Chemotherapy for Advanced Testicular Cancer

Fox, Edward P.; Loehrer, Patrick J.

doi:10.1016/s0889-8588(18)30377-0

Cited by 12 publications

(6 citation statements)

References 42 publications

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“…Randomized trials for patients with NSGCT have demonstrated 56 to 74% complete response rate with primary chemotherapy, and an additional 10 to 25% of patients have been rendered disease-free with postchemotherapy resection of residual radiologic abnormalities. [2] RPLND defines three subsets of patients based on histopathologic analysis of the resected specimen: 40%, necrosis/fibrosis; 40%, adult teratoma; and 20%, residual NSGCT. Therefore, approximately 60% of patients with evidence of a residual mass on postchemotherapy imaging studies either have viable cancer or teratoma.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in postchemotherapy residual masses in germ cell tumor of the testis

Bansal¹,

Agrawal

Mandhani³

2011

Indian J Urol

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Residual masses following chemotherapy in testicular tumors have been characterized as necrosis, mature or immature teratoma, and malignant tumors. Twenty four patients had retroperitoneal lymph node dissection for postchemotherapy residual masses between January 2000 and December 2008. We report two patients; one with late relapse and other with postchemotherapy residual mass, who had tuberculosis. Tumor markers were normal, and PET scan showed increased uptake in residual mass. There are no previous reports of tuberculosis in postchemotherapy residual masses.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis in postchemotherapy residual masses in germ cell tumor of the testis

Bansal¹,

Agrawal

Mandhani³

2011

Indian J Urol

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“…The group of patients analyzed included those who had been entered into a series of Indiana University and Southeastern Cancer Study Group (SECSG) randomized clinical trials for advanced testicular cancer, the results of which have been reviewed elsewhere [9]. These patients were managed with a uniform treatment policy.…”

Section: Methodsmentioning

confidence: 99%

Persistent cancer in postchemotherapy retroperitoneal lymph-node dissection: outcome analysis

et al. 1994

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Surgery following chemotherapy for treatment of metastatic testis cancer is reserved for partial remissions with localized tumors considered resectable. After primary chemotherapy, about 90% will have teratoma or necrosis and only 10% will have cancer. The concept of two cycles of post operative chemotherapy in this small group with cancer is supported by a 70% long term cure rate. A more difficult group of patients are those who have had not only primary but also salvage chemotherapy for refractory tumor. About 55% of these patients undergoing post (salvage) chemotherapy RPLND surgery have persistent cancer in the resected specimen. There is no data to support the routine use of repeat salvage chemotherapy post operatively. Of 91 patients presenting for surgery post salvage chemotherapy, 53 were considered completely resected and 36 incompletely resected. Of the 53 realistic candidates for cure with complete resections, 25 were given post operative repeat salvage chemotherapy and 28 received none. 9 (36%) receiving more chemotherapy remained NED and 12 (43%) receiving none remained NED. 12 in each group died of disease. Therefore, there is no data to support routine repeat salvage chemotherapy in patients considered completely resected who had already received salvage chemotherapy pre-operatively. Rather the outcome in this cohort depends more on the completeness of its resectability. Testicular cancer has become the model for a curable neoplasm [1]. With cisplatin-based chemotherapy and the integration of postchemotherapy resection of residual neoplastic deposits, one can expect an overall cure rate of approximately 80% in patients presenting with disseminated disease. Of the patients requiring resections of residual disease after primary chemotherapy, historically, approximately 90% will have either necrosis or teratoma in their resected specimens. This number drops to 50% in patients resected after salvage chemotherapy [2]. In those cases in which necrosis or teratoma is the histologic diagnosis, it is clear that no further chemotherapy is immediately indicated since these patients have historically done quite well,with only a few patients requiring any further chemotherapy for relapsed disease. However, further surgery is often required for patients with bulky (> 5 cm) teratoma, who are at high risk for recurrent teratoma [3].Conversely, the finding of viable-appearing nonseminomatous germ-cell tumor (NSGCT) in the postchemotherapy resection specimen has been associated with a high risk of relapse if no postoperative chemotherapy is given [4,5]. For this reason, it has become standard practice to give an additional two cycles of cisplatin-based induction chemotherapy when viable NSGCT is identified. This chemotherapy is given on the presumption that even with an apparently complete surgical resection there is residual microscopic NSGCT that would potentially be eradicated by an additional two cylces of induction chemotherapy.This concept of giving an additional two cycles of induction chemotherapy postoperat...

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“…Markerpositive Keimzelltumoren · Residualtumorresektion (RTR) · Salvagechemotherapie · Hochdosischemotherapie Etwa 70±80 % der Patienten mit fortgeschrittenen Stadien von Keimzelltumoren werden allein durch die Chemotherapie oder durch Kombination mit einer Residualtumorresektion (RTR) geheilt, wenn ein markernegativer Status erreicht wurde [5,7,15]. Eine Chemoresistenz ist anzunehmen, wenn die Tumormarker Alphafetoprotein (AFP) und/oder humanes Choriongonadotropin (HCG) nach Chemotherapie nicht zeitgerecht abfallen, persistieren oder gar ansteigen.…”

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Marker-positive patients with germ-cell tumors: when is residual tumor resection useful?

Weinknecht

Hartmann

Weißbach

1998

Urologe

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We analyzed 33 patients with disseminated germ cell tumors (GCT) who underwent residual tumor resection (RTR) during the period from 1991-1997. The patients were marker positive prior to surgery were analyzed. The histopathological examination of the resected masses, the marker dynamics and the relapse-free respectively the progression free survival, were evaluated. The status differed at primary diagnosis: minimal disease n = 1, moderate disease n = 15, advanced disease n = 17. The patients received at average 8.5 cisplatin-containing cycles of polychemotherapy. Only 11 patients underwent surgery after first-line-chemotherapy. The remaining received second- or third-line-chemotherapy prior to surgery. In 12 of 31 evaluable patients, a durable CR was achieved. The median follow-up for this group is 30 months (2-58 months). The histopathologic examination of the resected specimen and the tumor marker level prior to RTR do not permit determination of prognostic outcome. After operation 44% of the AFP-positive and 30% of the beta-HCG-positive patients had a durable remission. If tumor marker levels at time of RTR are within normal range, disease-free survival is 72%; in case of elevated markers 39% will survive. If intensive chemotherapy fails to normalize markers, RTR remains the only option to change the fatal course of the disease.

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Chemotherapy for Advanced Testicular Cancer

Cited by 12 publications

References 42 publications

Tuberculosis in postchemotherapy residual masses in germ cell tumor of the testis

Tuberculosis in postchemotherapy residual masses in germ cell tumor of the testis

Persistent cancer in postchemotherapy retroperitoneal lymph-node dissection: outcome analysis

Marker-positive patients with germ-cell tumors: when is residual tumor resection useful?

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