Bone metastases in germ cell tumor patients

Bokemeyer, Carsten; Kollmannsberger, Christian; Mayer, Frank; Berger, Lars Arne; Oing, Christoph; Honecker, Friedemann

doi:10.1007/s00432-012-1169-3

Cited by 31 publications

(31 citation statements)

References 19 publications

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“…Retrospective data from the German Testicular Cancer Study Group reported that 63% of NSGCT patients (including primary mediastinal cases) with bone metastases receiving HDCT as a first-line treatment achieved lasting progression-free survival. 18 Although important findings were observed, many potential biases resulting from the retrospective design of the analysis have to be considered. First, information on the decisionmaking process for selecting the first-line or second-line chemotherapy or marker-positive surgery is not available.…”

Section: Discussionmentioning

confidence: 99%

Identification of a subgroup with worse prognosis among patients with poor‐risk testicular germ cell tumor

et al. 2015

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Results: The median follow-up period of all patients was 57 months. A total of 50 patients (43%) were classified as having intermediate prognosis, and 67 patients (57%) as poor prognosis according to the International Germ Cell Cancer Collaborative Group classification. As first-line chemotherapy, 92 patients (79%) received bleomycin, etoposide and cisplatin. Of all patients, 74 patients (63%) received second-line chemotherapy. The most commonly used second-line chemotherapy regimens were a combination of taxanes, ifosfamide and platinum in 49 cases (66%). Overall, 33 patients (28%) received third-line chemotherapy. A total of 88 patients (75%) underwent post-chemotherapy surgery. The 5-year overall survival for intermediate (n = 50) and poor prognosis (n = 67) was 89% and 83% (P = 0.21), respectively. In poor prognosis patients, patients with two or more risk factors (any of high lactic dehydrogenase, alpha-fetoprotein and human chorionic gonadotropin levels, and presence of non-pulmonary visceral metastases) had significantly worse survival than those with only one risk factor (71% and 91%, respectively, P = 0.01). Conclusions:The 5-year overall survivals of poor-prognosis testicular nonseminomatous germ cell tumor patients reached 83%. Further stratification of poorprognosis patients based on a number of risk factors has the potential to further identify those with poorer prognosis.

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Section: Discussionmentioning

confidence: 99%

Identification of a subgroup with worse prognosis among patients with poor‐risk testicular germ cell tumor

et al. 2015

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“…Bone metastasis is also rare, constituting less than 1% of metastasis at the time of primary diagnosis or relapse [40]. However, it has been shown in patients specifically with poorrisk disease to constitute up to 9% [41]. In this study, Oechsle et al retrospectively reviewed40 patientswith bonemetastases from a cohort of 434 patients with poor-risk disease [41].…”

Section: Postchemotherapy Surgery For Sites Outside the Retroperitoneummentioning

confidence: 99%

“…However, it has been shown in patients specifically with poorrisk disease to constitute up to 9% [41]. In this study, Oechsle et al retrospectively reviewed40 patientswith bonemetastases from a cohort of 434 patients with poor-risk disease [41]. All patients underwent primary high-dose cisplatin-based chemotherapy with peripheral blood stem cell reinfusion.…”

Section: Postchemotherapy Surgery For Sites Outside the Retroperitoneummentioning

confidence: 99%

“…All patients underwent primary high-dose cisplatin-based chemotherapy with peripheral blood stem cell reinfusion. Four patients (10%) underwent surgical consolidation, all of whom had the finding of necrosis at the time of surgery [41]. As with disease of the brain, the ultimate timing and role of surgery for bone metastasis remain uncertain.…”

Section: Postchemotherapy Surgery For Sites Outside the Retroperitoneummentioning

confidence: 99%

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Postchemotherapy Surgery for Germ Cell Tumors—What Have We Learned in 35 Years?

et al. 2014

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Postchemotherapy surgery for advanced testicular cancer has evolved over the last couple of decades. Patients with nonseminomatous germ cell tumors and residual retroperitoneal mass ≥1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (RPLND). For seminoma, RPLND is considered in those patients with masses ≥3 cm that are also positron emission tomography positive. Masses that occur outside of the retroperitoneum should be completely resected with the possible exception of bilateral lung masses when resection of the first mass shows necrosis. The role of surgery in patients with extragonadal germ cell tumors is most vital in those with primary mediastinal nonseminomatous germ cell tumors. Importantly, patient selection, surgical planning, and consideration of referral to centers with this expertise are important to optimize success.

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“…In one series including 19 patients with bone involvement (13 primary and 6 relapsed tumors) treated by conventional chemotherapy, no information on the further management of the bone lesions after initial chemotherapy was given [36]. In the largest series available which included 40 patients with primary bone metastases from germ cell tumors (all had non-seminomas) who underwent primary high-dose chemotherapy, long-term progression-free survival was achieved in 63% of patients [37]. In this study, the overall treatment response rate (85%) was identical in patients with and without metastatic bone involvement.…”

Section: Germ Cell Tumorsmentioning

confidence: 99%

Treatment of Bone Metastases in Urologic Malignancies

Froehner¹,

Hölscher

Hakenberg

et al. 2014

Urol Int

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The skeletal system is the most common site of metastatic cancer spread. Bone metastases are often associated with severe morbidity, pain and functional impairment. Timely diagnosis and proper treatment may decrease morbidity, improve quality of life and in some cases even improve survival. External beam radiotherapy may effectively give pain relief in patients with painful bone metastases. In bone metastases from castration-resistant prostate cancer or urothelial bladder cancer, treatment with zoledronic acid or denosumab may reduce skeletal-related events. In contrast to castration-resistant prostate cancer, in patients with bone metastases from bladder cancer such treatment may even improve survival. On the other hand, the efficacy of these agents is questionable in patients with bone involvement from metastatic renal cell carcinoma or germ cell tumors. When bisphosphonates or denosumab are considered in such cases, the potential benefits of treatment should be critically weighed against the risk of side effects. In germ cell tumors, bone metastases may be cured by cisplatin-based chemotherapy, however, there are only limited data on the specific management of residual disease. Oligometastases may be treated by stereotactic radiotherapy or - especially in patients with renal cell carcinoma - by surgical resection and endoprosthetic replacement. Limited data are available on the management of bone involvement in germ cell tumors. Decisions on the resection or local radiotherapy of residual disease should be individualized considering the overall response and the feasibility and risks of resection.

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Bone metastases in germ cell tumor patients

Cited by 31 publications

References 19 publications

Identification of a subgroup with worse prognosis among patients with poor‐risk testicular germ cell tumor

Identification of a subgroup with worse prognosis among patients with poor‐risk testicular germ cell tumor

Postchemotherapy Surgery for Germ Cell Tumors—What Have We Learned in 35 Years?

Treatment of Bone Metastases in Urologic Malignancies

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