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Patients with “difficult-to-treat” advanced testicular cancer can require multiple therapies. We retrospectively assessed our patients with advanced germ cell tumors (GCTs) and characterized the clinical efficacy, outcomes, and factors affecting overall survival (OS).
Two hundred fifty-three patients with advanced GCTs were treated at Kyoto Prefect...
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Objective:Patients with recurrent metastatic germ cell tumor (GCT) can be treated with second-line or even third-line regimens; 20-30% of testicular GCT (TGCT) relapse or become refractory after first-line therapy and optimal treatment for this group is not very well defined.Materials and Methods:We presented the analysis of the efficacy of high-do...
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... Trong một nghiên cứu tại Nhật Bản tiến hành bởi Nakamura và cs trên 253 trường hợp UTTH được đánh giá "bệnh dai dẳng" khi các bệnh nhân này đều phải điều trị với nhiều phác đồ hóa chất. Kết quả thu được cho thấy việc đạt được đáp ứng hoàn toàn về mặt sinh hóa là một trong những yếu tố tiên lượng độc lập liên quan tới thời gian sống thêm [10]. Kết quả này gợi ý rằng việc tiếp tục hóa trị với nhiều phác đồ cho đến khi chất chỉ điểm u trở về bình thường là rất quan trọng để cải thiện thời gian sống còn toàn bộ, và chiến lược này cũng tương đồng với các hướng dẫn điều trị phố biến như của NCCN, Hội niệu học châu Âu hay của ESMO. ...
Mục tiêu nghiên cứu: Đánh giá kết quả sống thêm và một số yếu tố liên quan của phác đồ BEP trên bệnh nhân ung thư tinh hoàn giai đoạn di căn tại bệnh viện K. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang, hồi cứu kết hợp tiến cứu trên 36 bệnh nhân ung thư tinh hoàn giai đoạn di căn được điều trị hóa chất phác đồ BEP tại bệnh viện K từ 1/2014 đến hết tháng 6/2022. Kết quả: Độ tuổi trung bình trong nghiên cứu là 32,6 tuổi. 33,3% bệnh nhân thuộc loại u tế bào dòng tinh và 66,7% bệnh nhân u không phải tế bào dòng tinh. Di căn phổi là vị trí di căn thường gặp nhất chiếm 38,9%. Trung bình thời gian sống thêm bệnh không tiến triển và sống thêm toàn bộ lần lượt là 67,6 tháng và 75,5 tháng. Tỷ lệ sống thêm bệnh không tiến triển và sống thêm toàn bộ tại thời điểm 5 năm là 66,7% và 77,8%. Những bệnh nhân đáp ứng hoàn toàn về mặt sinh hóa và những bệnh nhân phân nhóm nguy cơ trung bình - thấp có thời gian sống thêm bệnh không tiến triển và thời gian sống thêm toàn bộ tốt hơn so với những bệnh nhân không đạt đáp ứng hoàn toàn trên sinh hóa, bệnh nhân phân nhóm nguy cơ cao (p<0,05). Kết luận: Phác đồ BEP đem lại hiệu quả cao, do đó có thể áp dụng áp dụng rộng rãi trong thực hành lâm sàng điều trị ung thư tinh hoàn giai đoạn di căn.
... Among patients with metastatic disease, 38.3% had good risk disease and 26.02% of patients were in the poor-risk category. This is similar to most of the published literature where the majority of the patients were categorised as good-risk group [17,18]. The proportion of poor-risk patients is comparable to previously published Indian data also [3,4]. ...
... Thirty-nine patients had the residual paraaortic nodal disease after first-line chemotherapy, but only 14 patients underwent RPLND. The rates of post-chemotherapy RPLND were less in our series compared to some previously published data [18,19]. Many of our patients refused surgery, considering the likely complications such as retrograde ejaculation and the need for major vascular repair. ...
Germ cell tumour of the testis is the most common cancer in young men in the western world. India has the lowest incidence globally, and hence Indian data are sparse. We report the outcomes of patients with nonseminomatous germ cell tumours of testis treated at a tertiary cancer centre in South India over a period of 10 years. Patients with a histopathological diagnosis of nonseminomatous germ cell tumours of the testis from 1 January 2006 to 31 December 2016 were included in the study. Patient demographics, tumour characteristics and treatment details were retrieved from case records. Kaplan–Meier method was used to estimate progression-free survival (PFS) and overall survival (OS). Cox regression model was used to analyse the prognostic factors.
One hundred and nineteen patients with nonseminomatous germ cell tumours of the testis were included in the study. The median follow-up was 81 months. The estimated 4-year OS and progression-free survival were 87.1% and 84.5%, respectively. The four-year OS for good, intermediate and poor-risk groups was 93.6%, 87.5% and 52.6%, respectively. The PFS at 4 years was 91.4%, 87.8% and 47.4% for good, intermediate and poor-risk groups, respectively. The presence of nonpulmonary visceral metastasis and biochemical response after chemotherapy were significant predictors for OS and PFS in multivariate cox proportional hazards regression. The survival figures are comparable to the rest of the world except in the poor prognostic risk group. The inferior survival noticed in this group of patients may be due to the lack of good salvage procedures. High-dose chemotherapy with stem-cell support may be considered more often for this group of patients.
... The importance of continuous sequential chemotherapy aiming for STM normalization is reconfirmed, as a recent study reported. 14 In conclusion, the initial accurate risk stratification is an important prognostic factor to achieve better oncological outcomes for metastatic testicular cancer patients to undergo chemotherapy. Aiming for STM normalization with continuous sequential chemotherapy could improve OS in patients with NSGCT. ...
Objectives:
To assess clinicopathological data and oncological outcomes focused on metastatic testicular cancer patients, who received chemotherapy as the initial treatment, in the nationwide multi-institutional study by the Cancer Registration Committee of the Japanese Urological Association.
Methods:
A testicular cancer survey was carried out by the Japanese Urological Association in 2011 to register newly diagnosed testicular cancers in 2005 and 2008. Among 1121 registered patients, 278 patients with metastases who received chemotherapy as the initial treatment and could be categorized by the Japanese Urological Association classification were eligible for the analysis.
Results:
As first-line chemotherapy, bleomycin, etoposide and cisplatin, and etoposide and cisplatin therapies were chosen for 260 patients (93.5%). As second-line therapy, vinblastine, ifosfamide and cisplatin/etoposide, ifosfamide and cisplatin; and paclitaxel, ifosfamide and cisplatin/paclitaxel, ifosfamide and nedaplatin therapies were carried out in 23 out of 63 (36.5%) and 29 out of 63 (46.0%) patients, respectively. The response rate and serum tumor marker normalization rate were 93.4% and 81.3% at first line, 75.4% and 60.7% at second line, and 41.7% and 16.7% at third line, respectively. The Japanese Urological Association classification (≥IIIB2 vs ≤IIIB1) and choriocarcinoma component in primary histology were independent prognostic factors of overall survival before starting chemotherapy. Furthermore, in patients with non-seminomatous germ cell tumors, serum tumor marker normalization was an independent factor that was associated with better outcome of overall survival after completion of the initial series of chemotherapies.
Conclusions:
The initial accurate diagnosis and risk stratification is an important prognostic factor to achieve better oncological outcomes. In patients with non-seminomatous germ cell tumors, aiming for serum tumor marker normalization with continuous sequential chemotherapy could improve overall survival.
... As University Hospital, Kyoto Prefecture University of Medicine, Kyoto, Japan, is a high-volume center for "difficult-to-treat" advanced GCT, most patients were referred from a variety of institutions and received at least one regimen in our hospital. 5 This study was approved by the institutional review board of Kyoto Prefecture University of Medicine (ERB-C-691-1), and conformed to the provisions of the Declaration of Helsinki. Written informed consent was obtained from all patients. ...
Objectives
To analyze cases of therapy‐related acute myeloid leukemia and myelodysplastic syndrome diagnosed after chemotherapy for refractory testicular and extragonadal germ cell tumor in our experience.
Methods
A total of 171 consecutive patients who were diagnosed and treated as refractory germ cell tumor and had records of detailed chemotherapy doses between April 1998 and December 2015 were retrospectively reviewed.
Results
Four testicular tumor patients (4/171, 2.3%) developed therapy‐related acute myeloid leukemia and myelodysplastic syndrome. Three of them were affected after complete remission of the primary testicular tumor. A median time interval from a start of chemotherapy to a secondary tumor development was 6.8 years (range 3.7–11.5 years). The median total dose of etoposide, ifosfamide, cisplatin and nedaplatin were 3640 mg/m² (range 2906–4000 mg/m²), 42.7 g (range 19.5–54.0 g), 1100 mg/m² (range 600–1500 mg/m²) and 500 mg/m² (range 300–1600 mg/m²), respectively. Etoposide had the only significant relationship between a cumulative dose and leukemogenesis in univariate analysis (P < 0.05). One patient had complete remission, but the other three patients died.
Conclusions
The present findings show that refractory germ cell tumor patients have an increased risk of therapy‐related acute myeloid leukemia and myelodysplastic syndrome. A cumulative dose of etoposide is a significant risk of leukemogenesis. As therapy‐related acute myeloid leukemia and myelodysplastic syndrome has a poor prognosis, close follow up is required for refractory germ cell tumor patients.
Objectives
To evaluate the histologic findings and clinical outcomes of post-chemotherapy retroperitoneal lymph node dissection for advanced germ cell tumor.
Methods
We analyzed the medical records of 66 patients who underwent post-chemotherapy retroperitoneal lymph node dissection between 2005 and 2019 at Tsukuba University Hospital.
Results
The proportions of necrosis, teratoma, and viable germ cell tumor in the specimens were 62.1%, 36.4%, and 1.5%, respectively. The 5-year progression-free and overall survival rates were 82.3% and 91.3%, respectively. The 5-year overall survival rate of patients with residual teratoma was significantly worse than that of patients with necrosis only (74.1% vs 100%). Overall, three patients died: one from cancer and two from teratoma with somatic-type malignancy. Of these, two patients relapsed after incomplete resection of residual teratoma. When limited to patients with completely resected teratoma, the 5-year overall survival rate was 91.7%, which did not differ from that for patients with necrosis only. Multivariate analysis showed that presence of teratoma in the primary site and decrease in retroperitoneal lymph node mass to less than 50% of the initial tumor size were independent factors for residual teratoma. However, the absence of these factors could not reliably predict necrosis only in retroperitoneal lymph node dissection specimens.
Conclusions
In our series, 98% of post-chemotherapy retroperitoneal lymph node dissection pathology was either necrosis or teratoma, with viable germ cell tumor only found in 2% of patients. Residual teratoma was associated with poorer prognosis, especially in cases of incomplete resection.
We report the case of a patient who achieved complete remission (CR) of cisplatin-refractory metastatic pure seminoma after treatment with high-dose carboplatin and etoposide (CE) with peripheral blood stem cell transplantation as fourth-line chemotherapy. A 38-year-old man was diagnosed with advanced pure seminoma (pT3N3M1aS3). In the international germ cell consensus classification, his prognosis was classified as intermediate. He was treated with high-dose CE as fourth-line chemotherapy after treatment with BEP, VeIP, and TIN. After two cycles of high-dose CE, the concentrations of T-HCG and other tumor markers showed normal levels. A CT scan and PET–CT showed that the lymph node swelling had disappeared and there was no uptake. The CR has continued for 27 months after the treatment. High-dose CE might be less toxic and have a better prognostic outcome than other treatments as salvage chemotherapy for patients with cisplatin-refractory advanced testicular cancer.
