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1. Spiess PE, Pisters LL, Liu P, Pettaway CA, Kamat AM, Gomez JA, Tannir NM: Malignant transformation of testicular teratoma: a chemoresistant phenotype. Urol Oncol; 2008 Nov-Dec;26(6):595-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Malignant transformation of testicular teratoma: a chemoresistant phenotype.
  • PURPOSE: To review our experience in the management of malignant transformation of teratoma (MTT).
  • RESULTS: Two patients presented with clinical stage I disease in which malignant transformation occurred within the primary testis tumor (rhabdomyosarcoma in 1 and adenocarcinoma in 1).
  • No viable tumor was identified in the specimen, and both patients were alive without disease at 16 months follow-up.
  • Of the remaining 7 patients, the clinical stages were IIA (N = 1), IIB (N = 3), and III (N = 3), and all were treated with chemotherapy followed by RPLND.
  • Following preoperative chemotherapy, a significant radiologic response (defined as more than a 25% reduction in maximum tumor circumferential diameter) was demonstrated in 1 patient, and normalization of serum tumor markers was demonstrated in 6.
  • CONCLUSIONS: In our experience, MTT is significantly resistant to current chemotherapeutic regimens, as demonstrated by its poor radiologic response to treatment.
  • Alternative therapeutic strategies targeted to MTT are thus needed.
  • [MeSH-major] Teratoma / drug therapy. Testicular Neoplasms / drug therapy
  • [MeSH-minor] Adolescent. Adult. Drug Resistance, Neoplasm. Humans. Lymph Node Excision. Male. Neoplasm Staging. Retroperitoneal Space

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  • [CommentIn] Urol Oncol. 2009 Mar-Apr;27(2):218; author reply 218-9 [19285238.001]
  • (PMID = 18367105.001).
  • [ISSN] 1078-1439
  • [Journal-full-title] Urologic oncology
  • [ISO-abbreviation] Urol. Oncol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / P30 CA016672
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Other-IDs] NLM/ NIHMS610854; NLM/ PMC4121060
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2. Kesler KA, Wilson JL, Cosgrove JA, Brooks JA, Messiha A, Fineberg NS, Einhorn LH, Brown JW: Surgical salvage therapy for malignant intrathoracic metastases from nonseminomatous germ cell cancer of testicular origin: analysis of a single-institution experience. J Thorac Cardiovasc Surg; 2005 Aug;130(2):408-15
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  • [Title] Surgical salvage therapy for malignant intrathoracic metastases from nonseminomatous germ cell cancer of testicular origin: analysis of a single-institution experience.
  • BACKGROUND: Cisplatin-based chemotherapy followed by surgical extirpation of residual benign disease represents the usual sequence of curative therapy for metastatic nonseminomatous germ cell cancer of testicular origin.
  • Occasionally, residual disease is malignant in the form of either a persistent nonseminomatous germ cell cancer tumor or degeneration into non-germ cell cancer.
  • We reviewed our institution's experience with patients undergoing salvage operations to remove malignant intrathoracic metastases.
  • METHODS: From 1981 through 2001, 438 patients with nonseminomatous germ cell cancer had operations to remove residual intrathoracic disease after cisplatin-based chemotherapy at Indiana University Hospital.
  • A subset of 134 patients who underwent 186 surgical procedures to remove malignant metastases is the basis of this review.
  • Surgical pathology demonstrated 84 patients with persistent nonseminomatous germ cell cancer tumors, 38 with degeneration into non-germ cell cancer, and 12 with both malignant pathologic categories.
  • CONCLUSIONS: Salvage thoracic surgery to remove malignant metastases from nonseminomatous germ cell cancer tumors of testicular origin can result in long-term survival in select patients.
  • [MeSH-major] Lung Neoplasms / therapy. Mediastinal Neoplasms / therapy. Neoplasms, Germ Cell and Embryonal / therapy. Testicular Neoplasms / therapy. Thoracic Surgical Procedures / methods
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Agents / therapeutic use. Cisplatin / therapeutic use. Combined Modality Therapy. Follow-Up Studies. Humans. Male. Middle Aged. Neoplasm Staging. Survival Analysis. Treatment Outcome

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  • (PMID = 16077406.001).
  • [ISSN] 0022-5223
  • [Journal-full-title] The Journal of thoracic and cardiovascular surgery
  • [ISO-abbreviation] J. Thorac. Cardiovasc. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; Q20Q21Q62J / Cisplatin
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3. Antman K, Hassan R, Eisner M, Ries LA, Edwards BK: Update on malignant mesothelioma. Oncology (Williston Park); 2005 Sep;19(10):1301-9; discussion 1309-10, 1313-6
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  • [Title] Update on malignant mesothelioma.
  • About 85% of mesotheliomas arise in the pleura, about 91% in the peritoneum, and a small percentage in the pericardium or tunica vaginalis testis.
  • Multicystic mesotheliomas and well-differentiated papillary mesotheliomas are associated with long survival in the absence of treatment and should be excluded from clinical trials intended for the usual rapidly lethal histologic variants of the disease.
  • Recent randomized trials have shown significant improvement in time to progression and survival for the addition of new antifolates to platinum-based chemotherapy.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Mesothelioma / diagnosis. Mesothelioma / epidemiology. Mesothelioma / pathology. Mesothelioma / therapy
  • [MeSH-minor] Asbestos / adverse effects. Folic Acid Antagonists / administration & dosage. Folic Acid Antagonists / therapeutic use. Heart Neoplasms / pathology. Humans. Incidence. Male. Neoplasm Staging. Peritoneal Neoplasms / pathology. Platinum Compounds / administration & dosage. Platinum Compounds / therapeutic use. Pleural Neoplasms / pathology. Prognosis. Quality of Life / psychology. Survival Analysis. Testicular Neoplasms / pathology. Treatment Outcome. United States / epidemiology

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  • (PMID = 16285225.001).
  • [ISSN] 0890-9091
  • [Journal-full-title] Oncology (Williston Park, N.Y.)
  • [ISO-abbreviation] Oncology (Williston Park, N.Y.)
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Folic Acid Antagonists; 0 / Platinum Compounds; 1332-21-4 / Asbestos
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4. Calaminus G, Schneider DT, Weissbach L, Schönberger S, Okpanyi V, Leuschner I, Poremba C, Göbel U: Survival after an antiangiogenetic therapy and surgery in a wide spread growing teratoma originating from a testicular mixed malignant germ cell tumor. Klin Padiatr; 2009 May-Jun;221(3):136-40
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  • [Title] Survival after an antiangiogenetic therapy and surgery in a wide spread growing teratoma originating from a testicular mixed malignant germ cell tumor.
  • Growing teratoma is still an often unsolved problem especially in male with mixed malignant GCTs of the testis or the mediastinum.
  • This specific situation with progressive tumor growth and simultaneous normalization of tumor markers during or after treatment of malignant GCTs with teratomatous elements is judged as a fatal situation if this situation can not be controlled by extensive surgery, as teratoma are not sensible to chemotherapy or irradiation.
  • Here, we report the case history of a 17-year old male patient with a testicular malignant GCT and wide spread lymph node metastases, who developed a rapidly progressive growing teratoma within the lymph node metastases.
  • Within the molecular profile of the tumor we could find a cytogenetic picture typically found in malignant adult GCTs.
  • In view of the bulky abdominal, thoracic and cervical metastases and the uncontrolled tumor progression, the situation was considered incurable.
  • However, following an individual treatment attempt, this patient was treated with a four-agent combination of drugs with antiangiogenetic potential as well as low-dose cyclic chemotherapy.
  • We therefore would like to highlight this treatment approach in unresectable growing teratoma and would like to stimulate further research and collaboration to come to an optimized treatment suggestion for this group of poor prognostic patients.
  • [MeSH-major] Angiogenesis Inhibitors / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Endodermal Sinus Tumor / drug therapy. Endodermal Sinus Tumor / surgery. Lymph Node Excision. Lymphatic Metastasis. Neoplasms, Germ Cell and Embryonal / drug therapy. Neoplasms, Germ Cell and Embryonal / surgery. Neoplasms, Multiple Primary / drug therapy. Neoplasms, Multiple Primary / surgery. Teratoma / drug therapy. Teratoma / surgery. Testicular Neoplasms / drug therapy. Testicular Neoplasms / surgery
  • [MeSH-minor] Adolescent. Antibodies, Monoclonal / administration & dosage. Antibodies, Monoclonal / adverse effects. Antibodies, Monoclonal, Humanized. Bevacizumab. Combined Modality Therapy. Dose-Response Relationship, Drug. Drug Administration Schedule. Follow-Up Studies. Humans. Interferon-alpha / administration & dosage. Interferon-alpha / adverse effects. Lymph Nodes / blood supply. Lymph Nodes / pathology. Magnetic Resonance Imaging. Male. Neoplasm Recurrence, Local / drug therapy. Neoplasm Recurrence, Local / pathology. Neoplasm Recurrence, Local / surgery. Neoplasm Staging. Recombinant Proteins. Reoperation. Salvage Therapy. Survival Rate. Thalidomide / administration & dosage. Thalidomide / adverse effects. Tomography, X-Ray Computed. Vinblastine / administration & dosage. Vinblastine / adverse effects

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  • [CommentIn] Klin Padiatr. 2009 May-Jun;221(3):134-5 [19437359.001]
  • (PMID = 19437360.001).
  • [ISSN] 1439-3824
  • [Journal-full-title] Klinische Pädiatrie
  • [ISO-abbreviation] Klin Padiatr
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Angiogenesis Inhibitors; 0 / Antibodies, Monoclonal; 0 / Antibodies, Monoclonal, Humanized; 0 / Interferon-alpha; 0 / Recombinant Proteins; 2S9ZZM9Q9V / Bevacizumab; 4Z8R6ORS6L / Thalidomide; 5V9KLZ54CY / Vinblastine; 76543-88-9 / interferon alfa-2a
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5. Carver BS, Al-Ahmadie H, Sheinfeld J: Adult and pediatric testicular teratoma. Urol Clin North Am; 2007 May;34(2):245-51; abstract x
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  • [Title] Adult and pediatric testicular teratoma.
  • Although pure testicular teratomas in prepubertal boys have not been reported to metastasize, testicular teratomas in adults are associated with clinical metastases in 60% of cases.
  • Teratoma has a diverse biological potential, with propensity for local growth, distant metastases, and transformation to somatic malignant cell types.
  • Because of the chemoresitant nature of teratomas, complete surgical resection is the treatment of choice.
  • Since the biology of teratoma is unpredictable and it is frequently found in the retroperitoneum following chemotherapy for nonseminomatous germ-cell tumors, complete control of the retroperitoneum is advocated for all patients regardless of residual mass size.
  • [MeSH-major] Teratoma. Testicular Neoplasms
  • [MeSH-minor] Adult. Clinical Trials as Topic. Humans. Male. Neoplasm Staging. Treatment Outcome

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  • (PMID = 17484929.001).
  • [ISSN] 0094-0143
  • [Journal-full-title] The Urologic clinics of North America
  • [ISO-abbreviation] Urol. Clin. North Am.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 36
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6. Donadio AC, Motzer RJ, Bajorin DF, Kantoff PW, Sheinfeld J, Houldsworth J, Chaganti RS, Bosl GJ: Chemotherapy for teratoma with malignant transformation. J Clin Oncol; 2003 Dec 1;21(23):4285-91
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  • [Title] Chemotherapy for teratoma with malignant transformation.
  • PURPOSE: Teratoma with malignant transformation (MT) is a well-described entity that refers to the MT of a somatic teratomatous component in a germ cell tumor (GCT) to a histology that is identical to a somatic malignancy (eg, rhabdomyosarcoma [RMS]).
  • Surgical resection has been the mainstay of therapy for localized transformed disease because these tumors are thought to be resistant to standard treatment.
  • We report that chemotherapy has a role in selected patients with MT, determined by cell type.
  • PATIENTS AND METHODS: Chemotherapy was administered to 12 patients with MT of GCT limited to a single cell type (two patients with primitive neuroectodermal tumors, five with undifferentiated RMS, one with anaplastic small-cell tumor, two with adenocarcinoma, and two with leukemia); 10 patients had measurable disease.
  • Each patient received chemotherapy regimens based on the specific malignant cell observed in the transformed histology.
  • Three patients did not respond to treatment, and all of those patients died as a result of their disease.
  • CONCLUSION: Chemotherapy for MT limited to a single cell type may result in major responses and long-term survival in selected patients.
  • Local therapy after chemotherapy is an important component of treatment to achieve maximum response.
  • [MeSH-major] Cell Transformation, Neoplastic / drug effects. Mediastinal Neoplasms / drug therapy. Teratoma / drug therapy. Testicular Neoplasms / drug therapy
  • [MeSH-minor] Adenocarcinoma / drug therapy. Adenocarcinoma / pathology. Adult. Carcinoma / drug therapy. Carcinoma / pathology. Carcinoma, Small Cell / drug therapy. Carcinoma, Small Cell / pathology. Chemotherapy, Adjuvant. Cytogenetics. Humans. Leukemia, Mast-Cell / drug therapy. Leukemia, Mast-Cell / pathology. Male. Middle Aged. Neoplasm Staging. Neuroectodermal Tumors, Primitive / drug therapy. Neuroectodermal Tumors, Primitive / pathology. Rhabdomyosarcoma / drug therapy. Rhabdomyosarcoma / pathology. Treatment Outcome

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  • (PMID = 14645417.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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7. Lin CK, Liu HT: Evidence-based treatment for advanced germ cell tumor of the testis with a case illustration. J Chin Med Assoc; 2010 Jul;73(7):343-52
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  • [Title] Evidence-based treatment for advanced germ cell tumor of the testis with a case illustration.
  • Testicular germ cell tumor is rare in the Asian population.
  • Nevertheless, it is a prototypic cancer of young adults because it can be highly malignant but is also highly curable, even at an advanced stage.
  • This case has shown very good results from the treatment.
  • This is the standard therapy for poor- and intermediate-risk patients with germ cell tumors in the advanced stage, supported by current evidence-based literature.
  • BEP x 3 cycles or EP x 4 cycles is the standard therapy for good-risk patients with advanced germ cell tumors.
  • Using these treatments, we can achieve durable remissions of approximately 90%, 75%, and 45% in good-, intermediate-, and poor-risk patients, respectively.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Evidence-Based Practice. Neoplasms, Germ Cell and Embryonal / drug therapy. Testicular Neoplasms / drug therapy
  • [MeSH-minor] Adolescent. Bleomycin / administration & dosage. Cisplatin / administration & dosage. Etoposide / administration & dosage. Follow-Up Studies. Humans. Male. Neoplasm Staging. Tomography, X-Ray Computed

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  • [Copyright] 2010 Elsevier. Published by Elsevier B.V. All rights reserved.
  • (PMID = 20688298.001).
  • [ISSN] 1728-7731
  • [Journal-full-title] Journal of the Chinese Medical Association : JCMA
  • [ISO-abbreviation] J Chin Med Assoc
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] China (Republic : 1949- )
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; BEP protocol
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8. Sato S, Tanaka T, Takahashi A, Sasai M, Kitamura H, Masumori N, Tsukamoto T: Late recurrence and second primary malignancy among 139 patients with germ cell tumors: long-term outcome of the disease in a single-center experience. Jpn J Clin Oncol; 2010 Feb;40(2):157-62
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  • METHODS: This study included a total of 139 males with newly diagnosed GCTs of the testis or extragonadal origin who received treatment, including surgery, chemotherapy and radiation therapy, at our hospital between 1980 and 2005.
  • Late recurrence was found in five (3.6%) patients and all of them responded to salvage treatment and achieved disease-free status.
  • CONCLUSIONS: Late recurrence was successfully managed with appropriate treatments, although its incidence was not negligible.
  • Periodic follow-up may be necessary for >5 years in patients with GCTs for early detection of late recurrence.
  • In addition, care should be taken to watch for the development of life-threatening second primary malignant disease during long-term follow-up.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / pathology. Neoplasms, Second Primary / pathology. Testicular Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Disease-Free Survival. Follow-Up Studies. Humans. Male. Middle Aged. Neoplasm Staging. Retrospective Studies. Seminoma / pathology. Seminoma / therapy. Time Factors

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  • (PMID = 19906660.001).
  • [ISSN] 1465-3621
  • [Journal-full-title] Japanese journal of clinical oncology
  • [ISO-abbreviation] Jpn. J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC2813544
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9. Göbel U, Calaminus G, Schneider DT, Koch S, Teske C, Harms D: The malignant potential of teratomas in infancy and childhood: the MAKEI experiences in non-testicular teratoma and implications for a new protocol. Klin Padiatr; 2006 Nov-Dec;218(6):309-14
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  • [Title] The malignant potential of teratomas in infancy and childhood: the MAKEI experiences in non-testicular teratoma and implications for a new protocol.
  • Since 1982, mature and immature teratomas have been recruited into the MAHO and MAKEI protocols of the German Society for Pediatric Oncology and Hematology (GPOH) for testicular and non-testicular germ cell tumors in order to study the epidemiology and clinical behaviour of teratomas.
  • Patients were registered in the epidemiologic German Childrens Cancer Registry and the GPOH Childrens Tumor Registry for pathological review.
  • Patients with immaturity grade 2 and 3 according to Gonzales-Crussi were eligible for adjuvant chemotherapy.
  • 1) EFS after complete tumor resection has been estimated to 0.96 +/- 0.01 in both observation periods.
  • 2) Incomplete tumor resection remains the main risk factor for relapse (EFS 0.55 +/- 0.09).
  • 4) In MAKEI 83/86/89 four newborns with teratoma died due to perioperative complications and nine children as a result of tumor progression, whereas in MAKEI 96 no newborn died, only one child died from tumor progression, and another child died during long time observation for another reason (meningitis).
  • 5) In accordance to the experience of the MAKEI 83/86/89 studies, no child of the MAKEI 96 study presented with yolk sac tumor at recurrence if adjuvant chemotherapy was administered during first-line treatment because of immaturity.
  • In contrast, more than half of the children with tumor recurrence after watch and wait strategy had yolk sac tumor in addition to teratoma.
  • [MeSH-minor] Adolescent. Adult. Age Factors. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chemotherapy, Adjuvant. Chi-Square Distribution. Child. Child, Preschool. Data Interpretation, Statistical. Disease Progression. Female. Humans. Infant. Infant, Newborn. Male. Neoplasm Recurrence, Local. Neoplasm Staging. Neoplasms, Germ Cell and Embryonal / pathology. Ovary / pathology. Prospective Studies. Randomized Controlled Trials as Topic. Sacrococcygeal Region. Sex Factors. Treatment Outcome. World Health Organization

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  • (PMID = 17080332.001).
  • [ISSN] 0300-8630
  • [Journal-full-title] Klinische Pädiatrie
  • [ISO-abbreviation] Klin Padiatr
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
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10. Schmidt P, Haas RJ, Göbel U, Calaminus G: [Results of the German studies (MAHO) for treatment of testicular germ cell tumors in children--an update]. Klin Padiatr; 2002 Jul-Aug;214(4):167-72
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  • [Title] [Results of the German studies (MAHO) for treatment of testicular germ cell tumors in children--an update].
  • [Transliterated title] Risikoadaptierte Therapie-Strategie bei malignen Hodentumoren im Kindesalter - Die MAHO-Studien: Rückblick und aktueller Stand.
  • BACKGROUND: The MAHO studies for treatment of testicular germ cell tumors in childhood and adolescence registered between 1982 and 1/2001 260 patients (pts.).
  • Delay of chemotherapy in YST of stage I A. 2. Delay of modified lymphadenectomy for staging in I A tumors.
  • 3. Stepwise reduction of therapy in low stage tumors but increasing therapy in tumors of metastatic pattern.
  • Standard therapy consisted of 4 courses of vinblastine, bleomycin and cisplatin.
  • In stage II C or higher chemotherapy included cisplatin, VP 16 and bleomycin.
  • As salvage therapy VP16, ifosfamide and cisplatin was given.
  • RESULTS: According to histology and stage only 75/260 pts. needed chemotherapy.
  • 16 of these patients (13 %) needed a delayed standard chemotherapy 6 - 60 weeks after orchiectomy.
  • 59 pts. suffered from other malignant non-seminomatous tumors (EC, chorio, mixed tumors).
  • 20 of these had a clinical stage I including 5 with a pathologic stage I A. 15 received adjuvant chemotherapy and all 20 pts. survived relapse-free.
  • 22 pts. had stage II, 8 of these received salvage therapy in addition to standard chemotherapy, 21 of 22 pts. survived.
  • 17 pts. had stage III or IV, 5 of these died despite receiving salvage therapy, 9 pts. survived in complete remission, 3 pts. had partial remission.
  • In summary, the probability of disease free survival of 260 pts. is 97 % after a median observation time of 60 months.
  • Only about 13 % of these patients had to be treated by chemotherapy at a later time point and thus could be cured.
  • For YST pts. of stages greater than stage I A and all other malignant testicular tumors in childhood effective chemotherapy exists with an overall cure rate of about 95 %.
  • Local irradiation or staging lymphadenectomy is unnecessary.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Neoplasms, Germ Cell and Embryonal / drug therapy. Testicular Neoplasms / drug therapy
  • [MeSH-minor] Adolescent. Chemotherapy, Adjuvant. Child. Combined Modality Therapy. Drug Administration Schedule. Follow-Up Studies. Humans. Lymph Node Excision. Lymph Nodes / pathology. Male. Neoplasm Staging. Orchiectomy. Salvage Therapy. Survival Rate

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  • (PMID = 12165897.001).
  • [ISSN] 0300-8630
  • [Journal-full-title] Klinische Pädiatrie
  • [ISO-abbreviation] Klin Padiatr
  • [Language] ger
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Germany
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11. Thijssens K, Vaneerdeweg W, Schrijvers D, Eyskens E, Van Oosterom A: Retroperitoneal lymph node dissection as adjuvant therapy in the treatment of non-seminomatous testicular cancer. Acta Chir Belg; 2003 Nov-Dec;103(6):599-602
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  • [Title] Retroperitoneal lymph node dissection as adjuvant therapy in the treatment of non-seminomatous testicular cancer.
  • OBJECTIVE: To assess the results of retroperitoneal lymph node dissection (RPLND) of residual masses in patients with disseminated non-seminomatous germ cell tumour treated with cisplatin-based chemotherapy, both in terms of extension of surgery, morbidity and survival.
  • In patients with non-seminomatous testicular cancer more than stage I, the 'wait and see' strategy changed and patients were treated with chemotherapy.
  • Patients were assessed at the end of chemotherapy and if a residual masses persisted, a RPLND was performed.
  • RESULTS: Sixty patients had a non-seminomatous germ cell tumor of the testis and were analysed.
  • Forty-seven patients were treated with cisplatin-based chemotherapy.
  • In two patients malignant cells or fibrotic tissue were found above the renal trunk and bilateral.
  • The survival of the patients treated with a RPLND was 97% and in the whole group of patients with a non-seminomatous testicular cancer 98%.
  • CONCLUSION: RPLND has a place in the treatment of patients with non-seminomatous testicular cancer after chemotherapy in case of residual masses.
  • [MeSH-major] Germinoma / secondary. Germinoma / surgery. Lymph Node Excision. Testicular Neoplasms / pathology. Testicular Neoplasms / surgery
  • [MeSH-minor] Adult. Belgium. Chemotherapy, Adjuvant. Cohort Studies. Disease-Free Survival. Follow-Up Studies. Humans. Lymph Nodes / pathology. Lymph Nodes / surgery. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Staging. Retrospective Studies. Risk Assessment. Sensitivity and Specificity. Survival Rate. Treatment Outcome

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  • (PMID = 14743567.001).
  • [ISSN] 0001-5458
  • [Journal-full-title] Acta chirurgica Belgica
  • [ISO-abbreviation] Acta Chir. Belg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Belgium
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12. Michael H, Lucia J, Foster RS, Ulbright TM: The pathology of late recurrence of testicular germ cell tumors. Am J Surg Pathol; 2000 Feb;24(2):257-73
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The pathology of late recurrence of testicular germ cell tumors.
  • A total of 91 men had histologically documented late recurrences of testicular germ cell tumors characterized by a complete response to treatment with a subsequent disease-free interval of at least 2 years and no evidence of a second primary lesion.
  • Ninety percent of the patients for whom information was available received chemotherapy shortly after their initial diagnosis of testicular germ cell tumors; most of the other patients were known to have stage I disease initially.
  • Thus, teratoma was the most common type of neoplasm in late recurrences.
  • Excluding teratoma coexisting with other types of neoplasms, yolk sac tumor was the most frequent type of tumor in patients with late recurrence.
  • It occurred in 47% of patients, either alone or with teratoma, another nonteratomatous germ cell tumor type, or a "nongerm cell malignant tumor."
  • Unusual types of yolk sac tumor, including glandular, parietal, clear cell, and pleomorphic patterns, were seen frequently in late recurrences and often raised differential diagnostic problems with "nongerm cell" carcinomas.
  • A smaller number of late recurrences consisted of other types of neoplasms.
  • Twenty percent of patients with late recurrence had a nonteratomatous germ cell tumor other than yolk sac tumor, either alone, with yolk sac tumor, or with a "nongerm cell malignant tumor."
  • Most of these nonteratomatous germ cell tumors other than yolk sac tumor were embryonal carcinoma, although rarely seminoma and choriocarcinoma were encountered.
  • "Nongerm cell malignant tumors," including both sarcomas and carcinomas of various types, occurred in 23% of late-recurrence patients, either alone or with a nonteratomatous germ cell tumor.
  • Patients whose late recurrences consisted of pure "nongerm cell malignant tumor" or pure germ cell tumor (yolk sac tumor or other types) had a much worse prognosis: Only 36% to 37% were alive with no evidence of disease.
  • Patients with two different types of nonteratomatous malignancies in their late recurrences had a dismal clinical course: Only 17% with both yolk sac tumor and other nonteratomatous germ cell tumor had no evidence of disease, whereas no patient with both nonteratomatous germ cell tumor and "nongerm cell malignant tumor" was disease free.
  • Furthermore, late recurrence is not likely to respond to chemotherapy and is best treated by surgical excision when possible.
  • [MeSH-major] Germinoma / pathology. Neoplasm Recurrence, Local / pathology. Testicular Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Carcinoma, Embryonal / complications. Carcinoma, Embryonal / pathology. Carcinoma, Embryonal / therapy. Choriocarcinoma / complications. Choriocarcinoma / pathology. Choriocarcinoma / therapy. Endodermal Sinus Tumor / complications. Endodermal Sinus Tumor / pathology. Endodermal Sinus Tumor / therapy. Fluorescent Antibody Technique, Direct. Humans. Male. Neoplasm Staging. Neoplasms, Second Primary / pathology. Neoplasms, Second Primary / therapy. Sarcoma / complications. Sarcoma / pathology. Sarcoma / therapy. Seminoma / complications. Seminoma / pathology. Seminoma / therapy. Teratoma / complications. Teratoma / pathology. Teratoma / therapy

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  • (PMID = 10680894.001).
  • [ISSN] 0147-5185
  • [Journal-full-title] The American journal of surgical pathology
  • [ISO-abbreviation] Am. J. Surg. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
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13. Skolarus TA, Bhayani SB, Chiang HC, Brandes SB, Kibel AS, Landman J, Figenshau RS: Laparoscopic retroperitoneal lymph node dissection for low-stage testicular cancer. J Endourol; 2008 Jul;22(7):1485-9
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  • [Title] Laparoscopic retroperitoneal lymph node dissection for low-stage testicular cancer.
  • BACKGROUND AND PURPOSE: Current management options for low-stage mixed malignant germ-cell testicular tumors (MMGCT) after radical orchiectomy include surveillance, chemotherapy, or retroperitoneal lymph node dissection (RPLND).
  • The open RPLND is the surgical gold standard and has been duplicated laparoscopically with confirmed diagnostic effectiveness; however, its therapeutic oncologic value in MMGCT has never been proven.
  • Mean operative time was 250 minutes (range 176-369 min); estimated blood loss was 145 mL (range 50-500 mL); lymph node count was 23.8 (range 8-48); and hospital stay was 1.5 days (range 1-3 d).
  • There were no conversions to an open procedure, blood transfusions, or operative complications.
  • Chemotherapy was instituted in five of six patients with pathologic stage II disease.
  • CONCLUSION: L-RPLND as a diagnostic and therapeutic tool provides the benefits of a minimally invasive approach to MMGCT.
  • It is the procedure of choice at our institution for low-stage MMGCT and paratesticular rhabdomyosarcoma.

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  • (PMID = 18613781.001).
  • [ISSN] 1557-900X
  • [Journal-full-title] Journal of endourology
  • [ISO-abbreviation] J. Endourol.
  • [Language] ENG
  • [Publication-type] Journal Article
  • [Publication-country] United States
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14. Tröbs RB, Krauss M, Geyer C, Tannapfel A, Körholz D, Hirsch W: Surgery in infants and children with testicular and paratesticular tumours: a single centre experience over a 25-year-period. Klin Padiatr; 2007 May-Jun;219(3):146-51
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  • [Title] Surgery in infants and children with testicular and paratesticular tumours: a single centre experience over a 25-year-period.
  • Testicular and even more paratesticular tumours in children are rare.
  • The aim of the study is to characterise the spectrum of these lesions with focus on the feasibility and effectiveness of testis sparing surgery.
  • Generally a high rate of malignant or potentially malignant tumours was observed.
  • The spectrum of testicular tumours comprised 13 germ cell tumours (6 yolk sac tumours, 6 teratomas, 1 embryonal carcinoma) and 4 sex cord stromal tumours (2 Leydig's cell, Sertoli's cell, granulosa cell).
  • Further on, we observed 3 boys with paratesticular rhabdomyosarcoma (RMS), and three with testicular and paratesticular metastases (Wilms' tumour, neuroblastoma, leukaemia).
  • Dependent on tumour histology, stage and the recommended treatment schedule postoperative chemotherapy was added.
  • Testis sparing surgery was performed in 3 boys with primary testicular tumours (2 Leydig's cell, mature cystic teratoma).
  • During a median follow up of 5 years all patients with primary testicular tumours survived event free.
  • Meta-analysis of the recent literature revealed that testis sparing surgery is feasible and save in prepubertal boys after exclusion of a malignant tumour.
  • If a testis sparing approach is planned, the following criteria are essential: 1.
  • 3. The presence of sufficient healthy testicular parenchyma.
  • However, the high rate of malignant or potentially malignant tumours suggests that high inguinal orchidectomy should remain the surgical standard of therapy.
  • [MeSH-major] Granulosa Cell Tumor / surgery. Leydig Cell Tumor / surgery. Neoplasms, Germ Cell and Embryonal / surgery. Sertoli Cell Tumor / surgery. Testicular Neoplasms / surgery
  • [MeSH-minor] Adolescent. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Biomarkers, Tumor / blood. Chemotherapy, Adjuvant. Child. Child, Preschool. Chorionic Gonadotropin, beta Subunit, Human / blood. Combined Modality Therapy. Diagnostic Imaging. Feasibility Studies. Follow-Up Studies. Humans. Infant. Male. Neoplasm Staging. Orchiectomy / methods. Retrospective Studies. alpha-Fetoproteins / metabolism

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  • (PMID = 17525908.001).
  • [ISSN] 0300-8630
  • [Journal-full-title] Klinische Pädiatrie
  • [ISO-abbreviation] Klin Padiatr
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin, beta Subunit, Human; 0 / alpha-Fetoproteins
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15. Warde P, Gospodarowicz MK, Panzarella T, Chow E, Murphy T, Catton CN, Sturgeon JF, Moore M, Milosevic M, Jewett MA: Long term outcome and cost in the management of stage I testicular seminoma. Can J Urol; 2000 Apr;7(2):967-72; discussion 973.
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  • [Title] Long term outcome and cost in the management of stage I testicular seminoma.
  • PATIENTS AND METHODS: Between January 1981 and December 1994, 471 patients with stage I testicular seminoma were treated at our institution.
  • Of these, 245 patients received post-operative RT (25 Gy) to the retroperitoneal lymph nodes, and 226 have been managed with surveillance following orchidectomy.
  • Of the 226 patients on surveillance 37 patients have relapsed to date; five of those developed a second relapse.
  • Thirteen patients on surveillance (5.7%) and 10 patients treated with post-operative RT (4.1%) have received chemotherapy as part of their management.
  • One hundred and eighty-nine patients on surveillance have received no post-orchidectomy treatment to date.
  • The documented increased risk of second malignant tumors following RT must be taken into account when considering the additional cost of surveillance.
  • [MeSH-major] Seminoma / economics. Seminoma / therapy. Testicular Neoplasms / economics. Testicular Neoplasms / therapy
  • [MeSH-minor] Actuarial Analysis. Adult. Aged. Aged, 80 and over. Costs and Cost Analysis. Humans. Male. Middle Aged. Neoplasm Staging. Time Factors. Treatment Outcome

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  • (PMID = 11119439.001).
  • [ISSN] 1195-9479
  • [Journal-full-title] The Canadian journal of urology
  • [ISO-abbreviation] Can J Urol
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Canada
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16. Oldenburg J, Alfsen GC, Lien HH, Aass N, Waehre H, Fossa SD: Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses. J Clin Oncol; 2003 Sep 1;21(17):3310-7
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  • [Title] Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses.
  • PURPOSE: To determine preoperative parameters that predict the histology of specimens obtained by retroperitoneal lymph node dissection (RPLND) in patients with nonseminomatous germ cell cancer (NSGCT) whose residual mass was </= 20 mm in diameter after modern cisplatin-based induction chemotherapy.
  • PATIENTS AND METHODS: Eighty-seven patients with metastatic NSGCT underwent RPLND after having received cisplatin- or carboplatin-based induction chemotherapy.
  • In all patients, the largest diameter of the residual mass on the transaxial plane was </= 20 mm, as assessed by abdominal computed tomography (CT) immediately before RPLND.
  • RESULTS: Complete fibrosis or necrosis was found in 58 patients (67%), teratoma was found in 23 patients (26%), and vital malignant germ cell tumor was found in six patients (7%), including one patient with rhabdomyosarcoma in the RPLND specimen.
  • CONCLUSION: One third of retroperitoneal postchemotherapy lesions </= 20 mm contained residual vital tumor tissue, despite modern chemotherapy regimens.
  • Therefore, postchemotherapy RPLND remains necessary in patients with minimal-size residual lesions to facilitate easy and safe follow-up and initiate additional therapy as early as possible, thus avoiding recurrences.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / surgery. Testicular Neoplasms / surgery
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Bleomycin / administration & dosage. Carboplatin / administration & dosage. Chi-Square Distribution. Cisplatin / administration & dosage. Combined Modality Therapy. Etoposide / administration & dosage. Humans. Ifosfamide / administration & dosage. Lymph Node Excision. Male. Middle Aged. Neoplasm Staging. Peritoneum. Statistics, Nonparametric. Tomography, X-Ray Computed. Treatment Outcome

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  • [CommentIn] J Clin Oncol. 2005 Jun 1;23(16):3853 [15923581.001]
  • (PMID = 12947067.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; BG3F62OND5 / Carboplatin; Q20Q21Q62J / Cisplatin; UM20QQM95Y / Ifosfamide
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17. Stewart RJ, Martelli H, Oberlin O, Rey A, Bouvet N, Spicer RD, Godzinski J, Stevens MC, International Society of Pediatric Oncology: Treatment of children with nonmetastatic paratesticular rhabdomyosarcoma: results of the Malignant Mesenchymal Tumors studies (MMT 84 and MMT 89) of the International Society of Pediatric Oncology. J Clin Oncol; 2003 Mar 1;21(5):793-8
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  • [Title] Treatment of children with nonmetastatic paratesticular rhabdomyosarcoma: results of the Malignant Mesenchymal Tumors studies (MMT 84 and MMT 89) of the International Society of Pediatric Oncology.
  • PURPOSE: To report the results of the Malignant Mesenchymal Tumors studies (MMT 84 and 89) of the International Society of Pediatric Oncology (SIOP) in males with nonmetastatic paratesticular rhabdomyosarcoma.
  • Disease was staged according to the SIOP tumor-node-metastasis staging system.
  • Treatment was stratified by stage.
  • In the MMT 89 study, males with completely resected tumors at diagnosis received less chemotherapy (vincristine and dactinomycin) than patients in the MMT 84 study (ifosfamide, vincristine, and dactinomycin).
  • RESULTS: Median age at diagnosis was 65 months.
  • Thirty-one tumors were larger than 5 cm, and 13 males were older than 10 years with a tumor larger than 5 cm.
  • OS and EFS were significantly worse for males with tumors greater than 5 cm and for males older than 10 years at diagnosis.
  • CONCLUSION: Males with paratesticular RMS have an excellent prognosis except for a selected group of patients older than 10 years or with tumor greater than 5 cm.
  • Intensified chemotherapy incorporating alkylating agents for this subgroup may be preferred to the use of systematic lymphadenectomy to improve survival while minimizing the burden of therapy.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Dactinomycin / therapeutic use. Ifosfamide / therapeutic use. Mesenchymoma / drug therapy. Rhabdomyosarcoma / drug therapy. Testicular Neoplasms / drug therapy. Vincristine / therapeutic use
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Combined Modality Therapy. Disease-Free Survival. Humans. Infant. Lymph Node Excision. Male. Neoplasm Recurrence, Local / drug therapy. Neoplasm Recurrence, Local / surgery. Neoplasm Staging. Salvage Therapy. Survival Rate. Treatment Outcome

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  • (PMID = 12610176.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 1CC1JFE158 / Dactinomycin; 5J49Q6B70F / Vincristine; UM20QQM95Y / Ifosfamide; IVA protocol; SIOP protocol
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18. Ding QM, Liang W, Wang G, Lu Y, Jin CD, Ren HL, Zhang HB, Qiu ZK, Su Z: [Testicular mixed nonseminomatous germ cell cancer: a case report and review of the literature]. Zhonghua Nan Ke Xue; 2010 Oct;16(10):925-7
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  • [Title] [Testicular mixed nonseminomatous germ cell cancer: a case report and review of the literature].
  • OBJECTIVE: Testicular mixed nonseminomatous germ cell cancer (TMNGCC) is rarely reported.
  • This study aimed to explore the clinical symptoms, pathological characteristics and treatment methods of TMNGCC.
  • RESULTS: The patient presented with a chief complaint of painless testicular swelling for 3 years.
  • Histopathological examinations revealed a tumor of papillary, fissural or adenoid structure, with large polygonal or columnar cells with one or more irregular vesicular nuclei, the nuclear membrane clear, the cytoplasm eosinophilic or basophilic, and the interstitium infiltrated by a few lymphocytes.
  • The tumor was pathologically diagnosed as teratogenic embryonic testicular cancer, and treated by radical surgery, followed by adjuvant chemotherapy according to the treatment of TMNGCC.
  • CONCLUSION: TMNGCC is a rare malignant tumor, mostly with unobvious clinical symptoms.
  • Its diagnosis primarily depends on physical examination, ultrasonography, CT, and measurement of serum tumor markers; its confirmation necessitates pathological examination, and its first-choice treatment is surgical resection.
  • [MeSH-major] Seminoma. Testicular Neoplasms
  • [MeSH-minor] Adult. Humans. Male. Neoplasm Staging


19. Gale J, Mead GM, Simmonds PD: Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours. Clin Oncol (R Coll Radiol); 2002 Dec;14(6):481-90
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  • [Title] Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours.
  • AIM: To review the management and clinical outcome of 10 patients, presenting to a single centre with symptoms and signs of spinal cord or cauda equina compression secondary to epidural metastatic disease from a testicular germ cell cancer.
  • METHODS: Clinical data regarding presenting history, physical examination, staging investigations, treatment and clinical outcome were retrospectively obtained from patient records.
  • RESULTS: Eight patients exhibited neurological deficits at the time of initial presentation of germ cell cancer or as a first manifestation of relapse following dog leg irradiation.
  • Four of these cases were managed with chemotherapy alone, with excellent neurological recovery, whilst four underwent decompressive laminectomy--in three cases prior to referral and in one case after commencing chemotherapy.
  • Four required further chemotherapy (high dose in two cases).
  • Two patients presented with cord compression as a feature of disease relapse following chemotherapy, and were managed with radiotherapy alone in an attempt to achieve local disease control and limit neurological dysfunction.
  • CONCLUSION: Epidural spinal cord or cauda equina compression is a rare complication of metastatic germ cell cancer, which can be successfully managed in chemo-naive patients with good neurological outcome.
  • [MeSH-major] Bone Neoplasms / secondary. Cauda Equina / pathology. Neoplasms, Germ Cell and Embryonal / secondary. Peripheral Nervous System Neoplasms / secondary. Spinal Cord Compression / etiology. Spinal Cord Compression / therapy. Testicular Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Humans. Male. Middle Aged. Neoplasm Recurrence, Local. Physical Examination. Retrospective Studies. Treatment Outcome

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  • (PMID = 12512971.001).
  • [ISSN] 0936-6555
  • [Journal-full-title] Clinical oncology (Royal College of Radiologists (Great Britain))
  • [ISO-abbreviation] Clin Oncol (R Coll Radiol)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] England
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20. Suita S, Shono K, Tajiri T, Takamatsu T, Mizote H, Nagasaki A, Inomata Y, Hara T, Okamura J, Miyazaki S, Kawakami K, Eguchi H, Tsuneyoshi M, Committee for Pediatric Solid Malignant Tumors in the Kyushu Area: Malignant germ cell tumors: clinical characteristics, treatment, and outcome. A report from the study group for Pediatric Solid Malignant Tumors in the Kyushu Area, Japan. J Pediatr Surg; 2002 Dec;37(12):1703-6
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  • [Title] Malignant germ cell tumors: clinical characteristics, treatment, and outcome. A report from the study group for Pediatric Solid Malignant Tumors in the Kyushu Area, Japan.
  • PURPOSE: This study aims to assess the prognostic factors and optimal treatments for malignant germ cell tumors (MGCT) in childhood.
  • The prognostic factors and treatments were assessed based on the 5-year survival rate. RESULTS:.
  • (1) Stage: 100% for stage I (n = 54), 75.0% for stage II (n = 4), 67.3% for stage III (n = 14), and 54.8% for stage IV (n = 33); Unknown: n = 12. (2) Primary site: 93.4% for the testis (n = 52), 86.7% for the ovary (n = 31), 56.9% for the sacrococcygeal (n = 21), and 60.6% for others (n = 12); unknown: n = 1. (3) Surgical intervention for primary tumor: 100% for stage I with a complete resection (n = 53), 78.4% for stage III, IV with a complete resection (n = 26), and 33.3% for stage III, IV with an incomplete resection (n = 21). (4) Type of chemotherapy for the stage III and IV: 83.9% for the PVB (cisplatin, vinblastin, bleomycin; n = 13), 66.7% for the VAC (vincristine, actinomycin D, cyclophosphamide; n = 6), and 47.1% for other regimens (n = 25).
  • CONCLUSIONS: An early stage, a diagnosis under 1 year of age and a primary site in the gonads were favorable prognosis factors, whereas histologic findings of choriocarcinoma and liver or lung metastasis were unfavorable.
  • Radical complete resection alone is a sufficient treatment for localized MGCT.
  • The PVB regimen is optimal chemotherapy for advanced MGCT; however, high-risk cases still may require more aggressive treatment.
  • [MeSH-major] Germinoma / diagnosis. Germinoma / therapy
  • [MeSH-minor] Adolescent. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Child. Child, Preschool. Female. Humans. Incidence. Infant. Infant, Newborn. Liver Neoplasms / secondary. Lung Neoplasms / secondary. Male. Neoplasm Staging. Ovarian Neoplasms / diagnosis. Ovarian Neoplasms / epidemiology. Ovarian Neoplasms / surgery. Prognosis. Retrospective Studies. Survival Rate. Testicular Neoplasms / diagnosis. Testicular Neoplasms / epidemiology. Testicular Neoplasms / surgery. Treatment Outcome

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  • [Copyright] Copyright 2002, Elsevier Science (USA). All rights reserved.
  • [CommentIn] J Urol. 2003 Sep;170(3):1040 [12926414.001]
  • (PMID = 12483635.001).
  • [ISSN] 1531-5037
  • [Journal-full-title] Journal of pediatric surgery
  • [ISO-abbreviation] J. Pediatr. Surg.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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21. Lo Curto M, Lumia F, Alaggio R, Cecchetto G, Almasio P, Indolfi P, Siracusa F, Bagnulo S, De Bernardi B, De Laurentis T, Di Cataldo A, Tamaro P: Malignant germ cell tumors in childhood: results of the first Italian cooperative study "TCG 91". Med Pediatr Oncol; 2003 Nov;41(5):417-25
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  • [Title] Malignant germ cell tumors in childhood: results of the first Italian cooperative study "TCG 91".
  • BACKGROUND AND AIMS: About 20% of patients with germ cell tumor (GCT) are still resistant to therapy.
  • The site of the primary tumor was gonadal in 59, extragonadal in 36.
  • The treatment was surgery alone in 31; surgery plus radiotherapy in 1; chemotherapy +/- surgery in 63.
  • Post-chemotherapy resection in 19 (10 complete, 9 partial).
  • The chemotherapy regimen was carboplatin 400 mg/m2/day on days 1, 2; etoposide 150 mg/m2/day on days 1, 2; ifosfamide 1,500 mg/m2/day on days 21, 22; dactinomycin 1.5 mg/m2/day on day 21; vincristine 1.5 mg/m2/day on day 21.
  • Three patients died because of toxicity and two non-responders (to primary chemotherapy), died of progression; among the remaining 90 patients 20 relapsed, 9 are in second remission, 2 are alive with disease, and 9 died of disease progression (one from progression and intracranial hemorrhage).
  • Survival according to: (a) site: testis: 100%; ovary: 88%; sacrococcyx: 69.6%; other sites: 33.3% (P < 0.001);.
  • All the pts who had complete resection of the primary tumor at diagnosis or at delayed surgery, remained in remission.
  • CONCLUSIONS: Multivariate analysis showed that the primary site of tumor was the only independent prognostic factor for survival and EFS.
  • [MeSH-major] Germinoma / pathology. Germinoma / therapy. Ovarian Neoplasms / pathology. Ovarian Neoplasms / therapy. Testicular Neoplasms / pathology. Testicular Neoplasms / therapy
  • [MeSH-minor] Adolescent. Age Distribution. Child. Child, Preschool. Cohort Studies. Combined Modality Therapy. Confidence Intervals. Female. Humans. Incidence. Italy / epidemiology. Male. Multivariate Analysis. Neoplasm Staging. Probability. Prognosis. Retrospective Studies. Risk Assessment. Sex Distribution. Survival Analysis. Treatment Outcome

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  • [Copyright] Copyright 2003 Wiley-Liss, Inc.
  • (PMID = 14515380.001).
  • [ISSN] 0098-1532
  • [Journal-full-title] Medical and pediatric oncology
  • [ISO-abbreviation] Med. Pediatr. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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22. Machtens S, Serth J, Meyer A, Kleinhorst C, Ommer KJ, Herbst U, Kieruij M, Boerner AR: Positron emission tomography (PET) in the urooncological evaluation of the small pelvis. World J Urol; 2007 Aug;25(4):341-9
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  • [Title] Positron emission tomography (PET) in the urooncological evaluation of the small pelvis.
  • Positron emission tomography (PET) with the use of ((18)F)2-fluoro-D: -2-desoxyglucose (FDG) has been investigated to be a highly sensitive and specific imaging modality in the diagnostic of primary and recurrent tumors and in the control of therapies in numerous non-urologic cancers.
  • The aim of this review is to validate the significance of PET as a diagnostic tool in malignant urological tumors of the small pelvis.
  • A systematic review of the current literature concerning the role of PET for malignant prostate, testicular and bladder tumors was carried out.
  • The data indicate no additional role for PET in comparison with conventional imaging in tumor detection and local staging for prostate, bladder or testicular cancer.
  • Tumor recurrence in prostate cancer seems to be more effectively identified with acetate and choline than with FDG, but this effect is more pronounced with higher PSA values.
  • The value of PET in the identification of metastatic disease in either tumor entity can not be finally outlined as the clinical data are partly missing, controversial or in the process of evaluation.
  • FDG-PET can be regarded as accepted imaging modality in the restaging of seminomatous germ cell tumors after chemotherapy.
  • [MeSH-major] Pelvis / diagnostic imaging. Prostatic Neoplasms / diagnostic imaging. Testicular Neoplasms / diagnostic imaging. Tomography, Emission-Computed, Single-Photon / methods. Urinary Bladder Neoplasms / diagnostic imaging
  • [MeSH-minor] Diagnosis, Differential. Humans. Male. Neoplasm Staging / methods. Reproducibility of Results

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  • (PMID = 17624533.001).
  • [ISSN] 0724-4983
  • [Journal-full-title] World journal of urology
  • [ISO-abbreviation] World J Urol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Germany
  • [Number-of-references] 66
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23. Donadio AC, Bosl GJ: The future of therapy for nonseminomatous germ cell tumors. Chest Surg Clin N Am; 2002 Nov;12(4):769-89
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  • [Title] The future of therapy for nonseminomatous germ cell tumors.
  • This article has reviewed recent advances in understanding the molecular mechanisms of germ cell transformation, germ cell tumor differentiation, and germ cell tumor chemotherapy sensitivity and resistance.
  • Future developments should include the following: The use of high-throughput techniques to assess tumor biology and evaluate new markers will allow more sophisticated assessment of prognosis.
  • Future therapy will use oligonucleotide chips, perhaps specific to germ cell tumors or gene products associated with drug resistance, to assign treatment (radiation, RPLND, chemotherapy).
  • The pathways associated with metastases and resistance will either replace or amplify the current risk algorithms and the clinician's ability to select therapy.
  • The same high-throughput techniques will identify critical molecules and pathways, providing new specific treatment targets.
  • In this context, the treatment of malignant transformation and the prediction of teratoma at metastatic sites will take on a greater importance.
  • Over the past 2 decades, the treatment of germ cell tumors has become well-defined.
  • Further improvement requires that investigators find new markers corresponding to tumor phenotype.
  • This achievement will prevent unnecessary treatment in patients destined to have a favorable outcome, and will target biologically unfavorable or resistant disease for new therapy developed specifically to target the molecular or genetic defects that disrupt normal cell cycle control.
  • [MeSH-major] Germinoma / diagnosis. Germinoma / therapy. Teratoma / diagnosis. Teratoma / therapy. Testicular Neoplasms / diagnosis. Testicular Neoplasms / therapy
  • [MeSH-minor] Antineoplastic Agents / therapeutic use. Cell Transformation, Neoplastic. Combined Modality Therapy. Drug Resistance, Neoplasm. Forecasting. Humans. Male. Molecular Biology. Neoplasm Metastasis. Neoplasm Staging. Prognosis. Treatment Outcome

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  • (PMID = 12471877.001).
  • [ISSN] 1052-3359
  • [Journal-full-title] Chest surgery clinics of North America
  • [ISO-abbreviation] Chest Surg. Clin. N. Am.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
  • [Number-of-references] 90
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24. Stephenson AJ: Current treatment options for clinical stage I seminoma. World J Urol; 2009 Aug;27(4):427-32
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  • [Title] Current treatment options for clinical stage I seminoma.
  • Adjuvant radiotherapy, surveillance, and single-agent carboplatin chemotherapy are all accepted treatment options for clinical stage (CS) I seminoma with cure rates approaching 100%.
  • Low-dose (25-35 Gy) adjuvant radiotherapy to the retroperitoneum and ipsilateral pelvis has been the mainstay of treatment for decades and is associated with excellent long-term survival and acceptable short-term toxicity.
  • The use of lower radiation doses (20 Gy) and the omission of pelvic radiation have been investigated to reduce toxicity.
  • However, the risk of late toxicity (specifically cardiovascular disease and secondary malignant neoplasms) resulting from radiation exposure have diminished the appeal of this approach, particularly given the fact that 80-85% of patients are cured by orchiectomy.
  • The appeal of surveillance is the avoidance of treatment-related morbidity in 80-85% of patients and the successful salvage of relapses with 30-35 Gy radiotherapy in most cases.
  • However, given the prolonged time course to relapse in CS I seminoma on surveillance, long-term follow-up with frequent abdominal-pelvic imaging is required.
  • However, concerns about the risk of inadequate therapy and late toxicity limit the acceptance of this approach until long-term results are available.
  • With potential of avoiding treatment-related toxicity without compromising curability and given the overall low risk of occult metastasis in clinical stage I seminoma, surveillance is the recommended treatment option.
  • [MeSH-major] Seminoma / drug therapy. Seminoma / radiotherapy. Testicular Neoplasms / drug therapy. Testicular Neoplasms / radiotherapy
  • [MeSH-minor] Antineoplastic Agents / therapeutic use. Carboplatin / therapeutic use. Combined Modality Therapy. Humans. Male. Neoplasm Staging. Population Surveillance. Radiotherapy, Adjuvant

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  • (PMID = 19370354.001).
  • [ISSN] 1433-8726
  • [Journal-full-title] World journal of urology
  • [ISO-abbreviation] World J Urol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Antineoplastic Agents; BG3F62OND5 / Carboplatin
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25. vom Dorp F, Krege S, Rübben H: [Inductive systemic therapy of urological tumors with curative intent]. Urologe A; 2007 Oct;46(10):1400-3
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  • [Title] [Inductive systemic therapy of urological tumors with curative intent].
  • [Transliterated title] Induktive Systemtherapie mit kurativer Zielsetzung urologischer Tumoren.
  • Up to now systemic therapy with curative intent is possible in only a few tumors.
  • Concerning advanced malignant tumors in urology only testicular cancer can be cured.
  • In metastatic urothelial cancer of the bladder this might be possible in single cases.
  • The amazing results in testicular cancer were possible by consistent performance of clinical trials.
  • The success in treatment also is an example for interdisciplinarity.
  • Especially in advanced stages treatment consists of two components, chemotherapy, correctly performed concerning dose and interval, followed by complete residual tumor resection.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Neoadjuvant Therapy
  • [MeSH-minor] Biomarkers, Tumor / blood. Bleomycin / administration & dosage. Bleomycin / adverse effects. Cisplatin / administration & dosage. Cisplatin / adverse effects. Combined Modality Therapy. Drug Delivery Systems. Etoposide / administration & dosage. Etoposide / adverse effects. Humans. Ifosfamide / administration & dosage. Ifosfamide / adverse effects. Lymph Node Excision. Male. Neoplasm Staging. Neoplasms, Germ Cell and Embryonal / drug therapy. Neoplasms, Germ Cell and Embryonal / mortality. Neoplasms, Germ Cell and Embryonal / pathology. Neoplasms, Germ Cell and Embryonal / surgery. Orchiectomy. Prognosis. Seminoma / drug therapy. Seminoma / mortality. Seminoma / pathology. Seminoma / surgery. Survival Rate. Taxoids / administration & dosage. Taxoids / adverse effects. Testicular Neoplasms / drug therapy. Testicular Neoplasms / mortality. Testicular Neoplasms / pathology. Testicular Neoplasms / surgery. Treatment Outcome. Vinblastine / administration & dosage. Vinblastine / adverse effects

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  • (PMID = 17874061.001).
  • [ISSN] 0340-2592
  • [Journal-full-title] Der Urologe. Ausg. A
  • [ISO-abbreviation] Urologe A
  • [Language] ger
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Taxoids; 11056-06-7 / Bleomycin; 5V9KLZ54CY / Vinblastine; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; UM20QQM95Y / Ifosfamide; BEP protocol; ICE protocol 1; TIP regimen; VeIP protocol
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26. Patterson DM, Murugaesu N, Holden L, Seckl MJ, Rustin GJ: A review of the close surveillance policy for stage I female germ cell tumors of the ovary and other sites. Int J Gynecol Cancer; 2008 Jan-Feb;18(1):43-50
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  • There is good evidence that surveillance for stage I dysgerminomas is a safe option although many centers worldwide still advocate adjuvant chemotherapy for stage IA nondysgerminomatous tumors, despite the significant risk of developing long-term treatment side effects.
  • Patients underwent surgery and staging followed by intense surveillance, which included regular tumor markers and imaging.
  • Relapse rates for stage IA nondysgerminomatous tumors and dysgerminomas were 8 of 22 (36%) and 2 of 9 (22%), respectively, plus one patient with mature teratoma and glial implants also relapsed; 10 of these 11 patients (91%) were successfully cured with platinum-based chemotherapy.
  • The overall disease-specific survival of malignant ovarian germ cell tumors was 94%.
  • We have confirmed again that surveillance of all stage IA ovarian germ cell tumors is very safe and that the outcome is comparable with testicular tumors.
  • We question the need for potentially toxic adjuvant chemotherapy in nondysgerminoma patients who have greater than 90% chance of being salvaged with chemotherapy if they relapse later.
  • [MeSH-major] Dysgerminoma / diagnosis. Neoplasm Recurrence, Local / diagnosis. Ovarian Neoplasms / diagnosis. Teratoma / diagnosis
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Biomarkers, Tumor / metabolism. Female. Humans. Middle Aged. Neoplasm Staging. Population Surveillance. Prognosis. Risk Management. Treatment Outcome

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  • (PMID = 17466047.001).
  • [ISSN] 1525-1438
  • [Journal-full-title] International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
  • [ISO-abbreviation] Int. J. Gynecol. Cancer
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
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27. Schneider DT, Calaminus G, Wessalowski R, Pathmanathan R, Harms D, Göbel U: Therapy of advanced ovarian juvenile granulosa cell tumors. Klin Padiatr; 2002 Jul-Aug;214(4):173-8
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  • [Title] Therapy of advanced ovarian juvenile granulosa cell tumors.
  • In local disease (FIGO stage I), the beneficial role of tumor-ovarectomy is well established.
  • In contrast, life expectancy in patients with advanced JGCT (FIGO stage >/= II) is short even after complete tumor resection.
  • The current literature provides only limited and inconclusive data regarding the value of adjuvant chemotherapy in such patients with advanced disease.
  • PATIENTS AND METHODS: Therefore, we analyzed the patients with FIGO stage >/= II JGCT who were prospectively documented as follow-up patients of the German MAKEI trials for non-testicular germ cell tumors and received the recommended cisplatin-based chemotherapy in an adjuvant setting.
  • Two patients received laparoscopic tumor resection, which was incomplete in both.
  • All patients received 4 or 6 cycles of adjuvant cisplatin-based three-agent chemotherapy in analogy to the current therapeutic concept applied in malignant germ cell tumors.
  • One patient with a large tumor and multiple peritoneal metastases additionally received 40 Gy abdominal irradiation.
  • RESULTS: All patients achieved complete clinical remission after initial surgery and adjuvant chemotherapy.
  • One patient developed a metachronous tumor of the contralateral ovary after 126 months follow-up and is still alive but currently in therapy of another recurrence.
  • Another patient suffered a tumor recurrence after 12 months but achieved a second complete remission with cisplatin chemotherapy after a follow-up of currently 4 months.
  • One patient achieved complete clinical remission but suffered a diffuse peritoneal tumor recurrence with massive ascites and finally died as a result of tumor progression.
  • In summary, at the time of this report 6 of 7 patients are alive after a median of 47 (15 - 138) months.
  • CONCLUSION: This analysis clearly demonstrates that advanced JGCT can be successfully treated with surgery followed by adjuvant cisplatin-based chemotherapy.
  • Therefore, this study reveals encouraging therapeutic perspectives in these otherwise fatal tumors that merit further investigation in a prospective cooperative trial.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Granulosa Cell Tumor / drug therapy. Ovarian Neoplasms / drug therapy
  • [MeSH-minor] Adolescent. Chemotherapy, Adjuvant. Child. Cisplatin / administration & dosage. Cisplatin / adverse effects. Combined Modality Therapy. Female. Follow-Up Studies. Germany. Humans. Neoplasm Staging. Prospective Studies. Survival Rate

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  • (PMID = 12165898.001).
  • [ISSN] 0300-8630
  • [Journal-full-title] Klinische Pädiatrie
  • [ISO-abbreviation] Klin Padiatr
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
  • [Chemical-registry-number] Q20Q21Q62J / Cisplatin
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28. Göbel U, Calaminus G, Schneider DT, Schmidt P, Haas RJ, MAKEI and MAHO Study Groups of the German Society of Pediatric Oncology and Hematology, and the SIOP CNS GCT Study Group: Management of germ cell tumors in children: approaches to cure. Onkologie; 2002 Feb;25(1):14-22
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  • The introduction of cisplatinum chemotherapy and current advances in the surgical treatment have resulted in a dramatic improvement of the prognosis of children with malignant germ cell tumors (GCT).
  • Cisplatinum chemotherapy generally results in sufficient systemic tumor control, but local relapses may still occur in patients who did not receive adequate local treatment.
  • Therefore, the therapeutic consideration must take into account age, primary site of the tumor, and its histology.
  • In gonadal tumors, there is a high chance of primary complete resection since these tumors tend to be encapsulated, and particularly testicular GCT are often detected at a low tumor stage.
  • In these tumors, a neoadjuvant or preoperative chemotherapy after clinical diagnosis by imaging and evaluation of tumor markers significantly facilitates complete resection on delayed surgery.
  • In addition, the impact of chemotherapy on local tumor control may be enhanced by locoregional hyperthermia.
  • Nevertheless, biopsy is essential for diagnosis in nonsecreting tumors.
  • In intracranial GCT, radiotherapy significantly contributes to local tumor control, and doses are stratified according to histology.
  • These general considerations have been integrated into national and international cooperative treatment protocols.
  • In most current protocols, treatment is stratified according to an initial risk assessment that includes the parameters age, site, histology, stage, completeness of resection and the tumor markers alpha(1)-fetoprotein (AFP) and human choriogonadotropin (beta-HCG).
  • Moreover, the previously high-risk groups may now expect a favorable prognosis with this risk-adapted treatment, whereas an increasing number of low-risk patients are treated expectantly or with significantly reduced chemotherapy.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / therapy
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Chorionic Gonadotropin, beta Subunit, Human / blood. Cisplatin / administration & dosage. Cisplatin / adverse effects. Combined Modality Therapy. Female. Humans. Infant. Infant, Newborn. Male. Neoadjuvant Therapy. Neoplasm Staging. Prognosis. alpha-Fetoproteins / metabolism

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  • [Copyright] Copyright 2002 S. Karger GmbH, Freiburg
  • (PMID = 11893878.001).
  • [ISSN] 0378-584X
  • [Journal-full-title] Onkologie
  • [ISO-abbreviation] Onkologie
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] Switzerland
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human; 0 / alpha-Fetoproteins; Q20Q21Q62J / Cisplatin
  • [Number-of-references] 66
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29. Gupta P, Singh U, Singh SK, Kapoor R, Gupta V, Das A: Bilateral symmetrical metastasis to all extraocular muscles from distant rhabdomyosarcoma. Orbit; 2010 Jun;29(3):146-8
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  • After 2 weeks of initial surgery the patient developed bilateral axial proptosis and radiological imaging revealed bilateral extraocular muscle thickening involving all the extraocular muscles.
  • COMMENT: Although rhabdomyosarcoma is the commonest primary orbital malignant mass developing in young patients, it is an uncommon metastasis.
  • The present report describes one such patient with favorable initial response to chemotherapy and muscle thickness reverting to normal.
  • Metastasis from a distant site should be considered in differential diagnosis when evaluating a patient with bilateral enlargement of all extraocular muscles.
  • [MeSH-major] Muscle Neoplasms / secondary. Rhabdomyosarcoma / secondary. Scrotum / pathology. Testicular Neoplasms / pathology
  • [MeSH-minor] Adolescent. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Disease Progression. Follow-Up Studies. Humans. Male. Neoplasm Invasiveness / pathology. Neoplasm Staging. Oculomotor Muscles. Orbital Neoplasms / drug therapy. Orbital Neoplasms / secondary. Orchiectomy / methods. Risk Assessment

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  • (PMID = 20497080.001).
  • [ISSN] 1744-5108
  • [Journal-full-title] Orbit (Amsterdam, Netherlands)
  • [ISO-abbreviation] Orbit
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] England
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30. Koukourakis G, Kouloulias V: Lymphoma of the testis as primary location: tumour review. Clin Transl Oncol; 2010 May;12(5):321-5
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  • [Title] Lymphoma of the testis as primary location: tumour review.
  • Non-Hodgkin's lymphoma as a primary testicular neoplasm accounts approximately 9% of all testicular malignant tumours and about 1-2% of all non-Hodgkin's lymphoma.
  • This neoplasm is the most common malignant tumour of the testis in the elderly.
  • The most common histotype in primary forms is the diffuse large B-cell lymphoma, whereas more aggressive histologies such as Burkitt's lymphoma are principal founded in cases of secondary involvement of the testis.
  • In 35% of patients, bilateral testicular involvement is detected.
  • Despite the fact that responses to doxorubicin- containing chemotherapy, especially in early stages, show good results, relapses are often seen, and the prognosis of this tumour is very poor.
  • Testicular lymphoma often disseminates to other extranodal organs, such as contralateral testis, central nervous system (CNS), lung, pleura, Waldeyer's ring and soft tissue.
  • For patients with limited disease, the recommended first-line treatment is orchiectomy followed by rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) combination chemotherapy, with central nervous system (CNS) prophylaxis and prophylactic irradiation of the contralateral testis.
  • [MeSH-major] Lymphoma / diagnosis. Lymphoma / therapy. Testicular Neoplasms / diagnosis. Testicular Neoplasms / therapy
  • [MeSH-minor] Disease Progression. Humans. Male. Neoplasm Metastasis. Neoplasm Staging / methods. Prognosis

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  • (PMID = 20466616.001).
  • [ISSN] 1699-3055
  • [Journal-full-title] Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
  • [ISO-abbreviation] Clin Transl Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
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31. Schmoll HJ, Souchon R, Krege S, Albers P, Beyer J, Kollmannsberger C, Fossa SD, Skakkebaek NE, de Wit R, Fizazi K, Droz JP, Pizzocaro G, Daugaard G, de Mulder PH, Horwich A, Oliver T, Huddart R, Rosti G, Paz Ares L, Pont O, Hartmann JT, Aass N, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Classen J, Clemm S, Culine S, de Wit M, Derigs HG, Dieckmann KP, Flasshove M, Garcia del Muro X, Gerl A, Germa-Lluch JR, Hartmann M, Heidenreich A, Hoeltl W, Joffe J, Jones W, Kaiser G, Klepp O, Kliesch S, Kisbenedek L, Koehrmann KU, Kuczyk M, Laguna MP, Leiva O, Loy V, Mason MD, Mead GM, Mueller RP, Nicolai N, Oosterhof GO, Pottek T, Rick O, Schmidberger H, Sedlmayer F, Siegert W, Studer U, Tjulandin S, von der Maase H, Walz P, Weinknecht S, Weissbach L, Winter E, Wittekind C, European Germ Cell Cancer Consensus Group: European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol; 2004 Sep;15(9):1377-99
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  • [Title] European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG).
  • Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years.
  • Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively.
  • The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion.
  • Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient.
  • However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure.
  • Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations.

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  • [CommentIn] Ann Oncol. 2005 Jan;16(1):172-3 [15598959.001]
  • (PMID = 15319245.001).
  • [ISSN] 0923-7534
  • [Journal-full-title] Annals of oncology : official journal of the European Society for Medical Oncology
  • [ISO-abbreviation] Ann. Oncol.
  • [Language] ENG
  • [Publication-type] Consensus Development Conference; Guideline; Journal Article; Practice Guideline; Review
  • [Publication-country] England
  • [Number-of-references] 244
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32. Lo Curto M, D'Angelo P, Cecchetto G, Klersy C, Dall'Igna P, Federico A, Siracusa F, Alaggio R, Bernini G, Conte M, De Laurentis T, Di Cataldo A, Inserra A, Santoro N, Tamaro P, Indolfi P: Mature and immature teratomas: results of the first paediatric Italian study. Pediatr Surg Int; 2007 Apr;23(4):315-22
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  • Teratoma is the most common germ cell tumour in childhood; mature (MT) and immature teratomas (IT) are benign tumours, but if they recur, they can be in some cases malignant.
  • Clinical data, treatment and results were all analysed.
  • Chemotherapy (CT) with Vinblastine, D: -actinomycin and cyclophosphamide was indicated for extra-testicular IT grade 2 or 3.
  • MT was diagnosed in 127 patients (93 F and 34 M, age 1-192 months, median 24): 58 patients had gonadic tumour (23 testicular, 35 ovaric), 69 extragonadic (45 sacrococcygeal, 11 mediastinic, 7 retroperitoneal, 6 in other sites).
  • The T grading was 1 in 14 cases, 2 in 26, 3 in 16; 28 had gonadic T (17 ovary, 11 testis), 28 extragonadic (sacrococcygeal 19, mediastinic 3, retroperitoneal 2, other sites 4).
  • CT was administered in eight patients; 15/182 patients relapsed (1 in a metastatic site) and in 5/15 the relapse showed malignant histology.
  • Seven MT (5.5%) relapsed (five sacrococcygeal, one retroperitoneal, one mediastinic): surgery at diagnosis had been complete in five and with residual in two; the relapse was malignant in two patients with sacrococcygeal (sc) tumours, who had a complete resection and a partial resection respectively.
  • A malignant recurrence occurred in two patients with sc tumours (after partial resection in one and after biopsy + CT in one) and in one patient with ovarian IT after a partial resection.
  • All the patients underwent surgical excision of the recurred mass; CT according to Protocol for Malignant GCT was administered to those who had malignant recurrence; 122/126 patients with MT and 53/56 with IT are alive without disease with a follow up of 8-144 months (median 56).
  • Two patients with malignant relapse (one with sc MT, one with sc IT) died because of the progression of the disease.
  • The number of patients treated with CT is not sufficient to evaluate the efficacy of CT in avoiding malignant relapse.
  • [MeSH-major] Ovarian Neoplasms / epidemiology. Teratoma / epidemiology. Testicular Neoplasms / epidemiology
  • [MeSH-minor] Age Distribution. Child. Child, Preschool. Combined Modality Therapy. Female. Humans. Incidence. Infant. Infant, Newborn. Italy / epidemiology. Male. Neoplasm Staging. Prospective Studies

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  • (PMID = 17333214.001).
  • [ISSN] 0179-0358
  • [Journal-full-title] Pediatric surgery international
  • [ISO-abbreviation] Pediatr. Surg. Int.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
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33. Carver BS, Shayegan B, Serio A, Motzer RJ, Bosl GJ, Sheinfeld J: Long-term clinical outcome after postchemotherapy retroperitoneal lymph node dissection in men with residual teratoma. J Clin Oncol; 2007 Mar 20;25(9):1033-7
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  • RESULTS: Of the 210 patients in our series, 192 (92%) received only induction chemotherapy, and 18 (9%) required additional chemotherapy regimens.
  • PC-RPLND pathology revealed mature teratoma in 178 patients (85%), immature teratoma in 15 patients (7%), and teratoma with malignant transformation in 17 patients (8%).
  • With a median follow-up time for survivors of 37 months, disease recurred in 30 patients.
  • Of the 30 patients with disease recurrence, 10 (33%) had recurrence with teratoma, five (17%) had recurrence with teratoma with malignant transformation, and 15 (50%) had recurrence with viable germ cell tumor.
  • On multivariable analysis, residual mass size and International Germ Cell Cancer Collaborative Group (IGCCCG) risk classification were predictors of disease recurrence (P < .0005 and = .001, respectively).
  • [MeSH-major] Antineoplastic Agents / therapeutic use. Lymph Node Excision. Retroperitoneal Neoplasms / secondary. Teratoma / secondary. Teratoma / surgery. Testicular Neoplasms / surgery
  • [MeSH-minor] Combined Modality Therapy. Disease-Free Survival. Follow-Up Studies. Humans. Kaplan-Meier Estimate. Lymph Nodes / pathology. Lymph Nodes / surgery. Male. Neoplasm Staging. Neoplasm, Residual. New York City / epidemiology. Predictive Value of Tests. Prognosis. Proportional Hazards Models. Registries. Retroperitoneal Space. Risk Assessment. Time Factors. Treatment Outcome

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  • [CommentIn] J Clin Oncol. 2007 Mar 20;25(9):1024-5 [17261852.001]
  • (PMID = 17261854.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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34. Porcaro AB, Antoniolli SZ, Martignoni G, Brunelli M, Curti P: Adult primary teratoma of the testis--report on 5 cases in clinical stage I disease. Int Urol Nephrol; 2001;33(4):657-9
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  • [Title] Adult primary teratoma of the testis--report on 5 cases in clinical stage I disease.
  • OBJECTIVES: Testis pure teratoma accounts for 2.7% to 3% of all germ cell tumors in adult where it behaves as a malignant neoplasm.
  • Pure teratoma of the testis presents in clinical stage I disease in 44% of the patients whose risk of having pathological stage II disease is 16.7% to 19.2%.
  • Herein we report on 5 cases of adult pure teratoma of the testis presenting itself in clinical stage I disease.
  • MATERIALS AND METHODS: From September 1976 to February 2000, 75 patients underwent orchidectomy for clinical stage I nonseminomatous germ cell cancer of the testis.
  • Testis pure teratoma was detected in 5 patients (7%).
  • Testis tumor markers were evaluated in all cases.
  • Treatment options after orchidectomy included retroperitoneal lymph node dissection (RPLND) in 4 patients and surveillance in 1.
  • The tumor was on the left sided in 3 cases (60%) and right in 2 (40%).
  • Tumor average size was 3.2 cm (rang 1-6).
  • Histopathology detected the following subtypes: mature teratoma in 3 cases (60%), immature teratoma in 1 (20%) and teratoma with malignant transformation in (20%).
  • Germ cell cancer microscopic metastatic disease including embryonal carcinoma was detected in I dissected lymph node of 1/4 patients (25%).
  • CONCLUSIONS: Primary pure teratoma of the testis does not respond to chemotherapy nor does it to radiation therapy.
  • The disease treatment options after orchidectomy for patients with clinical stage I disease include RPLND or surveillance with their relative risks and benefits.
  • RPLND is the chosen treatment because it is both staging and treating.
  • [MeSH-major] Orchiectomy. Teratoma / surgery. Testicular Neoplasms / surgery

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  • (PMID = 12452623.001).
  • [ISSN] 0301-1623
  • [Journal-full-title] International urology and nephrology
  • [ISO-abbreviation] Int Urol Nephrol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Netherlands
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35. Ross JH, Rybicki L, Kay R: Clinical behavior and a contemporary management algorithm for prepubertal testis tumors: a summary of the Prepubertal Testis Tumor Registry. J Urol; 2002 Oct;168(4 Pt 2):1675-8; discussion 1678-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Clinical behavior and a contemporary management algorithm for prepubertal testis tumors: a summary of the Prepubertal Testis Tumor Registry.
  • PURPOSE: The Prepubertal Testis Tumor Registry was established by the Urologic Section of the American Academy of Pediatrics in 1980 to record data on a large number of prepubertal testis tumors regarding presentation, treatment and outcome to define appropriate management better.
  • MATERIALS AND METHODS: Relevant data in the prepubertal testis tumor registry were tabulated and analyzed.
  • RESULTS: There were 395 prepubertal patients who had a primary testis tumor.
  • A significant proportion of tumors were benign regardless of patient age. alpha-Fetoprotein levels for patients with benign and malignant tumors overlapped in children younger than 6 months.
  • Of the patients with yolk sac tumor 80% presented with stage 1 disease and overall survival was excellent.
  • Of all patients with stromal tumors metastases developed in only 1.
  • CONCLUSIONS: We recommend initial excisional biopsy for all amenable prepubertal testis tumors, except those with an alpha-fetoprotein level that is clearly increased for patient age.
  • Patients with stage I yolk sac tumor should be monitored closely, and those with recurrent or metastatic yolk sac tumor should be treated with chemotherapy.
  • Retroperitoneal lymph node dissection is reserved for patients with recurrent retroperitoneal masses following chemotherapy.
  • Aggressive treatment of metastatic Sertoli cell or undifferentiated stromal tumors is warranted.
  • [MeSH-major] Registries / statistics & numerical data. Testicular Neoplasms / congenital
  • [MeSH-minor] Algorithms. Child. Child, Preschool. Combined Modality Therapy. Endodermal Sinus Tumor / congenital. Endodermal Sinus Tumor / mortality. Endodermal Sinus Tumor / pathology. Endodermal Sinus Tumor / therapy. Humans. Infant. Male. Neoplasm Staging. Prognosis. Sertoli Cell Tumor / congenital. Sertoli Cell Tumor / mortality. Sertoli Cell Tumor / pathology. Sertoli Cell Tumor / therapy. Sex Cord-Gonadal Stromal Tumors / congenital. Sex Cord-Gonadal Stromal Tumors / mortality. Sex Cord-Gonadal Stromal Tumors / pathology. Sex Cord-Gonadal Stromal Tumors / therapy. Survival Rate. United States. alpha-Fetoproteins / metabolism

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  • (PMID = 12352332.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / alpha-Fetoproteins
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36. Malagón HD, Valdez AM, Moran CA, Suster S: Germ cell tumors with sarcomatous components: a clinicopathologic and immunohistochemical study of 46 cases. Am J Surg Pathol; 2007 Sep;31(9):1356-62
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • The germ cell component consisted of pure mature or immature teratoma (23 cases), teratoma mixed with other seminomatous or nonseminomatous components (17), pure seminoma (2), intratubular germ cell neoplasia (1), and yolk sac tumor (1).
  • The SC included embryonal rhabdomyosarcoma (29), angiosarcoma (6), leiomyosarcoma (4), undifferentiated sarcoma (3), myxoid liposarcoma (1), malignant peripheral nerve sheath tumor (1), malignant "triton" tumor (1), and epithelioid hemangioendothelioma (1).
  • All patients were treated by cisplatinum-based chemotherapy plus other agents followed by surgery.
  • Thirty-two of 40 patients either died of tumor (25/40; 62.5%) or were alive with advanced, progressive disease (7/40; 17.5%), and only 8/40 (20%) were alive and free of disease between 5 to 40 months (mean=18 mo).
  • [MeSH-major] Immunohistochemistry. Mediastinal Neoplasms / diagnosis. Neoplasms, Germ Cell and Embryonal / diagnosis. Ovarian Neoplasms / diagnosis. Retroperitoneal Neoplasms / diagnosis. Sarcoma / diagnosis. Testicular Neoplasms / diagnosis
  • [MeSH-minor] Adolescent. Adult. Aged. Antineoplastic Combined Chemotherapy Protocols. Disease-Free Survival. Female. Follow-Up Studies. Humans. Male. Middle Aged. Neoplasm Metastasis. Neoplasm Staging. Orchiectomy. Ovariectomy. Time Factors. Treatment Outcome

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  • (PMID = 17721191.001).
  • [ISSN] 0147-5185
  • [Journal-full-title] The American journal of surgical pathology
  • [ISO-abbreviation] Am. J. Surg. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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37. Lim LP, Tan AM, Chan MY, Rajalingam V, Lou J, Tan CL: Paediatric extracranial germ cell tumours: a retrospective review. Ann Acad Med Singapore; 2002 Mar;31(2):206-11
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • The median age at diagnosis was 1.7 years (0 to 13 years).
  • Cisplatin-based combination chemotherapy was given to 11 patients (28.9%).
  • Complications from chemotherapy included anaemia requiring packed red cell transfusion (n = 3), Port-a-cath sepsis requiring removal (n = 1), febrile neutropenia (n = 1) and nephropathy (n = 1).
  • CONCLUSION: Using the Kaplan-Meier life tables, the overall and event-free survivals at 10 years for the patients with malignant GCTs were 96% and 88%, respectively, with a mean follow-up period of 5.1 years (0.7 to 10 years).
  • [MeSH-major] Germinoma / epidemiology. Ovarian Neoplasms / epidemiology. Testicular Neoplasms / epidemiology
  • [MeSH-minor] Adolescent. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Child. Child, Preschool. Female. Humans. Infant. Infant, Newborn. Male. Neoplasm Staging. Retrospective Studies. Singapore / epidemiology

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  • (PMID = 11957559.001).
  • [ISSN] 0304-4602
  • [Journal-full-title] Annals of the Academy of Medicine, Singapore
  • [ISO-abbreviation] Ann. Acad. Med. Singap.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Singapore
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