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

Weinknecht, S.; Hartmann, Melanie; Weißbach, L.

doi:10.1007/s001200050224

Cited by 4 publications

(1 citation statement)

References 9 publications

(14 reference statements)

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“…It is only known that patients with more than one tumor localisation or elevated HCG values have a worse prognosis. In a series from Weinknecht et al [1998], the successfully treated patients had values of AFP between 38 and 30.552 ng/ml and of HCG between 4.4 and 76.2 U/l prior to RTR.…”

Section: Weißbachmentioning

confidence: 99%

Guidelines for the Diagnosis and Therapy of Testicular Cancer and New Developments

Weißbach

1999

Urol Int

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The guidelines of testicular cancer were elaborated and agreed upon interdisciplinarily. Standard therapy of stage I seminoma is infradiaphragmatic radiotherapy. Possible alternatives are adjuvant carboplatin therapy (still in test procedure) and, in case of lacking risk factors, the watch-and-wait strategy. If small metastases of lymph nodes exist, radiotherapy requires a higher dose and a larger beam field. Standard therapy in clinical stage IIC–III is cisplatin-based multidrug chemotherapy. In regard to nonseminomatous germ cell tumor there are no universal recommendations: retroperitoneal lymphadenectomy (RLA) with protection of ejaculation function, watch-and-wait strategy as well as adjuvant chemotherapy have the same cure rate but differ in relapse rate and morbidity. Knowing the crucial risk factors – depending on the expected relapse rate – it will be possible to recommend adjuvant chemotherapy or wait-and-see strategy in the future. In case of lymph nodes up to 5 cm, three different therapeutic strategies are possible. They reach the same cure rate, but are associated with different morbidity: primary nerve-sparing RLA plus adjuvant chemotherapy, primary nerve-sparing RLA without adjuvant chemotherapy, and primary chemotherapy. Advanced stages are related to three different groups in reference to their prognosis. At present, they are still treated with three or four cycles of PEB. In current protocols, patients with ‘poor prognosis’ receive high-dose therapy afterwards. These results have to be taken in consideration when updating the guidelines. The present guidelines also give notes for the therapy of TIN, residual tumor resection (RTR), management of CNS metastases, and therapy of recurrences.

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Section: Weißbachmentioning

confidence: 99%

Guidelines for the Diagnosis and Therapy of Testicular Cancer and New Developments

Weißbach

1999

Urol Int

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Chirurgische Therapie von Lungenmetastasen

Schirren¹,

Muley²,

Trainer³

et al. 2006

Kompendium Internistische Onkologie

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Regression von Keimzelltumoren nach Chemotherapie

2004

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Today the treatment of gonadal germ cell tumors is standardized. The cisplatin containing chemotherapy and the multi-modal therapy strategies have increased the rate of successful treatment enormously. Germ cell tumors are almost always treated surgically. Following the rare, primary chemotherapy, the residual tumor must be classified according to the WHO as accurately as possible. A binding system for the documentation of tumor regression does not exist. The diagnostic retroperitoneal lymphadenectomy is also rare. Here as well, the classification is performed according to the WHO and the TNM classification. The examination of the tissue samples from a retroperitoneal lymphadenectomy after chemotherapy is problematic. The morphology is often bizarre, preparatory and terminological standards do not exist. Is there still vital tumor present then it can most often be diagnosed as a teratoma. In that case a classification takes place as to whether it is "mature" or "immature". If a tissue sample contains other differentiations, the classification is performed in detail according to the WHO classification of germ cell tumors. Sarcomas or carcinomas must be reliably distinguished and classified, as they lead to different therapeutic consequences. The terminology must be defined in a binding manner between both the pathology and the clinic, due to the lack of global definitions.

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

Cited by 4 publications

References 9 publications

Guidelines for the Diagnosis and Therapy of Testicular Cancer and New Developments

Guidelines for the Diagnosis and Therapy of Testicular Cancer and New Developments

Chirurgische Therapie von Lungenmetastasen

Regression von Keimzelltumoren nach Chemotherapie

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