RESUMO
Objective: The aim of our study is to describe the progression-free survival (PFS) in patients with clinical stage (CS) II and III NSGCT with an RM after primary or secondary CT with negative serum markers (NSM). A residual mass (RM) in non-seminomatous germ cell tumors (NSGCT) after chemotherapy (CT) is defined as a mass >1 cm in greatest diameter. The preferred treatment for RM is retroperitoneal lymph node dissection (RPLND), with a cure rate greater than 80%. Methods: We identified 60 patients with NSGCT, RM, and NSM between 2007 and 2020. Data regarding clinical and oncological outcomes as well as pathological information were obtained in a retrospective fashion from our electronic database. Results: A total of 60 patients were included. 50% of cases were CS II, and 50% CS III. About 90% of the patients had undergone RPLND. Teratoma was found in 73.6% of these patients. PFS and OS were better in CS II patients, compared to CS III. The patients treated with observation were found to have a shorter PFS compared to patients who underwent RPLND. Patients with viable tumors after RPLND had shorter OS compared to patients with teratoma and fibrosis. Conclusions: RPLND continues to be the treatment of choice to patients with RM after CT and NSM
Objetivo: Nuestro objetivo es describir la supervivencia libre de progresión (SLP) en pacientes con TCGNS en estadio clínico (CS) II y III con masa residual tras QT primaria o secundaria con marcadores séricos negativos (MSN). Métodos: Se incluyeron pacientes con TCGNS, MR y MSN atendidos entre 2007-2020. Los datos se obtuvieron de forma retrospectiva de nuestra base de datos electrónica. Resultados: Se identificaron 60 pacientes, el 50% eran CS II y el 50% CS III, y el 90% de los pacientes fueron sometidos a DGLRP. Se evidenció teratoma en el 73,6% de los pacientes. La SLP y la supervivencia global (SG) fue mejor en pacientes con CS II, frente a CS III. Los pacientes observados tuvieron una SLP menor frente a los que se sometieron a DGLRP. Los pacientes tratados con DGLRP y evidencia de tumor viable en la patología tenían una SG más corta comparado con teratomay fibrosis. Conclusión: La DGLRP sigue siendo el tratamiento de elección para las MR posterior a QT y MSN.
Assuntos
Humanos , Masculino , Pacientes , Sobrevivência , Cisplatino , Intervalo Livre de ProgressãoRESUMO
Sensorineural hearing loss (SNHL) is a common adverse effect for nasopharyngeal carcinoma (NPC) patients treated with chemoradiotherapy. We report a case of 12-year follow-up from a patient with stage IIB NPC, treated in 2004 with intensity-modulated radiotherapy and cisplatin-based chemotherapy. Pure-tone audiograms were conducted before treatment and at two other points in the 12-year period after treatment. Analysis of the patient's audiograms reveals that the development of high-frequency SNHL started after treatment and reached a plateau accompanied by tinnitus approximately 32 months after treatment conclusion. After the plateau, high-frequency SNHL continued to develop slowly in the next 10 years, possibly a long-term effect from radiation-induced microvascular change of the hearing apparatus. The continuous high-frequency hearing decline is associated with increased tinnitus pitch in the patient. With experience learned from this case, we recommend hearing tests at regular intervals for at least 3-5 years for NPC patients treated with chemoradiotherapy. Patients need to be educated about tinnitus and counseling can be offered when they begin to feel inconvenienced by tinnitus. These patients also need to be advised against exposure to noise that can aggravate the already compromised hearing apparatus, leading to further hearing loss and worsening tinnitus. Limiting the peak dose and total cumulative dose of cisplatin should be considered based on the patients' risk factors to achieve a balance between treatment efficacy and long-term adverse effects.