Late Recurrence of Nonseminomatous Germ Cell Tumor Successfully Treated with Intensity-modulated Radiation Therapy

Kita, Yuki; Imamura, Masaaki; Mizowaki, Takashi; Norihisa, Yoshiki; Yoshimura, Koji; Hiraoka, Masahiro; Ogawa, Osamu

doi:10.1093/jjco/hyt090

Cited by 9 publications

(2 citation statements)

References 9 publications

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“…Kitsukawa et al [ 7 ] reported a case of mediastinal embryonic carcinoma with cerebellar metastases that disappeared completely after 30 Gy of radiotherapy. Kita et al [ 18 ] reported complete clinical remission of a residual retrocrural NSGCT with 60 Gy delivered by intensity-modulated radiation therapy (IMRT). In our case, radical resection of the residual tumor was difficult because of extensive pericardium and great blood vessel involvement; thus, radiotherapy using the VMAT technique was administered to reduce the exposure dose to normal tissues.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of radiotherapy and apatinib in patient with mediastinal mixed non-seminomatous germ cell tumor

et al. 2021

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Rationale: Mediastinal non-seminomatous germ cell tumors (MNSGCTs) are rare malignancies. Chemotherapy followed by surgical resection has been regarded as the standard management, but treatment options for chemotherapy-refractory patients or those with unresectable tumors are limited, resulting in a very poor prognosis.Patient concerns: An 18-year-old female presented with symptoms of cough, chest tightness, and shortness of breath for 2 months, and the symptoms gradually worsened.Diagnosis: Computed tomography (CT) revealed a large mediastinal mass invading the pericardium and great blood vessels. Serum human chorionic gonadotropin (HCG) and a-fetoprotein (AFP) levels were normal. Histopathological examination of biopsy specimens revealed mixed MNSGCT with embryonal carcinoma and immature teratoma components. Interventions:The patient achieved complete remission (CR) and long-term survival after multimodal therapy comprising chemotherapy, positron emission tomography/CT (PET/CT)-guided volumetric-modulated arc therapy (VMAT), and anti-angiogenic targeted therapy.Outcomes: The patient was followed up for more than 4 years without recurrence, metastasis, or treatment-related adverse effects.Lessons: The case presented here highlights the importance of multidisciplinary diagnosis and treatment, providing evidence that radiotherapy and anti-angiogenic therapy may play an important role in unresectable or residual tumors after failure of conventional treatments of MNSGCT. Percutaneous biopsy is necessary for diagnosis if the tumor is unresectable, and serum AFP and HCG levels are normal. Additionally, PET/CT is an effective method for evaluation of efficacy and radiotherapy guidance for patients with MNSGCTs. Abbreviations: AFP = a-fetoprotein, CA125 = carbohydrate antigen 125, CR = complete remission, CTV = clinical target volume, DVH = dose volume histogram, GCT = germ cell tumor, GTV = gross tumor volume, HCG = human chorionic gonadotropin, ISRT = involved-site radiation therapy, LDH = lactate dehydrogenase, MGCT = mediastinal germ cell tumor, MNSGCT = mediastinal nonseminomatous germ cell tumor, NSE = neuron-specific enolase, PET/CT = positron emission tomography/computed tomography, PASP = pulmonary artery systolic pressure, PR = partial response, ProGRP = pro-gastrin-releasing peptide, PTV = planning target volume, SD = stable disease, VEGFR = vascular endothelial growth factor receptor, VMAT = volumetric-modulated arc therapy.

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Section: Discussionmentioning

confidence: 99%

Successful treatment of radiotherapy and apatinib in patient with mediastinal mixed non-seminomatous germ cell tumor

et al. 2021

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“…The role of radiation therapy for late relapsed tumor with SM remains poorly understood. There has been one report of metastatic late relapsed GCT successfully managed with radiation therapy [ 10 ]. Chemotherapy against transformed component and/or radiation therapy may have roles for unresectable tumor.…”

Section: Discussionmentioning

confidence: 99%

Two cases of somatic-type malignancy as a very late relapse of testicular cancer successfully managed by surgical resection

Washino

Konishi

Saito

et al. 2017

Journal of Surgical Case Reports

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A late-relapse germ cell tumor might contain malignant non-germ cell tumors, known as ‘somatic-type malignancy (SM)’. The development of a secondary SM is rare, and this phenomenon remains poorly understood. Case 1 developed lung metastasis 13 years after chemotherapy followed by retroperitoneal lymph node dissection for stage IIA non-seminoma. The tumor increased in size after chemotherapy. The patient underwent a pneumonectomy. Pathology revealed an adenocarcinoma with immature teratoma. The patient has experienced no relapse for 9 years. Case 2 developed a pelvic tumor after 10 years of surveillance for stage I seminoma. The tumor increased in size after chemotherapy. The patient underwent pelvic tumor resection with cystectomy. Pathology revealed a mature teratoma with SMs consisting of sarcoma and adenocarcinoma. The patient has experienced no relapse for 6 months. Surgical resection played a major role in the treatment of very late-relapse germ cell tumors with SM.

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Radiotherapy role in non-seminomatous germ cell tumors, radiobiological and technical issues of an unexplored scenario

et al. 2021

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Late Recurrence of Nonseminomatous Germ Cell Tumor Successfully Treated with Intensity-modulated Radiation Therapy

Cited by 9 publications

References 9 publications

Successful treatment of radiotherapy and apatinib in patient with mediastinal mixed non-seminomatous germ cell tumor

Successful treatment of radiotherapy and apatinib in patient with mediastinal mixed non-seminomatous germ cell tumor

Two cases of somatic-type malignancy as a very late relapse of testicular cancer successfully managed by surgical resection

Radiotherapy role in non-seminomatous germ cell tumors, radiobiological and technical issues of an unexplored scenario

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