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At least 703 records · Page 39Linked to original sources
PubMed1996

The management of patients with clinical stage I nonseminomatous testicular tumors and persistently elevated serologic markers.

PURPOSE: We reviewed our experience with patients who had nonseminomatous germ cell tumors clinically limited to the testis and persistently elevated serum human chorionic gonadotropin (HCG) or alpha-fetoprotein (AFP) levels after orchiectomy. MATERIALS AND METHODS: All patients had clinical stage I disease with persistently elevated tumor markers that were not decreasing in accordance with the expected metabolic decay rate at retroperitoneal lymph node dissection. RESULTS: Of 30 patients identified 3 had elevated AFP, 24 had elevated HCG and 3 had elevation of both markers. Of the 6 patients with elevated AFP with or without concurrent HCG elevation 5 (83%) had relapse and required chemotherapy, as did 6 of 24 (25%) with HCG elevation. CONCLUSIONS: Patients with persistently elevated AFP after orchiectomy should be treated initially with chemotherapy. Although the majority of patients with elevated serum HCG were disease-free after surgery alone, a fourth of these patients still had relapse and required chemotherapy.

Adolescent↗
PubMed1996

[Leiomyosarcoma of the spermatic cord].

Sarcoma of the spermatic cord is a rare disease with less than 300 cases reported in the literature. A case of leiomyosarcoma is presented, and an analysis of the therapeutic approaches of radical orchidectomy, and in some cases retroperitoneal lymph node dissection, chemotherapy and radiation is given. The total numbers of different types of sarcomas in the spermatic cord, reported to The Danish Department of Cancer Registration are briefly presented as well.

Diagnosis, Differential↗
PubMed1996

[Value of prognostic factors in early stage ovarian carcinoma].

Only 20-30% of all ovarian cancers are diagnosed in stage I. To achieve a correct pathohistological stage I disease a staginglaparotomy has to be performed. This surgery consists of a bilateral oophorectomy, salpingectomy and total abdominal hysterectomy, an omentectomy, peritoneal lavage, multiple biopsies of the peritoneum and a retroperitoneal lymph node dissection. The most important established prognostic factor for survival is the histologic grading. Well differentiated tumors do not get any further adjuvant treatment, but moderately well differentiated tumors or undifferentiated tumors are treated with adjuvant cytotoxic polychemotherapy. All other prognostic factors like FIGO staging, puncture of the tumor and/or rupture of the tumor and histologic subtypes do have just a minor relevance for survival prognosis. In addition to grading the following factors also seem to have an influence on further survival, according to the results of different study groups: tumor ploidy, dense adhesions of the tumor and preoperative tumor marker CA-125. New prognostic factors like her-2 neu, int-2, epidermal growth factor, insulin like growth factor, angiogenesis and proteases have to demonstrate their value for survival prognosis yet before they can be established in routine diagnosis.

Biomarkers, Tumor↗
PubMed1996

Adjuvant chemotherapy for stage II nonseminomatous testicular cancer: what is its role?

Two treatment options cure nearly all patients with pathological stage II testicular nonseminomatous germ cell tumor (NSGCT) following a retroperitoneal lymph node dissection (RPLND). These are (1) two cycles of adjuvant cisplatin-based chemotherapy and (2) close surveillance with chemotherapy reserved for patients who relapse. The decision to choose one of these options is dependent on the extent of tumor involvement at RPLND and patient compliance. Surveillance is the treatment of choice for compliant patients with minimal nodal involvement (<6 nodes involved, no node >2 cm, no extranodal extension; N(1), N(2a)) resected at RPLND; one third or less of these patients relapse to surveillance alone. Patients with "high volume" nodal involvement (<6 nodes involved, any node >2 cm; N(2b) or extranodal extension; N(3)) have a relapse rate of 50% to 90% to surveillance. The option of adjuvant chemotherapy in this group remains a strong consideration. A prospective trial of two cycles of etoposide plus cisplatin adjuvant chemotherapy for patients with pathological stage N(2b,3) showed that this regimen was highly effective and preferable to vinblastine-based regimens because it was better tolerated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Primary chemotherapy: how does it compare with surgery?

Small-volume metastatic nonseminoma primary chemotherapy following orchidectomy cures the same high proportion of patients as does retroperitoneal lymph node dissection (RPLND). The 5-year survival in 122 patients treated at the Royal Marsden Hospital was 97%; 35 of these men had postchemotherapy lymphadenectomy and only 5 suffered loss of ejaculation. Primary chemotherapy is a reasonable alternative to RPLND for stage II testicular nonseminoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

What are the chances of infertility and should sperm be banked?

Patients with testicular cancer have an excellent chance of surviving and may very well be interested in future fertility. This future fertility may be complicated by both pretreatment and treatment-related subfertility. The risk of ejaculatory dysfunction from retroperitoneal lymph node dissection (RPLND) for low-stage disease has been nearly erased by nerve-sparing techniques. In those patients with an ejaculation, electroejaculation and artificial insemination is effective. With cisplatinum-based chemotherapy, nearly all patients will become azoospermic with the majority recovering spermatogenesis within four years. Most patients undergoing prophylactic radiation therapy for seminoma will return to baseline semen quality within 2 years. In men with persistent poor semen quality, assisted reproductive technologies may allow having children, even with very low numbers of viable sperm. Assisted reproductive technologies have also greatly improved the chance of pregnancy with cryopreserved sperm. Therefore, prospects for procreation are quite good for men facing treatment for germ cell tumors. In those patients who do not recover spontaneous fertility, semen cryopreservation gives additional hope for having children. Patients should be given the option of semen cryopreservation if any viable sperm are present, even if the specimen is extremely poor.

Adult↗
PubMed1996

The value of prognostic factors in the management of stage I nonseminomatous germ cell testicular tumors (NSGCTT).

The prospective study, carried out from February 1992 to January 1996, included 49 patients in clinical Stage I nonseminomatous germ cell testicular tumors (NSGCTT). They were aged 16-40 years (mean, 25 years). Patients were stratified to different risk-adapted therapeutic approaches according to histopathologic findings of primary tumor removed by inguinal orchiectomy. Eleven patients of the 1st group with vascular invasion and majority of embryonal carcinoma components in the primary tumor were treated with adjuvant chemotherapy (2 cycles of BEP). None of them had disease progression after the follow-up of 4-43+ months (mean, 20.9 months) after orchiectomy. Five patients of the 2nd group with vascular invasion and majority of teratoma elements in the primary tumor were treated with primary retroperitoneal lymph node dissection (RPLND). They were followed-up 29-45+ months (mean, 33.4 months) after orchiectomy. Two of them (40%) had pathologic Stage II after RPLND and underwent subsequent BEP chemotherapy. One of them died due to disease progression in disseminated stage 29 months after orchiectomy. The second one lives with no evidence of the disease (NED). Thirty three patients in the 3rd group without vascular invasion were kept under surveillance. They were followed-up 3-48+ months (mean, 22.3 months) after orchiectomy. Disease progression was observed in 5 of them (15.1%), 7-10 months (mean, 8.8 months) following orchiectomy. These patients were treated with BEP chemotherapy and live with NED 1-16+ months (mean, 9.2 months) after completion of the therapy. The overall survival rate in clinical Stage 1 patients was 97.9%. The authors recommend the surveillance policy only in clinical Stage I NSGCTT patients without vascular invasion in the primary tumor.

Adolescent↗
PubMed1996

Management of germ cell testicular cancer with pulmonary metastases.

Twenty eight patients with germ cell testicular cancer pulmonary metastases received primary chemotherapy including bleomycin, etoposide, and cisplatin (BEP). Complete response was achieved in 21 (75%) patients, in 11 of them CR was achieved following chemotherapy alone. Postchemotherapy surgery of residual mass was performed in 12 (42.9%) patients with normalized serum tumor markers. Retroperitoneal lymph node dissection was performed in one patient, pulmonary surgery in four, and both postchemotherapy treatments in 7 patients. Overall cure rate was 89.3%, 26 (92.9%) patients are still alive at a mean follow-up of 19.7+ months (range, 3-34+ months) after the treatment start. Two (7.1%) patients died: one of them due to disease progression during chemotherapy, and the second one due to postoperative complication (acute respiratory failure). Relapse of disease was observed in one patient 21 months following CR achievement, and sequential chemotherapy was introduced. Authors recommend surgical remove of all radiologically detected residual deposits, because the available imaging methods are not adequate for determining the histologic composition of residual mass, which is decisive for further therapy and has prognostic value.

Adolescent↗
PubMed1996

Metastatic Sertoli cell carcinoma of the testis.

Metastatic Sertoli cell tumor is a very rare and deadly disease accounting for approximately 1% of all testicular carcinomas. With fewer than 30 cases reported in the literature, there has not been a uniform treatment regimen with good results. Retroperitoneal lymph node dissection, chemotherapy, and radiation therapy in combination appear to offer the best outcome. This report describes the occurrence of this rare tumor in a 38-year-old man 2 years after left orchiectomy.

Adult↗
PubMed1997

Lymphatogenous spread of renal cell carcinoma: an autopsy study.

PURPOSE: We investigated the occurrence and extent of metastatic spread, especially regarding lymph nodes, of renal cell carcinoma. MATERIALS AND METHODS: From 1958 to 1982, 554 cases of renal cell carcinoma were diagnosed at autopsy. Clinical data and autopsy findings were reevaluated, and the occurrence of lymph node metastases was analyzed by histological examination of retroperitoneal, mediastinal, supraclavicular, axillary and inguinal lymph nodes. RESULTS: Distant metastases were revealed in 119 cases (21.5%), including 31 (5.6%) with single metastases. In 88 cases (16%) renal cancer was the cause of death. Lymphatogenous dissemination was detected in 80 cases of which 75 had additional, mostly multifocal metastatic spread. Consequently lymph node metastases restricted to the paracaval and/or para-aortic lymph nodes were noted in only 5 cases (0.9%). CONCLUSIONS: Of the 554 cases of clinically unrecognized renal cell carcinoma almost all with lymphatic spread had additional distant metastases. Therefore, the therapeutic effect of extensive retroperitoneal lymph node dissection in association with radical nephrectomy seems to be low. However, more limited lymph node dissection may be useful, mainly as a staging procedure.

Adult↗
PubMed1997

Residual pulmonary masses after chemotherapy for metastatic nonseminomatous germ cell tumor. Prediction of histology. ReHiT Study Group.

BACKGROUND: After chemotherapy for a metastatic nonseminomatous germ cell tumor, pulmonary masses may be seen on a computed tomography scan. These residual masses may contain one of three histologic elements: necrosis, mature teratoma, or cancer. Because surgical resection of masses containing only necrosis is unnecessary, the authors aimed to predict the histology of these residual masses. METHODS: Six study groups contributed patient data on a total of 215 patients undergoing thoracotomy after cisplatin-based induction chemotherapy for metastatic testicular nonseminomatous germ cell tumors. Logistic regression analysis was used to estimate the probability of necrosis, mature teratoma, and cancer in relation to predictors known before thoracotomy. RESULTS: The pulmonary mass histology was necrosis in 116 patients (54%), mature teratoma in 70 (33%), and cancer in 29 (13%). Necrosis was found at thoracotomy in 89% of those patients with necrosis at retroperitoneal lymph node dissection (RPLND). Other predictors included the primary tumor histology, prechemotherapy tumor marker levels, change in mass size during chemotherapy, and the presence of a single, unilateral mass. Multivariate combination of predictors yielded reliable models (goodness-of-fit tests, P > 0.20), which discriminated necrosis well from other histologies, especially if RPLND histology was available (area under the receiver operating characteristic curve, 0.86). CONCLUSIONS: This analysis indicated subgroups of patients with a high probability of necrosis and a low risk of cancer for whom close follow-up of the residual pulmonary mass might be considered. In most patients, a RPLND should be performed before a thoracotomy is considered, because the probability of necrosis is generally higher at thoracotomy than at RPLND and the histology at RPLND is a strong predictor of the histology at thoracotomy.

Analysis of Variance↗
PubMed1997

MIB-1 immunohistochemistry in clinical stage I nonseminomatous testicular germ cell tumors predicts patients at low risk for metastasis.

BACKGROUND: The clinical Stage I of nonseminomatous germ cell tumors (NSGCT) is inaccurate in 30% of patients. In previous studies on tumor biologic risk factors, low tumor proliferation rates predicted a group of patients at low risk for occult metastatic disease. The goal of this study was to confirm the immunohistochemical assessment of tumor proliferation using MIB-1 (Ki-67 receptor) in a different patient cohort with different investigators to prove the method's reliability. METHODS: Orchiectomy specimens of 78 patients with clinical Stage I NSGCT (50 patients with pathologic Stage I and 28 patients with pathologic Stage II disease, all patients underwent retroperitoneal lymph node dissection) were retrospectively analyzed by histopathologic reevaluation and MIB-1 immunostaining. RESULTS: Mean MIB-1 values between the two pathologic stages differed significantly (51.5% MIB-1 positive tumors cells in pathologic Stage I and 75.1% MIB-1 positive tumor cells in pathologic Stage II disease; P = 0.02). Using a 70% cutoff value, pathologic stages were correctly classified in 69% of cases (sensitivity of 86%, specificity of 60%, negative predictive value of 88%, and positive predictive value of 55%). Compared with traditional risk factors such as percentage of embryonal carcinoma and vascular invasion, in multivariate analysis, MIB-1 was the best predictor of patients at low risk for metastasis. CONCLUSIONS: This study in a different patient population with different investigators confirmed previous results of MIB-1 staining to predict a group of patients with clinical Stage I NSGCT who were at low risk for metastasis. The method is simple and reproducible to improve risk classification in low stage testicular carcinoma. Using this technique, a group of patients at very low risk for metastasis can be identified. [See editorial counterpoint on pages 1641-5 and reply to counterpoint on page 1646, this issue.]

Antibodies, Monoclonal↗
PubMed1997

Adjuvant chemotherapy for testicular cancer.

Two treatment options cure nearly all patients with pathologic stage II testicular nonseminomatous germ cell tumor following a retroperitoneal lymph node dissection. These are (1) two cycles of adjuvant etoposide plus cisplatin (with or without bleomycin) chemotherapy and (2) close surveillance with chemotherapy reserved for relapse. The decision to choose one of these options is dependent on the extent of tumor involvement at surgery and patient compliance.

Antibiotics, Antineoplastic↗
PubMedDate not supplied

Peritoneal cytology and its prognostic value in endometrial carcinoma.

BACKGROUND: There has been a controversy about the prognostic significance of positive peritoneal cytology in endometrial carcinoma. MATERIALS AND METHODS: Peritoneal cytology was obtained at the time of surgery, including systematic retroperitoneal lymph node dissection, in 114 patients. RESULTS: The incidence of positive peritoneal cytology was 35.1%. The 5-year survival rates of the stage IIIA and IIIC (FIGO, 1988) cases were 82.8% and 58.3%, respectively. In pathological stage I (the disease was histologically confined to the uterine corpus), there was no significant difference in 5-year survival rates between patients with and without positive peritoneal cytology. Though the patients in stage IIIA who had only positive peritoneal cytology were given no postoperative therapy unless they had extrauterine disease, no patients developed recurrence. In stages IIIC and IV, the prognosis was significantly poorer for patients with positive peritoneal cytology than for those with negative cytology. CONCLUSION: Positive peritoneal cytology is not an adverse prognostic factor endometrial carcinoma if disease is limited to the uterus.

Adult↗
PubMed1997

Primary chemotherapy for stage 2 testis cancer.

To evaluate the efficacy and toxicity of primary chemotherapy in patients with stage 2 (retroperitoneal lymph node metastases) testis cancer, 20 consecutive patients referred to Groote Schuur Hospital between September 1992 and March 1994 were reviewed. There were 10 patients with non-bulky non-seminomatous germ cell tumour (NSGCT), 5 with bulky NSGCT and 5 with bulky seminoma. The treatment regimen consisted initially of 4 cycles of cisplatin, etoposide and bleomycin. Patients with NSGCT and a residual mass after chemotherapy subsequently underwent retroperitoneal lymph node dissection (RPLND) and those with seminoma underwent a low dose of irradiation to the mass. In 7 (70%) of the 10 patients with non-bulky NSGCT, there was a complete response to chemotherapy and 3 patients underwent limited RPLND. One patient relapsed at follow-up but remains clear of disease after salvage therapy. The survival rate is 100% at a median follow-up of 60 months (range 12-143 months). In 5 patients with bulky NSGCT there was no complete response to chemotherapy. Three have undergone limited RPLND. The survival rate is 52% at a median follow-up of 130 months (range 108-152 months). In 5 patients with bulky seminomas, the survival rate is 100% at a median follow-up of 55 months (range 29-92 months). Toxicity has been modest except for 1 patient who died postoperatively in the early part of the study. Four patients have fathered children after treatment. We conclude that primary chemotherapy is the treatment of choice for patients with stage 2 testis cancer.

Adolescent↗
PubMed1998

Primary chemotherapy after orchidectomy for stage I and II nonseminoma.

The effectiveness of combination chemotherapy in advanced germ cell cancer has led to re-evaluation of treatment approaches in early disease. For patients with stage I nonseminoma it became possible to contemplate an observation policy, relying on chemotherapy to rescue those who relapsed. Subsequently it has been shown that two cycels of adjuvant chemotherapy can prevent relapse in those at high risk. For patients with stage II nonseminoma, a policy of primary chemotherapy postorchidectomy leads to high cure rates, with avoidance of retroperitoneal lymph node dissection, and only a minority of patients requiring lymphadenectomy. The excellent prognosis of these patients increases the importance of minimising risks of any long-term treatment toxicity.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Integration of surgery and systemic therapy: results and principles of integration.

Eight hundred seventy patients with metastatic nonseminomatous germ cell cancer underwent postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for resection of residual disease. Several risk factors for relapse and survival were identified as highly significant (P = .00001), namely, presence of residual cancer in the specimen before salvage chemotherapy programs, tumor marker elevation, need for "re-do" PC-RPLND, or unresectability. Although more than half of the entire group (52.5%) had one or more of these risk factors, 67.5% are long-term survivors following PC-RPLND. The remaining 47.5% were referred after primary chemotherapy, without risk factors. Only 9.8% relapsed and 95.5% survived.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

A modified incision and technique for total retroperitoneal access and lymph node dissection.

Surgical assessment of aortocaval lymph nodes in patients with unresectable primary cervical cancer helps in planning radiation treatment ports. Removal of enlarged lymph nodes may also serve a therapeutic purpose in reducing the tumor load to be sterilized by radiation. An extraperitoneal dissection is considered to be superior to a transperitoneal approach, and numerous incisions to access either the upper or the lower retroperitoneum have been described. A modified supraumbilical incision and technique that provide wide bilateral exposure of the retroperitoneum from the suprarenal aorta to the obturator fossae were used in six patients.

Female↗