Postchemotherapy residual masses in germ cell tumor patients

Stenning, Sally; Parkinson, M. C.; Fisher, Cyril; Mead, G. M.; Cook, Arron; Fosså, Sophie D.; Horwich, A.; Jones, William G.; Newlands, E. S.; Oliver, R. T. D.; Stenwig, Anna E.; Wilkinson, Peter M

doi:10.1002/(sici)1097-0142(19981001)83:7<1409::aid-cncr19>3.0.co;2-8

Cited by 68 publications

(9 citation statements)

References 41 publications

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“…The presence of only mature differentiated cells in residual tumor masses after chemotherapy is a favorable prognostic factor, while the presence of residual undifferentiated cells predicts disease recurrence (Stenning et al, 1998). These and other data suggest that undifferentiated cells are primarily responsible for tumor growth and disease progression, consistent with the cancer stem cell model.…”

Section: The Cancer Stem Cell Modelmentioning

confidence: 99%

Cancer Stem Cells: Impact, Heterogeneity, and Uncertainty

2012

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The differentiation of tumorigenic cancer stem cells into non-tumorigenic cancer cells confers heterogeneity to some cancers beyond that explained by clonal evolution or environmental differences. In such cancers, functional differences between tumorigenic and non-tumorigenic cells influence response to therapy and prognosis. However, it remains uncertain whether the model applies to many, or few, cancers due to questions about the robustness of cancer stem cell markers and the extent to which existing assays underestimate the frequency of tumorigenic cells. In cancers with rapid genetic change, reversible changes in cell states, or biological variability among patients the stem cell model may not be readily testable.

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Section: The Cancer Stem Cell Modelmentioning

confidence: 99%

Cancer Stem Cells: Impact, Heterogeneity, and Uncertainty

2012

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“…Tait el al reported an observed relapse rate of 7% in 28 patients with completely resected teratoma at a median follow up of 37 months 73. In an international study, Stenning et al reported similar results in a cohort of 153 patients undergoing PCRPLND 74. The 2 year progression free survival for resected mature and immature teratoma was 86% and 89%, respectively.…”

Section: Clinical Stages 2 Andmentioning

confidence: 88%

Optimal management of testicular cancer: from self-examination to treatment of advanced disease

Beck¹

2010

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Germ-cell cancer is the most common solid tumor in men aged 15 to 35 years and has become the model for curable neoplasm. Over the last 3 decades, the cure rate has increased from 15% to 85%. This improved cure rate has been largely attributed to the introduction of cisplatin-based chemotherapy. In stage I seminoma and nonseminoma, cure rates approach 100% and treatment is governed by patient choice based on the perceived morbidities of each therapy and personal preferences. For seminoma, treatments include surveillance, radiotherapy, and single course carboplatin. For nonseminoma, treatments include surveillance, retroperitoneal lymph node dissection (RPLND), and adjuvant chemotherapy. Low volume (<3 cm) stage II seminoma is typically managed with radiotherapy while higher volume (>3 cm) stage II and stage III disease treated with chemotherapy. Positron emission tomography (PET) imaging can differentiate active cancer versus necrosis for postchemotherapy residual masses. PET-positive masses are managed with either surgery or second-line chemotherapy. Low volume (,5 cm) stage II nonseminoma with normal serum tumor markers may be managed with either RPLND or chemotherapy. Patients with persistently elevated serum tumor markers and larger volume stage II and stage III disease are managed with systemic chemotherapy. As with seminoma, good risk patients are typically treated with 3 courses of bleomycin, etoposide, and cisplatin (BEP) and intermediate and poor risk patients are treated with 4 courses. Residual postchemotherapy masses should be resected due to the uncertainty of the histology with 50% to 60% harboring residual teratoma or active cancer. The majority of patients completing initial therapy who relapse do so within 2 years. A minority of patients (2%-3%) recur after 2 years and this phenomenon is termed late relapse. Excluding chemonaïve patients, late relapse disease is typically managed surgically with 50% being cured of disease. Current therapeutic challenges in testis cancer include the accurate prediction of postchemotherapy histology to avoid surgery in patients harboring fibrosis only, improved therapy in platinum-resistant and platinum-refractory disease, and the understanding of the biology of late relapse.

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“…[478] Rates of disease progression have been shown to increase as much as 4-fold in patients with incompletely resected residual metastases. [733–35]…”

Section: Clinical Implications Of An Uncontrolled Retroperitoneummentioning

confidence: 99%

Surgery for retroperitoneal relapse in the setting of a prior retroperitoneal lymph node dissection for germ cell tumor

et al. 2010

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Recognition of the therapeutic role of retroperitoneal lymph node dissection (RPLND) in the setting of testicular germ cell tumors (GCTs) is of utmost importance. Although the histologic findings of RPLND provide diagnostic and prognostic information, the adequacy of initial RPLND is an independent predictor of clinical outcome. Despite the advent of effective cisplatin-based chemotherapy for testicular GCTs, patients who have undergone suboptimal surgery at the time of initial RPLND are compromised. Despite the initial enthusiasm surrounding anatomic mapping studies, the use of modified RPLND templates has the potential to leave a significant number of patients with unresected retroperitoneal disease. Teratomatous elements are particularly common. Patients with retroperitoneal relapse following initial RPLND should be treated with reoperative RPLND and chemotherapy and can expect long term survival rates nearing 70% when treated in tertiary centers by experienced surgeons.

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Postchemotherapy residual masses in germ cell tumor patients

Cited by 68 publications

References 41 publications

Cancer Stem Cells: Impact, Heterogeneity, and Uncertainty

Cancer Stem Cells: Impact, Heterogeneity, and Uncertainty

Optimal management of testicular cancer: from self-examination to treatment of advanced disease

Surgery for retroperitoneal relapse in the setting of a prior retroperitoneal lymph node dissection for germ cell tumor

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