RESUMEN
PURPOSE: To evaluate the probability of subsequent testicular cancer (STC) in patients with intratubular germ cell neoplasia unclassified (IGCNU) treated for first-time invasive germ cell cancer. PATIENTS AND METHODS: Sixty-one patients with germ cell testicular cancer or extragonadal germ cell cancer received follow-up from diagnosis of IGCNU to development of STC, initiation of IGCNU-definitive treatment (orchiectomy/radiotherapy), emigration, death, or end of follow-up. The probability of STC was assessed in subgroups according to chemotherapy burden. RESULTS: The probability of STC in the nonexposed patients was significantly increased compared with those exposed to chemotherapy (P = .05; 5-year probability of 54% [95% CI, 33% to 78%] and 23% [95% CI, 11% to 45%], respectively). In the group of patients treated with one to three cycles or no chemotherapy, the probability of STC was significantly increased compared with those exposed to four or more cycles (P = .03; 5-year probability of 42% [95% CI, 27% to 62%] and 22% [95% CI, 8% to 54%], respectively). Twenty-two of 22 patients were tumor-free and alive at a median of 56 months (range, 2 to 184 months) after diagnosis of STC. CONCLUSION: Platinum-based chemotherapy may reduce the probability of STC in patients with IGCNU, particularly in those treated with four or more cycles of chemotherapy. A watch-and-wait strategy for patients with IGCNU may be justified in selected patients with future plans for paternity.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Germinoma/tratamiento farmacológico , Germinoma/prevención & control , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/prevención & control , Orquiectomía , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/prevención & control , Espera Vigilante , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Biopsia , Bleomicina/administración & dosificación , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Supervivencia sin Enfermedad , Etopósido/administración & dosificación , Germinoma/diagnóstico , Germinoma/radioterapia , Germinoma/cirugía , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Primarias Secundarias/diagnóstico , Noruega/epidemiología , Compuestos de Platino/administración & dosificación , Radioterapia Adyuvante , Estudios Retrospectivos , Riesgo , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/radioterapia , Neoplasias Testiculares/cirugíaRESUMEN
Central nervous system (CNS) germinoma is a curable tumor and its recurrence rate after initial therapy may be approximately 10% or higher. This study elucidates the time-course of recurrence and results of salvage therapy. Twenty-five patients with recurrent germinoma treated at Hokkaido University Hospital were retrospectively reviewed. The median age at initial treatment was 12 years (range: 8-37). All patients had been tumor-free for at least 6 months after the initial treatment. The median follow-up period was 134 months (range: 44-338). The median age at first recurrence was 18 years and the median time to the first recurrence was 50 months. Among the patients, 9 (36%) had the first recurrence at 60 months or later. The latest recurrence in a patient occurred 230 months after the initial treatment. The results of salvage therapy were estimated in all 25 patients. Seventeen patients (68%) were salvaged and were tumor-free at the final observation. The remaining 8 patients died of disease. At first recurrence, 11 patients were treated using radiation therapy with or without surgery and 7 out of the 11 patients died due to the recurrent tumor. On the other hand, 13 patients who received salvage chemotherapy and radiotherapy were tumor-free at the last follow-up. In conclusion, late recurrence is not a rare event in patients with CNS germinoma. To identify a true cure rate of this disease, a 10-year or longer observation period may be required. As a salvage therapy, platinum-based chemotherapy followed by wide-field low-dose radiation therapy appears to be effective.
Asunto(s)
Neoplasias del Sistema Nervioso Central/prevención & control , Germinoma/prevención & control , Terapia Recuperativa/métodos , Adolescente , Adulto , Neoplasias del Sistema Nervioso Central/mortalidad , Niño , Femenino , Estudios de Seguimiento , Germinoma/mortalidad , Humanos , Masculino , Inducción de Remisión , Estudios Retrospectivos , Prevención Secundaria , Factores de Tiempo , Adulto JovenRESUMEN
Patients diagnosed with germ cell tumors (GCT) are relatively young, and most are rendered disease-free by primary treatment. Also, second-line therapies in nearly all instances are potentially curative. Therefore, the schedule and modalities of follow-up testing are important issues in detecting recurrence of GCT and for detecting secondary malignancies and complications of therapy. Follow-up is usually based on the pattern and probability of recurrence following primary therapy according to stage and histology. The National Comprehensive Cancer Network has outlined guidelines (www.nccn.org/physician_gls/index.html). There is a paucity of randomized data regarding the follow-up regimens most effective in identifying relapsed disease. Optimal means of imaging and frequency of physician visits and serum marker level measurements need to be further addressed.
Asunto(s)
Continuidad de la Atención al Paciente/normas , Germinoma/diagnóstico , Germinoma/secundario , Tamizaje Masivo/normas , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Primarias Secundarias/diagnóstico , Germinoma/prevención & control , Germinoma/terapia , Humanos , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Neoplasias Primarias Secundarias/prevención & control , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVE: To report a retrospective review of patients with a testicular germ cell tumour treated in a large cancer centre who developed a second tumour, as 1.8-5% of such patients will subsequently develop a new primary tumour in the contralateral testis. PATIENTS AND METHODS: From a database of 570 men treated for testicular cancer in the West of Scotland between 1989 and 1998, all those who developed bilateral testicular tumours were identified. RESULTS: Nineteen men (3.3%) developed a second primary testicular malignancy; the mean age at diagnosis of the first tumour was 29.5 years, with the mean (range) interval to diagnosis of the second tumour of 76 (11-181) months (except for one man with synchronous tumours). The first tumour was teratoma in 11 and seminoma in seven; one patient had synchronous bilateral teratoma. The second primary was teratoma in 10 and seminoma in eight. Known risk factors for carcinoma in situ were present in nine patients, i.e. a small atrophic contralateral testis in five, a family history of testicular cancer in two, a history of infertility in two and unilateral undescended testis in one. Two patients had had contralateral testicular biopsies at the first diagnosis; both were negative for intratubular germ cell neoplasia (IGCN). Eight patients had chemotherapy to treat the first tumour and 14 for the second. All underwent bilateral orchidectomy. Overall, 18 of 19 men are alive and disease-free, with a median follow-up of 51 months. Pathology for 12 of the second testicular tumours was available for review; there was no IGCN in any of the slides from three patients, it was only present focally around the tumour in seven, and was diffuse in two patients. CONCLUSIONS: Chemotherapy for the first testicular tumour does not eliminate the risk of developing a contralateral tumour. Despite careful follow-up, in most patients the second primary tumour was not diagnosed early enough to avoid chemotherapy. The focal nature of IGCN in the second testis in most patients questions the value of biopsy of the contralateral testis. Improved methods of detecting patients at risk of second testicular tumours are needed.
Asunto(s)
Germinoma/prevención & control , Neoplasias Primarias Múltiples/prevención & control , Neoplasias Testiculares/prevención & control , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Estudios de Seguimiento , Germinoma/patología , Germinoma/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/radioterapia , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Testiculares/patología , Neoplasias Testiculares/radioterapiaRESUMEN
A few dietary studies have found elevated testicular cancer risks for higher red meat, fat, and milk intakes and lower intakes of fruits, vegetables, and fiber. Because hormonal modulation by dietary intake of plant estrogens could affect risk of testicular cancer, we chose to explore the possible relationship between dietary phytoestrogens and testicular cancer. We conducted a hospital-based case-control study of 159 testicular cancer cases diagnosed between 1990 and 1996 and 136 adult friend-matched controls at the University of Texas M. D. Anderson Cancer Center. Amounts of phytoestrogenic compounds in foods were added to the National Cancer Institute's DietSys program and then grouped into prelignans, lignans, flavonoids, isoflavonoids, phytosterols, and coumestrol for statistical analysis, expressed per 1,000 kcal. The results of multivariate logistic regression analysis showed, after adjustment for age, education, income, ethnicity, cryptorchidism, body mass index, baldness unrelated to therapy, severe acne in adolescence, early puberty, daily fiber and fat intake, and total daily calories, no discernable monotonic increased or decreased risk estimates across quartiles of phytoestrogen intake. A U-shaped pattern was observed for lignans and coumestrol. Further evaluation of this pattern by cubic spline parameterization did fit the data, but the data were also consistent with no effect. This hypothesis-generating study does not support the premise that dietary phytoestrogens increase or decrease testicular cancer risk in young men.
Asunto(s)
Anticarcinógenos/administración & dosificación , Estrógenos no Esteroides/administración & dosificación , Isoflavonas , Neoplasias Testiculares/etiología , Adolescente , Adulto , Estudios de Casos y Controles , Análisis de los Alimentos , Germinoma/epidemiología , Germinoma/etiología , Germinoma/prevención & control , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Fitoestrógenos , Preparaciones de Plantas , Seminoma/epidemiología , Seminoma/etiología , Seminoma/prevención & control , Encuestas y Cuestionarios , Neoplasias Testiculares/epidemiología , Neoplasias Testiculares/prevención & control , Estados Unidos/epidemiologíaRESUMEN
Introducción: la presencia de material del cromosoma Y en mujeres con Síndrome de Turner se asocia con el desarrollo de tumores gonadales, teniendo un incremento del riesgo relacionado con la edad. Objetivo: investigar la correlación entre la presencia de cromosoma Y ó secuencias específicas del Y y los hallazgos histopatológicos de las gónadas en pacientes con Síndrome de Turner. Material y métodos: se estudiaron cinco niñas con síndrome de Turner, con edades comprendidas entre los 4.4 y 13.4 años de edad. En todas las pacientes se realizó el análisis cromosómico con bandeo G y técnicas de alta resolución, tales como análisis molecular por PCR amplificando las secuencias específicas del cromosoma Y (SRT, DYZ1, DYZ3 y AMGL). Tres niñas tenían un cariotipo conteniendo el cromosoma Y, mientras que en las otras dos niñas restantes fueron detectadas secuencias del cromosoma Y por análisis molecular. En todas la niñas fue realizada la gonadectomía bilateral con técnica laparoscópica. Resultados: el procedimiento laparoscópico fue adecuado y bien tolerado por las niñas. Tres de las pacientes (de 5.4, 8 y 13.4 años de edad) que tenían cromosoma Y presentaron tumores gonadales: gonadoblastoma uni o bilateral, y en una de ellas se encontró un disgerminoma. En las dos niñas restantes se encontraron las típicas gónadas tipo "streak" del Síndrome de Turner, sin tejido neoplásico. Conclusión: el hallazgo de tumores gonadales en 3 de las 5 niñas con Síndrome de Turner refuerza la importancia de la indicación de la gonadectomía a edades tempranas cuando las pacientes son portadoras de material del Y en sus cromosomas. La técnica laparoscópica es una elección adecuada para el tratamiento (AU)
Asunto(s)
Humanos , Femenino , Preescolar , Síndrome de Turner/complicaciones , Gonadoblastoma/complicaciones , Germinoma/complicaciones , Síndrome de Turner/cirugía , Síndrome de Turner/genética , Cromosoma Y , Mosaicismo , Gonadoblastoma/etiología , Gonadoblastoma/prevención & control , Germinoma/etiología , Germinoma/prevención & control , Ovario/cirugía , Gónadas/cirugíaRESUMEN
As one patient put it after hearing his treatment options for a stage I testicular tumor, "If you're gonna have cancer, this is about as easy a road as you get." With recognition of the importance of orchiectomy, development of the nerve-sparing lymph node dissection procedure, and availability of modern chemotherapy regimens, testicular cancer has become one of the most curable neoplasms. In this article, two oncologists discuss types of testicular tumor, patient evaluation, disease staging, risk categorization, and treatment selection. A patient handout on self-examination follows.
Asunto(s)
Germinoma , Neoplasias Testiculares , Antineoplásicos/uso terapéutico , Actitud Frente a la Salud , Germinoma/diagnóstico , Germinoma/prevención & control , Germinoma/terapia , Humanos , Masculino , Estadificación de Neoplasias , Factores de Riesgo , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/prevención & control , Neoplasias Testiculares/terapiaRESUMEN
BACKGROUND: Complete androgen insensitivity (CAI) is the most common cause of male pseudohermaphroditism. Affected individuals are advised to have bilateral gonadectomies to prevent the development of germ cell tumors. CASE: A 19-year-old phenotypic female presented for the evaluation of primary amenorrhea and was diagnosed with CAI. Operative videolaparoscopy was performed, and the intraabdominal gonads were resected; the patient was discharged in < 24 hours. CONCLUSION: Laparoscopic gonadectomy can be performed in individuals with CAI. This approach eliminates the need for laparotomy and results in rapid recovery with minimal blood loss. This approach should be considered for all patients with CAI and intraabdominal gonads.
Asunto(s)
Síndrome de Resistencia Androgénica/cirugía , Laparoscopía/métodos , Orquiectomía/métodos , Adulto , Síndrome de Resistencia Androgénica/diagnóstico , Germinoma/prevención & control , Humanos , Masculino , Fenotipo , Síndrome , Neoplasias Testiculares/prevención & control , Testosterona/sangreRESUMEN
We report on a patient who underwent left radical orchiectomy for a nonseminomatous germ cell tumor and was placed into a surveillance program only to experience recurrence 9 years later. The deficiencies with surveillance protocols, including inadequate followup, imaging study difficulties, possible higher mortality with relapse of carcinoma during the surveillance period, and increased cost and labor for longer surveillance protocols are discussed. Methods of distinguishing patients at low and high risk of relapse are still evolving and further studies are required.