient. Ongoing research in Stage I seminoma is focused at reducing the side-effects of treatment either by modifying the radiation treatment plan or by using adjuvant chemotherapy in lieu of radiation. Stage II patients with small bulk retroperitoneal lymphadenopathy have a high probability of long-term disease control with radiotherapy. Patients with bulky Stage II disease or Stage III disease should be treated with cisplatin-based chemotherapy.
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Affiliation(s)
- M F Milosevic
- Department of Radiation Oncology, Princess Margaret Hospital and the University of Toronto, Canada.
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49
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Abstract
The publication of the proceedings of Fourth Workshop on Carcinoma in situ was an impressive leap in our understanding of the interaction between prenatal and postpubertal factors in the development of germ cell cancer as well as increased insight into the molecular events that are involved in the development of these tumors. From this work, physicians are increasingly accepting that estrogen-mediated prenatal priming of germ cells generates a predisposition to postpubertal cyclin D2-driven initiation of full mitotic cell cycle replication of a tetraploid p53-expressing meiotically arrested pachytene spermatocyte that is under increased gonadotrophin drive because of testicular atrophy inducing events. From this new knowledge, new markers, eg, FGF4, CD30, and OCT-4, of embryonal carcinoma cells are identifying alternative ways of identifying poor risk tumors and leading to renewed interest in study of histopathology of these tumors. With greater attention to late events and increasing confirmation that chemotherapy is better than radiation even in seminoma and that seminoma is more chemosensitive than nonseminoma, a renewed clinical need exists for improved pathologic definition to reduce unnecessary usage of chemotherapy and maximize its benefits. With the failure of vinblastine, ifosfamide, and cisplatin to show any benefit over BEP (bleomycin, etoposide, and cisplatin) in the Southwest Oncology Group trial, re-examination of approaches to treatment of poor risk disease is emphasized as the priority for future trials.
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Affiliation(s)
- R T Oliver
- St. Bartholomew's Hospital and The Royal London School of Medicine, Queen Mary and Westfield College, West Smithfield, UK
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50
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Ravi R, Ong J, Oliver RT, Badenoch DF, Fowler CG, Hendry WF. The management of residual masses after chemotherapy in metastatic seminoma. BJU Int 1999; 83:649-53. [PMID: 10233573 DOI: 10.1046/j.1464-410x.1999.00974.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review our experience in management of residual masses after chemotherapy for metastatic seminoma. PATIENTS AND METHODS The study comprised a review of 107 patients with metastatic seminoma, treated with initial chemotherapy from 1978 to 1996. Forty-three patients had residual masses detected by computed tomography after chemotherapy, while 64 achieved a complete response. Residual masses were classified radiologically as <3 cm or >/=3 cm and as well- or poorly defined. Of the patients with residual masses, 19 underwent surgery, while 24 were observed. RESULTS Viable cancer was present in six of 11 patients with well-defined residual masses of >/=3 cm (positive histology in three of six undergoing surgery and site relapses in three of five observed), one of 14 patients with poorly defined masses of >/=3 cm (negative histology in nine undergoing surgery and site relapse in one of five observed), and in none of 17 patients with residual masses of <3 cm (negative histology in four undergoing surgery and no site relapses in 13 observed; one additional patient in this group died from treatment complications). CONCLUSION Patients with a complete response after chemotherapy, a residual mass of <3 cm and a poorly defined residual mass of >/=3 cm can be observed, reserving intervention for recurrent or progressive disease. Well-defined residual masses of >/=3 cm should be resected because there is a 55% likelihood of persistent tumour.
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Affiliation(s)
- R Ravi
- St Bartholomew's and The Royal London Hospital School of Medicine and Dentistry, London, UK
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