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1. Lajer H, Daugaard G, Andersson AM, Skakkebaek NE: Clinical use of serum TRA-1-60 as tumor marker in patients with germ cell cancer. Int J Cancer; 2002 Jul 10;100(2):244-6
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  • TRA-1-60 antigen has been related to the presence of embryonal germ cell carcinoma (EC) and carcinoma in situ.
  • Three groups of patients with germ cell tumors were included: Group 1, 34 patients with disseminated disease (24 nonseminomatous germ cell tumors [NSGCT] and 10 seminomatous germ cell tumors [SGCT]); this group of patients were followed during the course of chemotherapy with measurements of TRA-1-60, HCG and AFP; Group 2, 28 patients with Stage I NSGCT (22 with embryonal carcinoma [EC]-component and 6 without EC-component, median follow-up 15 months); and Group 3, 40 patients with Stage I pure SGCT (median follow-up 15 months).
  • Seventy-eight percent of patients with disseminated EC-positive NSGCT had increased levels of TRA-1-60 before chemotherapy.
  • After chemotherapy, levels of TRA-1-60 had dropped significantly (p < 0.01).
  • Levels of TRA-1-60 did not normalize in 15% of NSGCT and 30% of SGCT patients after chemotherapy.
  • Approximately one-third of patients with Stage I NSGCT had increased values of TRA-1-60 during follow-up without having a relapse.
  • Our study did confirm that elevated levels of TRA-1-60 were present in approximately 80% of patients with disseminated EC-positive NSGCT before start of chemotherapy and chemotherapy induced a significant decrease in levels of TRA-1-60.
  • [MeSH-major] Antigens, Neoplasm / blood. Biomarkers, Tumor / blood. Carcinoma, Embryonal / blood. Germinoma / blood. Glycoproteins / blood. Testicular Neoplasms / blood
  • [MeSH-minor] Antigens, Surface. Antineoplastic Agents / therapeutic use. Chorionic Gonadotropin / analysis. Follow-Up Studies. Humans. Male. Neoplasm Staging. Proteoglycans. alpha-Fetoproteins / analysis

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  • [Copyright] Copyright 2002 Wiley-Liss, Inc.
  • (PMID = 12115576.001).
  • [ISSN] 0020-7136
  • [Journal-full-title] International journal of cancer
  • [ISO-abbreviation] Int. J. Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antigens, Neoplasm; 0 / Antigens, Surface; 0 / Antineoplastic Agents; 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin; 0 / Glycoproteins; 0 / Proteoglycans; 0 / TRA-1-60 antigen, human; 0 / alpha-Fetoproteins
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2. Habuchi T, Kamoto T, Hara I, Kawai K, Nakao M, Nonomura N, Kobayashi T, Ogawa O, Kamidono S, Akaza H, Okuyama A, Kato T, Miki T: Factors that influence the results of salvage surgery in patients with chemorefractory germ cell carcinomas with elevated tumor markers. Cancer; 2003 Oct 15;98(8):1635-42
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  • BACKGROUND: A standard concept for the integration of surgery into the chemotherapy-based treatment of patients with advanced germ cell carcinoma has been that surgery should be avoided in patients with serum tumor markers (alpha-fetoprotein [AFP] and human chorionic gonadotropin [HCG]) that remain elevated.
  • The objective of this retrospective study was to clarify the outcome and clinical prognostic variables of salvage surgery in patients with disseminated (AJCC Stage II or III) testicular germ cell carcinoma or extragonadal germ cell carcinoma who had elevated serum markers.
  • METHODS: The authors reviewed the clinical records of 24 patients who underwent salvage surgery with elevated serum AFP and/or HCG levels after at least 3 courses of cisplatin-based, systemic chemotherapy between January, 1985 and December, 2000.
  • RESULTS: Ten of 24 patients (41.7%) were rendered free of disease and alive without disease after the surgery with or without adjuvant therapy at a median follow-up of 74 months (range, 24-207 months).
  • CONCLUSIONS: Salvage surgery in patients with high serum tumors markers resulted in long-term disease free status in approximately 40% of patients in a small subset with advanced germ cell carcinoma.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / surgery. Testicular Neoplasms / surgery
  • [MeSH-minor] Adolescent. Adult. Biomarkers, Tumor / analysis. Chorionic Gonadotropin / blood. Humans. Lymph Nodes / pathology. Male. Middle Aged. Prognosis. Retrospective Studies. Salvage Therapy. Survival Rate. alpha-Fetoproteins / analysis

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  • [Copyright] Copyright 2003 American Cancer Society.
  • (PMID = 14534879.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin; 0 / alpha-Fetoproteins
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3. Sanchez D, Zudaire JJ, Fernandez JM, Lopez J, Arocena J, Sanz G, Gimenez M, Rosell D, Robles JE, Berian JM: 18F-fluoro-2-deoxyglucose-positron emission tomography in the evaluation of nonseminomatous germ cell tumours at relapse. BJU Int; 2002 Jun;89(9):912-6
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  • [Title] 18F-fluoro-2-deoxyglucose-positron emission tomography in the evaluation of nonseminomatous germ cell tumours at relapse.
  • OBJECTIVES: To compare the performance of 18F-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) in the follow-up of nonseminomatous germ cell tumours (NSGCT) in the retroperitoneum.
  • PATIENTS AND METHODS: FDG-PET was used 25 times in 15 patients diagnosed with NSGCT.
  • At the time of diagnosis five patients each were in stage I, II and III.
  • Five patients had pure embryonal carcinoma, two had yolk sac tumours, one choriocarcinoma and seven had mixed tumours.
  • RESULTS: Eleven patients either presented with retroperitoneal disease or this did not disappear after chemotherapy.
  • CONCLUSION: In these patients FDG-PET detected the retroperitoneal relapse of NSGCT, in advanced stages treated with surgery plus chemotherapy, earlier than did CT; it also detected the presence of mature teratoma in residual retroperitoneal masses more accurately than CT.
  • [MeSH-major] Fluorodeoxyglucose F18. Germinoma / radionuclide imaging. Radiopharmaceuticals. Retroperitoneal Neoplasms / radionuclide imaging. Testicular Neoplasms / radionuclide imaging. Tomography, Emission-Computed / methods

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  • (PMID = 12010239.001).
  • [ISSN] 1464-4096
  • [Journal-full-title] BJU international
  • [ISO-abbreviation] BJU Int.
  • [Language] eng
  • [Publication-type] Comparative Study; Evaluation Studies; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 0Z5B2CJX4D / Fluorodeoxyglucose F18
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4. Al-Tourah AJ, Murray N, Coppin C, Kollmannsberger C, Man A, Chi KN: Minimizing treatment without compromising cure with primary surveillance for clinical stage I embryonal predominant nonseminomatous testicular cancer: a population based analysis from British Columbia. J Urol; 2005 Dec;174(6):2209-13, discussion 2213
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  • [Title] Minimizing treatment without compromising cure with primary surveillance for clinical stage I embryonal predominant nonseminomatous testicular cancer: a population based analysis from British Columbia.
  • PURPOSE: We evaluated the outcome of patients with embryonal carcinoma predominant (ECP) clinical stage (CS) I nonseminomatous testicular germ cell tumors (NSGCT) treated with primary surveillance or primary retroperitoneal lymph node dissection (RPLND).
  • MATERIALS AND METHODS: This study was a retrospective evaluation of the pathology, use of chemotherapy, surgery and outcomes in all patients with CS I NSGCT who were diagnosed within the province of British Columbia between 1990 and 2000.
  • Of these patients 72 (67%) underwent primary surveillance, 32 (33%) underwent primary RPLND and 3 refused treatment.
  • In the primary surveillance group 24 patients (33%) had relapse and all were treated initially with chemotherapy with 6 also requiring RPLND.
  • In the primary RPLND group 18 patients (56%) had pathological stage I disease and 14 (44%) had pathological stage II disease.
  • In the primary RPLND group 15 patients (46%) required chemotherapy with 11 (34%) receiving adjuvant chemotherapy and 4 receiving chemotherapy for post-RPLND relapse.
  • No deaths from ECP testicular cancer occurred in either group.
  • The 4-year chemotherapy-free survival rate was 65% in the surveillance group vs 50% in the RPLND group (p = 0.2).
  • CONCLUSIONS: For appropriately selected patients with CS I ECP NSGCT, primary surveillance results in fewer therapeutic interventions compared to RPLND without compromising the probability of cure.
  • [MeSH-major] Carcinoma, Embryonal / pathology. Carcinoma, Embryonal / therapy. Population Surveillance. Testicular Neoplasms / pathology. Testicular Neoplasms / therapy
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Agents / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. British Columbia. Chemotherapy, Adjuvant. Follow-Up Studies. Humans. Lymph Node Excision. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Recurrence, Local / therapy. Neoplasm Staging. Orchiectomy. Retroperitoneal Space. Retrospective Studies. Risk Factors. Survival Analysis. Treatment Outcome

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  • (PMID = 16280765.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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5. Ondrus D, Ondrusova M, Hornak M, Matoska J: Nonseminomatous germ cell testicular tumors clinical stage I: differentiated therapeutic approach in comparison with therapeutic approach using surveillance strategy only. Neoplasma; 2007;54(5):437-42
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  • [Title] Nonseminomatous germ cell testicular tumors clinical stage I: differentiated therapeutic approach in comparison with therapeutic approach using surveillance strategy only.
  • Surveillance after orchiectomy alone becomes popular for the management of clinical stage I nonseminomatous germ cell testicular tumors (CS I NSGCTT).
  • The aim of the study was to analyse own long-term experiences with different therapeutic approaches in CS I NSGCTT patients according to risk factors of the disease progression and to correlate these results with the group of patients who were treated with surveillance strategy only.
  • Patients, who had the disease progression, were treated with systemic chemotherapy.
  • From 1/1992 to 1/2007 a total of 323 patients with CS I NSGCTT were stratified to different risk-adapted therapeutic approaches (groups B1-3) according to histopathologic findings of primary tumor removed by inguinal orchiectomy.
  • 111 patients (group B1) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with adjuvant chemotherapy (2 cycles of BEP).
  • Disease progression developed in two patients (1.9 %).
  • Among 11 patients (group B2) with vascular invasion and majority with teratomatous elements in the primary tumor underwent primary retroperitoneal lymph node dissection (RPLND), 9 were found to be pathological stage I.
  • Two patients (18.2 %) with pathological stage II received adjuvant chemotherapy.
  • The disease progression was observed in 39 patients (19.4 %), who were treated with BEP chemotherapy.
  • Introduction of different therapeutic approaches in CS I NSGCTT patients according to risk factors of the disease progression might reduce the overall relapse rate of these patients from 35.9 % (group A) to 19.4 % (group B3) (P< 0.001).
  • Surveillance procedure is recommended only in patients without vascular invasion in the primary tumor.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / therapy. Testicular Neoplasms / therapy

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  • (PMID = 17688374.001).
  • [ISSN] 0028-2685
  • [Journal-full-title] Neoplasma
  • [ISO-abbreviation] Neoplasma
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Slovakia
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Chorionic Gonadotropin; 0 / alpha-Fetoproteins
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6. Sweeney CJ, Hermans BP, Heilman DK, Foster RS, Donohue JP, Einhorn LH: Results and outcome of retroperitoneal lymph node dissection for clinical stage I embryonal carcinoma--predominant testis cancer. J Clin Oncol; 2000 Jan;18(2):358-62
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  • [Title] Results and outcome of retroperitoneal lymph node dissection for clinical stage I embryonal carcinoma--predominant testis cancer.
  • PURPOSE: To determine the incidence of metastatic disease and usage of chemotherapy (adjuvant or metastatic) after primary retroperitoneal lymph node dissection (RPLND) in patients with clinical stage (CS) I embryonal carcinoma (EC)-predominant testicular cancer.
  • Eighty-five (68.0%) of 125 patients with EC-predominant disease had pathologic stage (PS) I, and 18 (21.2%) of this group of 85 relapsed.
  • Chemotherapy was administered to 48 (38.4%) of the 125 patients with CS I EC-predominant disease after RPLND.
  • This included 25 CS I patients with PS II disease who received adjuvant chemotherapy in addition to 23 patients who subsequently required chemotherapy for relapse after RPLND. Ten (66.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma, Embryonal / drug therapy. Testicular Neoplasms / drug therapy
  • [MeSH-minor] Adult. Chemotherapy, Adjuvant. Humans. Incidence. Lymph Node Excision. Male. Neoplasm Metastasis. Neoplasm Recurrence, Local. Neoplasm Staging. Retrospective Studies. Risk Assessment. Treatment Outcome

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  • (PMID = 10637250.001).
  • [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
  • [Grant] United States / NCI NIH HHS / CA / 2 R 35 CA 39844-14
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
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7. Valdevenito Sepúlveda JP, Merhe Nieva E, Valdevenito Sepúlveda R, Cuevas Toro M, Gómez Gallo A, Bermúdez Luna H, Contreras Meléndez L, Gallegos Méndez I, Gallardo Escobar J, Palma Ceppi C: [Reduced retroperitoneal lymphadenectomy for clinical stage I non seminomatous germ cell testicular cancer]. Arch Esp Urol; 2007 Apr;60(3):245-54
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  • [Title] [Reduced retroperitoneal lymphadenectomy for clinical stage I non seminomatous germ cell testicular cancer].
  • [Transliterated title] Linfadenectomia retroperitoneal reducida en cancer testicular de celulas germinales no seminomatoso estadio clinico I.
  • OBJECTIVES: The best treatment of clinical stage I non-seminomatous germ cell testicular cancer (NSGCTC) is controversial.
  • Lymphadenectomy allows an adequate retroperitoneal staging and cures up to 70% of patients in pathological stage II.
  • The objective of this study is to analyse our experience in the treatment of this patients with radical orchiectomy and reduced retroperitoneal lymphadenectomy (RRL) as the initial treatment.
  • METHODS: Retrospective study of patients with clinical stage I NSGCTC submitted to radical orchiectomy and RRL at the Urology Service of the University of Chile Clinical Hospital, from January 1990 to December 2000.
  • INCLUSION CRITERIA: retroperitoneal staging with computed tomography (CT), normal tumor markers after orchiectomy and testicular and retroperitoneal biopsy informed at our hospital.
  • The following metastatic risk factors in the testicular biopsy were checked: vascular invasion (venous and/or lymphatic), infiltration of tunica albuginea, rete testis, epididymis, and spermatic cord.
  • RESULTS: 36 patients with 37 testicular tumors were analysed (1 bilateral case).
  • Twenty nine mixed tumors (78%); most frequent histology embryonal carcinoma (76%).
  • Average surgery time 2 hr 7 min; average dissected lymph nodes 13.
  • Chemotherapy in 7 patients (19%) a total of 18 cycles.
  • Clinical stage I NSGCTC initially managed with RRL has a 100% survival.
  • [MeSH-major] Lymph Node Excision / methods. Neoplasms, Germ Cell and Embryonal / pathology. Neoplasms, Germ Cell and Embryonal / surgery. Testicular Neoplasms / pathology. Testicular Neoplasms / surgery

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  • (PMID = 17601299.001).
  • [ISSN] 0004-0614
  • [Journal-full-title] Archivos españoles de urología
  • [ISO-abbreviation] Arch. Esp. Urol.
  • [Language] spa
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Spain
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8. López-González A, Egui Rojo MA, Maximiano C, Martínez-Salamanca JI, González Hernando C, Sánchez Yuste R, Bonilla F, Carballido Rodríguez JA: Natural progression of embryonal carcinoma. Arch Esp Urol; 2010 Nov;63(9):803-7
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  • [Title] Natural progression of embryonal carcinoma.
  • OBJECTIVE: We report a rare case of advanced testicular cancer that describes the natural progression of testicular cancer without medical treatment.
  • This study also describes the effectiveness of chemotherapy, which was the approach used for treatment.
  • He was diagnosed of pT4 embryonal carcinoma by biopsy.
  • He was treated with five cycles of Bleomycin/Etoposide/Cisplatin with complete response after treatment.
  • RESULTS: Testicular tumors are the most frequent solid tumors in males between the ages of 20 and 39 years old.
  • Testicular tumors represent 1% of all neoplasias diagnosed in males and 0.1% of all male deaths due to cancer.
  • Several studies have reported the current real incidence rate of testicular tumors has increased to 3%, which accounts for the diagnosis of 450 new cases of testicular cancer a year in Spain.
  • CONCLUSIONS: The cure rate for patients with intermediate risk non-seminoma is around 70% following a conventional treatment approach of four cycles of BEP.
  • The present case is noteworthy because, in our experience, testicular tumors are diagnosed at an early stage without extensively affecting the skin or simulating another type of epithelial tumor.
  • As a result, the present study describes the natural progression of testicular cancer.
  • [MeSH-major] Carcinoma, Embryonal / pathology. Testicular Neoplasms / pathology

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  • (PMID = 21098905.001).
  • [ISSN] 1576-8260
  • [Journal-full-title] Archivos españoles de urología
  • [ISO-abbreviation] Arch. Esp. Urol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Spain
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9. Aide N, Poulain L, Briand M, Dutoit S, Allouche S, Labiche A, Ngo-Van Do A, Nataf V, Batalla A, Gauduchon P, Talbot JN, Montravers F: Early evaluation of the effects of chemotherapy with longitudinal FDG small-animal PET in human testicular cancer xenografts: early flare response does not reflect refractory disease. Eur J Nucl Med Mol Imaging; 2009 Mar;36(3):396-405
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  • [Title] Early evaluation of the effects of chemotherapy with longitudinal FDG small-animal PET in human testicular cancer xenografts: early flare response does not reflect refractory disease.
  • AIM: We aimed to evaluate the usefulness of FDG PET in the early prediction of the effects of chemotherapy on human testicular cancer xenografts.
  • MATERIAL AND METHODS: Nude rats bearing subcutaneous human embryonal carcinoma xenografts received either cisplatin (5 mg/kg) or saline serum.
  • RESULTS: Cisplatin treatment resulted in biphasic FDG uptake evolution: a peak was observed on day 2, followed by a marked decrease on day 7 despite an insignificant change in tumour volume.
  • In control tumours, continuous growth was observed, all immunostaining markers remaining stable over time.
  • CONCLUSION: FDG PET may be useful in the early evaluation of treatment in patients with testicular cancer.
  • In our model, a very early increased [(18)F]-FDG uptake was related to a transient cell cycle arrest and early stage apoptosis but did not reveal refractory disease.
  • [MeSH-major] Fluorine Radioisotopes. Fluorodeoxyglucose F18. Positron-Emission Tomography / methods. Radiopharmaceuticals. Testicular Neoplasms / diagnostic imaging. Testicular Neoplasms / drug therapy
  • [MeSH-minor] Animals. Antineoplastic Agents / therapeutic use. Apoptosis. Carcinoma, Embryonal / diagnostic imaging. Carcinoma, Embryonal / drug therapy. Carcinoma, Embryonal / metabolism. Carcinoma, Embryonal / pathology. Cell Cycle. Cell Line, Tumor. Cell Proliferation. Cisplatin / therapeutic use. Cyclin A / metabolism. Disease Models, Animal. Humans. Male. Neoplasm Transplantation. Rats. Rats, Nude. Time Factors. Transplantation, Heterologous. Xenograft Model Antitumor Assays

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  • (PMID = 19050878.001).
  • [ISSN] 1619-7089
  • [Journal-full-title] European journal of nuclear medicine and molecular imaging
  • [ISO-abbreviation] Eur. J. Nucl. Med. Mol. Imaging
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Cyclin A; 0 / Fluorine Radioisotopes; 0 / Radiopharmaceuticals; 0Z5B2CJX4D / Fluorodeoxyglucose F18; Q20Q21Q62J / Cisplatin
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10. Kempkensteffen C, Hinz S, Jäger T, Weikert S, Krause H, Schostak M, Christoph F, Strenziok R, Miller K, Schrader M: [Expression levels of the IAP antagonists XAF1, Smac/DIABLO and HtrA2 in testicular germ cell tumours]. Aktuelle Urol; 2008 Nov;39(6):436-41
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  • [Title] [Expression levels of the IAP antagonists XAF1, Smac/DIABLO and HtrA2 in testicular germ cell tumours].
  • [Transliterated title] Expression der pro-apoptotischen Apoptoseinhibitor-(IAP)Antagonisten XAF1, Smac/DIABLO und HtrA2 in Keimzelltumoren des Hodens.
  • We examined the mRNA-expression of these pro-apoptotic parameters in testicular germ cell tumors (TGCT) and normal testicular tissue and correlated their expression levels to clinicopathological tumour features.
  • MATERIAL AND METHODS: Real-time RT-PCR was used to quantify the mRNA-expression of XAF1, Smac/DIABLO and HtrA2 in normal testicular tissue (n = 18), carcinoma in situ (n = 4), seminomas (n = 64), and non-seminomatous germ cell tumors (n = 35).
  • RESULTS: Compared to normal testicular tissue, the expression levels of XAF1 were increased in TGCT (p < 0.001), whereas those of Smac/DIABLO and HtrA2 were decreased (p < 0.001 and p < 0.001).
  • Smac/DIABLO expression levels showed a significant trend towards a gradual decrease from normal testicular tissue to CIS and seminomas and finally to NSGCT (p < 0.001).
  • Moreover, XAF1 and HtrA2 expression levels gradually increased with progression of clinical tumour stage in seminoma patients (p = 0.001 and p = 0.018), their expression levels being strongly intercorrelated (Spearman rho correlation coefficient: 0.674; p < 0.001).
  • CONCLUSION: These data suggest that a down-regulation of Smac/DIABLO and HtrA2 is implicated in the development and progression of TGCT, whereas overexpression of XAF1 in TGCT might contribute to their extraordinary sensitivity to chemotherapy.
  • Regarding the additional correlation of XAF1 and HtrA2 expression with clinical tumour stage in seminoma patients, it appears reasonable to further evaluate these three IAP antagonists as molecular parameters for the prediction of treatment response and prognosis of TGCT patients.
  • [MeSH-major] Gene Expression Regulation, Neoplastic / genetics. Inhibitor of Apoptosis Proteins / antagonists & inhibitors. Inhibitor of Apoptosis Proteins / genetics. Intracellular Signaling Peptides and Proteins / genetics. Mitochondrial Proteins / genetics. Neoplasm Proteins / genetics. Neoplasms, Germ Cell and Embryonal / genetics. Serine Endopeptidases / genetics. Testicular Neoplasms / genetics
  • [MeSH-minor] Biopsy. Carcinoma in Situ / genetics. Carcinoma in Situ / pathology. Carcinoma, Embryonal / genetics. Carcinoma, Embryonal / pathology. Disease Progression. Down-Regulation / genetics. Humans. Male. Prognosis. RNA, Messenger / genetics. Reverse Transcriptase Polymerase Chain Reaction. Seminoma / genetics. Seminoma / pathology. Teratocarcinoma / genetics. Teratocarcinoma / pathology. Testis / pathology

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  • (PMID = 18979398.001).
  • [ISSN] 1438-8820
  • [Journal-full-title] Aktuelle Urologie
  • [ISO-abbreviation] Aktuelle Urol
  • [Language] ger
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / DIABLO protein, human; 0 / Inhibitor of Apoptosis Proteins; 0 / Intracellular Signaling Peptides and Proteins; 0 / Mitochondrial Proteins; 0 / Neoplasm Proteins; 0 / RNA, Messenger; 0 / XAF1 protein, human; EC 3.4.21.- / Omi serine protease; EC 3.4.21.- / Serine Endopeptidases
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11. Roeleveld TA, Horenblas S, Meinhardt W, van de Vijver M, Kooi M, ten Bokkel Huinink WW: Surveillance can be the standard of care for stage I nonseminomatous testicular tumors and even high risk patients. J Urol; 2001 Dec;166(6):2166-70
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  • [Title] Surveillance can be the standard of care for stage I nonseminomatous testicular tumors and even high risk patients.
  • PURPOSE: We investigate the results of a surveillance program for stage I nonseminomatous germ cell tumors to validate a surveillance policy, and furthermore improve it by analyzing diagnostic instruments and identifying prognostic factors for relapse.
  • MATERIALS AND METHODS: From 1982 to 1994, 90 patients with stage I nonseminomatous germ cell tumors entered a surveillance protocol after orchiectomy.
  • Patients with relapse were treated with cisplatin based chemotherapy.
  • Computerized tomography located all but 1 relapse.
  • Vascular invasion (p = 0.0001), tumor size (p = 0.0341) and presence of immature teratoma (p = 0.0154) were significantly predictive of relapse with the multivariate analysis, percentage embryonal carcinoma only by univariate analysis (p = 0.032).
  • CONCLUSIONS: With surveillance for stage I nonseminomatous germ cell tumors, excellent treatment results can be achieved that are comparable to primary retroperitoneal lymph node dissection.
  • Tumor markers and computerized tomography are highly reliable for detecting relapse.
  • Pathological factors may influence the choice of adjuvant treatment.
  • However, relapse risks of 50% to 60% are maximally achieved with presently available prognostic factors, and so sparing morbidity of adjuvant treatment by a surveillance protocol remains a feasible option even in these patients.
  • [MeSH-major] Germinoma / pathology. Testicular Neoplasms / pathology

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  • (PMID = 11696728.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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12. Beck SD, Foster RS, Bihrle R, Cheng L, Donohue JP: Does the histology of nodal metastasis predict systemic relapse after retroperitoneal lymph node dissection in pathological stage B1 germ cell tumors? J Urol; 2005 Oct;174(4 Pt 1):1287-90; discussion 1290
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  • [Title] Does the histology of nodal metastasis predict systemic relapse after retroperitoneal lymph node dissection in pathological stage B1 germ cell tumors?
  • PURPOSE: We evaluated the prognostic significance of the histology of metastatic lymph nodes to predict postoperative relapse in pathological stage B1 nonseminomatous germ cell tumor (NSGCT).
  • MATERIALS AND METHODS: A retrospective review of the testicular cancer database was performed to identify all patients with clinical stage A NSGCT who underwent primary retroperitoneal lymph node dissection and were found to have pathological stage B1 disease.
  • No patient received adjuvant chemotherapy and minimal followup was 24 months.
  • Embryonal cell carcinoma was identified in 92 of 118 (77%) surgical specimens, which was significantly greater than the presence of teratoma (22%), seminoma (16%) and yolk sac (14.4%, p < or = 0.001) with no difference in 5-year DFS comparing the presence or absence of each histology.
  • Embryonal cell carcinoma was the most common single histology identified at surgery at 64 of 88 (73%), with the incidence of seminoma, teratoma and yolk sac being 12.5%, 9.0% and 5.5%, respectively (p < or = 0.001).
  • Recurrence rates were similar for pure embryonal cell carcinoma (69%), mixed embryonal cell carcinoma (63%) and no embryonal cell carcinoma (73%) in the retroperitoneum (p=0.63).
  • CONCLUSIONS: Retroperitoneal histology does not appear to predict outcome in patients with pathological stage B1 NSGCT.
  • [MeSH-major] Lymph Node Excision. Lymphatic Metastasis. Neoplasm Recurrence, Local / pathology. Neoplasms, Germ Cell and Embryonal / pathology. Testicular Neoplasms / pathology
  • [MeSH-minor] Carcinoma, Embryonal / pathology. Humans. Male. Prognosis. Retrospective Studies. Seminoma / pathology. Teratoma / pathology

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  • (PMID = 16145394.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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13. Oliver RT, Ong J, Berney D, Nargund V, Badenoch D, Shamash J: Testis conserving chemotherapy in germ cell cancer: its potential to increase understanding of the biology and treatment of carcinoma-in-situ. APMIS; 2003 Jan;111(1):86-91; discussion 91-2
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  • [Title] Testis conserving chemotherapy in germ cell cancer: its potential to increase understanding of the biology and treatment of carcinoma-in-situ.
  • Prompted by recognition of the potential of chemotherapy to increase the success of testis conserving surgery in patients with germ cell cancer, background and outcome data are reviewed and their contribution to the ongoing debate about how germ cell cancer develops discussed.
  • The review is based on three previous studies of: a) time trends in tumour size in 578 personal series of all stages of testis cancer treated since 1978;.
  • b) impact of chemotherapy on actuarial risk of tumours in contralateral testis examined on 1221 patients treated in trials through the Anglian Germ Cell Cancer Consortium; and c) testes conservation attempted using chemotherapy in 78 patients.
  • There was no overall long term reduction in second cancers beyond 10 years in stage 1 patients after orchidectomy alone compared to stage 1 or metastatic disease patients receiving chemotherapy though the incidence was non significantly lower up to 10 years particularly in those patients receiving etoposide based combination.
  • In the 28 primary tumours cured by chemotherapy there was a 26% late relapse rate between 5 and 10 years (all cured by orchidectomy) compared to less than 5% in those cured with established metastases.
  • In conclusion, testis conservation with chemotherapy is safe and feasible, though relapse is too frequent for routine service use.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma in Situ / drug therapy. Neoplasm Recurrence, Local. Neoplasms, Germ Cell and Embryonal / drug therapy. Neoplasms, Second Primary. Testicular Neoplasms / drug therapy. Testis / pathology
  • [MeSH-minor] Bleomycin / administration & dosage. Cisplatin / administration & dosage. Combined Modality Therapy. Etoposide / administration & dosage. Humans. Male. Neoplasm Metastasis. Orchiectomy. Time Factors. Vinblastine / administration & dosage

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  • (PMID = 12752243.001).
  • [ISSN] 0903-4641
  • [Journal-full-title] APMIS : acta pathologica, microbiologica, et immunologica Scandinavica
  • [ISO-abbreviation] APMIS
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Meta-Analysis
  • [Publication-country] Denmark
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 5V9KLZ54CY / Vinblastine; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin
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14. Divrik RT, Akdoğan B, Ozen H, Zorlu F: Outcomes of surveillance protocol of clinical stage I nonseminomatous germ cell tumors-is shift to risk adapted policy justified? J Urol; 2006 Oct;176(4 Pt 1):1424-29; discussion 1429-30
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  • [Title] Outcomes of surveillance protocol of clinical stage I nonseminomatous germ cell tumors-is shift to risk adapted policy justified?
  • PURPOSE: We evaluated the potential risk factors for disease relapse in patients with clinical stage I nonseminomatous germ cell tumors treated with surveillance and reevaluated our treatment of these patients.
  • MATERIALS AND METHODS: A total of 211 consecutive patients with clinical stage I nonseminomatous germ cell tumors treated with surveillance after orchiectomy between 1993 and 2005 were included in this retrospective study.
  • Risk factors evaluated were presence of vascular invasion, proportion of embryonal carcinoma, age, tumor size, preoperatively increased serum alpha-fetoprotein and the absence of yolk sac component.
  • While 40.9% of patients with more than 50% embryonal carcinoma had disease relapse, the relapse rate was 20.8% in patients with less than 50% embryonal carcinoma (p = 0.002).
  • The relapse rates were 6.1% and 75.7% in patients with no risk factors (no vascular invasion and less than 50% embryonal carcinoma) and 2 risk factors (vascular invasion and more than 50% embryonal carcinoma), respectively (p < 0.001).
  • CONCLUSIONS: In light of our results we suggest that all patients with vascular invasion should receive chemotherapy.
  • However, patients with no risk factors and those with more than 50% embryonal carcinoma but without vascular invasion should be on surveillance after orchiectomy since the relapse rate is less than 30%.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / secondary. Population Surveillance. Testicular Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Follow-Up Studies. Humans. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Staging. Orchiectomy. Program Evaluation. Retrospective Studies. Risk Factors. Treatment Outcome

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  • (PMID = 16952649.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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15. Nicolai N, Miceli R, Necchi A, Biasoni D, Catanzaro M, Milani A, Piva L, Pizzocaro G, Stagni S, Torelli T, Salvioni R: Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage I nonseminomatous germ cell tumours: long-term outcome and analysis of risk factors of recurrence. Eur Urol; 2010 Dec;58(6):912-8
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  • [Title] Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage I nonseminomatous germ cell tumours: long-term outcome and analysis of risk factors of recurrence.
  • BACKGROUND: The best management for patients with clinical stage I (CS1) nonseminomatous germ cell tumours (NSGCT) is still under debate.
  • OBJECTIVE: We evaluated the long-term oncologic outcome of retroperitoneal lymph node dissection (RPLND) in patients with CS1 NSGCTs and reevaluated the traditional predictors of recurrence in a set of patients not undergoing adjuvant treatment.
  • DESIGN, SETTING, AND PARTICIPANTS: Between 1985 and 1995, 322 consecutive CS1 NSGCT patients underwent primary RPLND not followed by adjuvant chemotherapy in a single referral centre.
  • Patients were followed until relapse for a median time of 17 yr.
  • Categories pN and pT, vascular invasion (VI), percentage of embryonal carcinoma, and presence of teratoma were evaluated as 2-yr recurrence predictors of event in a binary logistic model.
  • Most patients could avoid the immediate and late toxicity of chemotherapy.
  • [MeSH-major] Lymph Node Excision. Neoplasm Recurrence, Local. Orchiectomy. Testicular Neoplasms / surgery
  • [MeSH-minor] Adult. Chemotherapy, Adjuvant. Humans. Italy. Logistic Models. Lymphatic Metastasis. Male. Neoplasm Staging. Neoplasms, Germ Cell and Embryonal / secondary. Neoplasms, Germ Cell and Embryonal / surgery. Patient Selection. Retroperitoneal Space / surgery. Risk Assessment. Risk Factors. Time Factors. Treatment Outcome. Young Adult

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  • [Copyright] Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
  • [CommentIn] Eur Urol. 2011 Apr;59(4):e20; author reply e21-2 [21255907.001]
  • (PMID = 20817343.001).
  • [ISSN] 1873-7560
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Switzerland
  • [Chemical-registry-number] Nonseminomatous germ cell tumor
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16. Porcaro AB, Zecchini Antoniolli S, Novella G, Martignoni G, Bassetto MA, Poli A, Schiavone D, Tallarigo C, D'Amico A, Ficarra V, Curti P: [Histopathologic risk factors in patients with non-seminomatous germ tumors of the testis in clinical stage 1. Retrospective study of 75 patients]. Arch Ital Urol Androl; 2001 Dec;73(4):177-80
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  • [Title] [Histopathologic risk factors in patients with non-seminomatous germ tumors of the testis in clinical stage 1. Retrospective study of 75 patients].
  • OBJECTIVES: This retrospective study was performed to evaluate histopathologic prognostic risk factors in 75 patients on clinical stage 1 nonseminomatous germ cell cancer of the testis (NSGCTT).
  • METHODS: From September 1976 to February 2000 we operated on 75 patients for NSGCTT on clinical stage 1 disease.
  • After orchiectomy, therapeutic options included retroperitoneal lymph node dissection (RLND) for 44 patients (58.6%), surveillance for 26 (34.6%) and neoadjuvant chemotherapy for 5 (6.6%).
  • Testis primary tumor samples were assessed for studying prognostic risk factors that included vascular and/or lymphatic invasion (IV/IL+), percentage of embryonal carcinoma (%EC) and absence of yolk sac tumor (YS-).
  • CONCLUSIONS: EC% > 80 is a prognostic risk factor for disease relapse in patients with clinical stage 1 NSGCT who are selected in a high risk group requiring RPLND or neoadjuvant chemotherapy as therapeutical option.

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  • (PMID = 11822063.001).
  • [ISSN] 1124-3562
  • [Journal-full-title] Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica
  • [ISO-abbreviation] Arch Ital Urol Androl
  • [Language] ITA
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Italy
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17. Chang SS, Smith JA Jr, Girasole C, Baumgartner RG, Roth BJ, Cookson MS: Beneficial impact of a clinical care pathway in patients with testicular cancer undergoing retroperitoneal lymph node dissection. J Urol; 2002 Jul;168(1):87-92
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  • [Title] Beneficial impact of a clinical care pathway in patients with testicular cancer undergoing retroperitoneal lymph node dissection.
  • MATERIALS AND METHODS: We examined the records of all patients with germ cell carcinoma who underwent retroperitoneal lymph node dissection from July 1990 to July 2001.
  • Variables examined included clinical/pathological stage, hospital stay, postoperative care and the complication rate.
  • RESULTS: A total of 118 patients underwent retroperitoneal lymph node dissection for germ cell carcinoma during this period, including 46 (39%) before pathway implementation in 1997 and 72 patients (61%) after pathway implementation.
  • Of the 118 patients 40 (34%) underwent the procedure after chemotherapy.
  • Mean hospital stay decreased after pathway implementation in all primary and post-chemotherapy retroperitoneal lymph node dissection cases (4.2 versus 6.4 days, p <0.005).
  • Although patients who underwent the procedure after chemotherapy were more likely to have complications than those who underwent a primary procedure, the difference was not statistically significant (p = 0.09).
  • [MeSH-major] Critical Pathways. Lymph Node Excision. Neoplasms, Germ Cell and Embryonal / surgery. Testicular Neoplasms / surgery
  • [MeSH-minor] Adult. Aged. Chemotherapy, Adjuvant. Follow-Up Studies. Humans. Length of Stay. Male. Middle Aged. Neoadjuvant Therapy. Neoplasm Staging. Outcome and Process Assessment (Health Care). Postoperative Complications / etiology. Retroperitoneal Space

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  • (PMID = 12050498.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Comparative Study; Evaluation Studies; Journal Article
  • [Publication-country] United States
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18. Kakiashvili DM, Zuniga A, Jewett MA: High risk NSGCT: case for surveillance. World J Urol; 2009 Aug;27(4):441-7
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  • INTRODUCTION: Active surveillance, primary retroperitoneal lymph node dissection and adjuvant chemotherapy are treatment options for high-risk clinical stage (CS) I nonseminomatous germ cell testicular tumors (NSGCT).
  • Since 1981, at Princess Margaret Hospital, Toronto, initial active surveillance with treatment delayed until relapse has been the preferred management option for all CS I NSGCT, regardless of baseline risk of relapse which has allowed us to better define and assess the natural history of high-risk tumors.
  • Outcomes were stratified into two cohorts by their time of diagnosis [initial, 157 patients (1981-1992); recent, 214 patients (1993-2005)].
  • Median time to relapse was 7.1 months.
  • Lympho-vascular invasion (P < 0.0001) and pure embryonal carcinoma (P = 0.02) were independent predictors of relapse.
  • CONCLUSIONS: Nonrisk adapted active surveillance is the preferred management strategy for all CS I NSGCT patients including those at high-risk, providing near 100% cure rate with reduced overall treatment burden.
  • Approximately half of the high-risk patients will be spared unnecessary treatment with little or no increase risk.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / pathology. Population Surveillance / methods. Testicular Neoplasms / pathology
  • [MeSH-minor] Chemotherapy, Adjuvant / adverse effects. Combined Modality Therapy. Humans. Male. Neoplasm Metastasis / prevention & control. Neoplasm Recurrence, Local / pathology. Neoplasm Recurrence, Local / prevention & control. Radiotherapy, Adjuvant / adverse effects. Retrospective Studies. Risk Factors

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  • (PMID = 19609532.001).
  • [ISSN] 1433-8726
  • [Journal-full-title] World journal of urology
  • [ISO-abbreviation] World J Urol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Germany
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19. Mann JR, Raafat F, Robinson K, Imeson J, Gornall P, Sokal M, Gray E, McKeever P, Hale J, Bailey S, Oakhill A: The United Kingdom Children's Cancer Study Group's second germ cell tumor study: carboplatin, etoposide, and bleomycin are effective treatment for children with malignant extracranial germ cell tumors, with acceptable toxicity. J Clin Oncol; 2000 Nov 15;18(22):3809-18
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  • [Title] The United Kingdom Children's Cancer Study Group's second germ cell tumor study: carboplatin, etoposide, and bleomycin are effective treatment for children with malignant extracranial germ cell tumors, with acceptable toxicity.
  • Stage I testicular and some ovarian GCTs were resected and monitored with alpha-fetoprotein (AFP) ("watch-and-wait" approach).
  • Patients with recurrent stage I disease and all other patients received JEB (etoposide 120 mg/m(2) on days 1 through 3, carboplatin 600 mg/m(2) on day 2, and bleomycin 15 mg/m(2) on day 3).
  • Chemotherapy toxicities were assessed using World Health Organization or Brock grading.
  • Eight were excluded because either there was no histologic diagnosis (n = 3) or chemotherapy was given off-study (n = 5).
  • The remaining 184 patients had germinoma (n = 20), malignant teratoma (n = 55), embryonal carcinoma (n = 1), yolk sac tumor (n = 107), or choriocarcinoma (n = 1).
  • The median follow-up after JEB treatment was 53 months (range, 0 to 109 months); the median number of courses was five (range, three to eight).
  • Site, stage, and AFP level had prognostic significance.
  • CONCLUSION: Conservative surgery, a watch-and-wait approach after complete excision, and JEB for those requiring chemotherapy produced high cure rates and few serious complications.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Germinoma / drug therapy. Ovarian Neoplasms / drug therapy. Testicular Neoplasms / drug therapy
  • [MeSH-minor] Adolescent. Bleomycin / administration & dosage. Bleomycin / adverse effects. Carboplatin / administration & dosage. Carboplatin / adverse effects. Child. Child, Preschool. Chorionic Gonadotropin / blood. Combined Modality Therapy. Etoposide / administration & dosage. Etoposide / adverse effects. Female. Humans. Infant. Infant, Newborn. Male. Prognosis. Survival Analysis. alpha-Fetoproteins / metabolism

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  • (PMID = 11078494.001).
  • [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] Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin; 0 / alpha-Fetoproteins; 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; BG3F62OND5 / Carboplatin; JEB protocol
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