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1. Kubota Y, Ohji H, Itoh K, Sasagawa I, Nakada T: Changes in cellular immunity during chemotherapy for testicular cancer. Int J Urol; 2001 Nov;8(11):604-8
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  • [Title] Changes in cellular immunity during chemotherapy for testicular cancer.
  • BACKGROUND: The changes in vivo in immunocyte functions during chemotherapy that is administered in combination with granulocyte colony-stimulating factor (G-CSF) in humans have not been fully investigated.
  • This study was designed to examine neutrophil functions and the activities of natural killer (NK) cells, during the administration of chemotherapy and G-CSF for the treatment of testicular cancer.
  • Numbers and activities of neutrophils and NK cells were measured at various times during and after the first course of chemotherapy.
  • RESULTS: After BEP chemotherapy, CD16+ and CD56+ cell counts, and neutrophil granulocyte counts decreased while there were no significant changes in the number of lymphocytes.
  • The activity of NK cells was severely impaired after chemotherapy and did not change after administration of G-CSF.
  • CONCLUSIONS: After BEP chemotherapy for testicular cancer with G-CSF, neutrophil function was not at all inferior to those before treatment.
  • Natural killer cell activity was suppressed by the BEP chemotherapy and did not change after administration of G-CSF.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Granulocyte Colony-Stimulating Factor / therapeutic use. Immunity, Cellular. Testicular Neoplasms / drug therapy. Testicular Neoplasms / immunology
  • [MeSH-minor] Adult. Antimetabolites, Antineoplastic / administration & dosage. Antineoplastic Agents / administration & dosage. Antineoplastic Agents, Phytogenic / administration & dosage. Bleomycin / administration & dosage. Carcinoma, Embryonal / drug therapy. Carcinoma, Embryonal / immunology. Choriocarcinoma / drug therapy. Choriocarcinoma / immunology. Cisplatin / administration & dosage. Etoposide / administration & dosage. Humans. Leukocyte Count. Male. Neutrophils / pathology. Seminoma / drug therapy. Seminoma / immunology

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  • (PMID = 11903686.001).
  • [ISSN] 0919-8172
  • [Journal-full-title] International journal of urology : official journal of the Japanese Urological Association
  • [ISO-abbreviation] Int. J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Australia
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / Antineoplastic Agents; 0 / Antineoplastic Agents, Phytogenic; 11056-06-7 / Bleomycin; 143011-72-7 / Granulocyte Colony-Stimulating Factor; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin
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2. Tanase K, Tawada M, Moriyama N, Muranaka K: [Intra-arterial infusion chemotherapy for liver metastases of testicular tumors: report of two cases]. Hinyokika Kiyo; 2000 Nov;46(11):823-7
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  • [Title] [Intra-arterial infusion chemotherapy for liver metastases of testicular tumors: report of two cases].
  • Two cases of testicular tumors with lymph node involvement and multiple lung and liver metastases were treated successfully with intra-arterial infusion chemotherapy.
  • Histopathological diagnosis revealed embryonal cell carcinoma and choriocarcinoma.
  • Cisplatin, vinblastine, VP-16 and pepleomycin combination chemotherapy (PVeBV) was started and repeated for 2 courses.
  • Systemic and intrahepatic arterial infusion combined with chemotherapy was administered, and intra-arterial chemotherapy (cisplatin, VP-16) was added.
  • The patient also received systemic chemotherapy (carboplatin, VP-16, ifosfamide).
  • After chemotherapy, retroperitoneal lymph node dissection was performed.
  • Microscopic examination revealed no viable cancer cells.
  • Cisplatin, vinblastine, VP-16 and pepleomycin combination chemotherapy (PVeBV) was administered, but the liver tumors ware enlarged on CT scan.
  • Intrahepatic arterial infusion chemotherapy (cisplatin, VP-16) was started and repeated for 4 courses.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Carcinoma, Embryonal / secondary. Choriocarcinoma / secondary. Liver Neoplasms / secondary. Seminoma / secondary. Testicular Neoplasms / pathology
  • [MeSH-minor] Adult. Bleomycin / administration & dosage. Cisplatin / administration & dosage. Etoposide / administration & dosage. Humans. Infusions, Intra-Arterial. Lung Neoplasms / drug therapy. Lung Neoplasms / secondary. Male. Neoplasms, Multiple Primary. Treatment Outcome. Vinblastine / administration & dosage

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  • (PMID = 11193306.001).
  • [ISSN] 0018-1994
  • [Journal-full-title] Hinyokika kiyo. Acta urologica Japonica
  • [ISO-abbreviation] Hinyokika Kiyo
  • [Language] jpn
  • [Publication-type] Case Reports; English Abstract; Journal Article; Review
  • [Publication-country] Japan
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 5V9KLZ54CY / Vinblastine; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; PVeBV protocol
  • [Number-of-references] 13
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3. Matsumoto S, Matsuda H, Uejima S, Kurita T: [Secondary leukemia following ultra high-dose chemotherapy with peripheral blood stem cell autotransplantation for refractory testicular cancer]. Nihon Hinyokika Gakkai Zasshi; 2000 Oct-Nov;91(10-11):687-91
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  • [Title] [Secondary leukemia following ultra high-dose chemotherapy with peripheral blood stem cell autotransplantation for refractory testicular cancer].
  • Secondary leukemia following chemotherapy or radiotherapy for mediastinal germ cell tumors in a well-described entity.
  • It also may occur in patients with testicular germ cell tumors.
  • We report a case of secondary leukemia occurring in a 31-year-old man who received ultra high-dose chemotherapy with peripheral blood stem cell autotransplantation (PBSCT) for a refractory testicular cancer (pathology; Seminoma, Embryonal carcinoma, Yolk sac tumor, Choriocarcinoma) with IIIB2 under Japanese classification, poor-risk group under Indiana classification.
  • He received total 11 cycles of systemic chemotherapy (2 cycles of PVB regimen, 4 cycles of PEB regimen, 3 cycles of VIP regimen and 2 cycles of ultra high-dose chemotherapy with PBSCT for pulmonary and para-aortic lymph node metastasis following his initial orchiectomy.
  • Severe and persistent pancytopenia developed 25 months after his initial orchiectomy.
  • Therefore, he was diagnosed as secondary leukemia following high-dose chemotherapy.
  • He received total 6 cycles of systematic chemotherapy for the secondary leukemia in the internal department.
  • To our knowledge, this is the first reported case in the literature relevant to secondary leukemia following ultra high-dose chemotherapy with PBSCT in testicular tumor in Japan.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / adverse effects. Carcinoma, Embryonal / drug therapy. Choriocarcinoma / drug therapy. Hematopoietic Stem Cell Transplantation. Leukemia / etiology. Neoplasms, Second Primary / etiology. Seminoma / drug therapy. Testicular Neoplasms / drug therapy
  • [MeSH-minor] Adult. Bleomycin / administration & dosage. Bleomycin / adverse effects. Cisplatin / administration & dosage. Cisplatin / adverse effects. Combined Modality Therapy. Etoposide / administration & dosage. Etoposide / adverse effects. Humans. Male. Transplantation, Autologous

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  • (PMID = 11109821.001).
  • [ISSN] 0021-5287
  • [Journal-full-title] Nihon Hinyōkika Gakkai zasshi. The japanese journal of urology
  • [ISO-abbreviation] Nippon Hinyokika Gakkai Zasshi
  • [Language] jpn
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] JAPAN
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; BEP protocol
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4. Hamid AR, Umbas R: Metastasis of testicular carcinoma in the inguinal region. Acta Med Indones; 2009 Jan;41(1):25-9
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  • [Title] Metastasis of testicular carcinoma in the inguinal region.
  • A standard protocol for the management of inguinal metastasis from testicular cancer still has not yet been established.
  • Metastasis of testicular cancer to inguinal lymph node rarely occurs, particularly in patients without any prior surgery in inguinal and scrotal region.
  • Daugaard reported 2% incidence of inguinal metastasis for stage 1 testicular cancer in 5-year period.
  • We reported a case of inguinal metastasis from residual testicular cancer with a large size of mass.
  • For this case, surgical treatment of residual tumor excision had been performed prior to the chemotherapy considering a quite large size of tumor mass, which may easily bleed and causing anemia to the patient.
  • Furthermore, we considered that chemotherapy treatment prior to surgical excision will only provide partial effect on the tumor.
  • After the surgery, a 4-cycle combined chemotherapy was administered despite the delay of chemotherapy treatment resulting in residual mass in inguinal region.
  • In fact, the post-surgical chemotherapy treatment in this case has demonstrated relatively good response.
  • [MeSH-major] Carcinoma, Embryonal / secondary. Choriocarcinoma / secondary. Endodermal Sinus Tumor / secondary. Seminoma / secondary. Testicular Neoplasms / pathology
  • [MeSH-minor] Adult. Chemotherapy, Adjuvant. Fatal Outcome. Groin. Humans. Lung Neoplasms / radiography. Lung Neoplasms / secondary. Lymphatic Metastasis. Male. Neoplasm, Residual. Skin Transplantation

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  • (PMID = 19258677.001).
  • [ISSN] 0125-9326
  • [Journal-full-title] Acta medica Indonesiana
  • [ISO-abbreviation] Acta Med Indones
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Indonesia
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5. Kalaitzis C, Bantis A, Tsakaldimis G, Giannakopoulos S, Sivridis E, Touloupidis S: Osteolytic bone destruction resulting from relapse of a testicular tumour 23 years after inguinal orchiectomy and adjuvant chemotherapy: a case report. J Med Case Rep; 2009;3:8702

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  • [Title] Osteolytic bone destruction resulting from relapse of a testicular tumour 23 years after inguinal orchiectomy and adjuvant chemotherapy: a case report.
  • INTRODUCTION: Late relapse of a testicular germ cell tumour is an uncommon occurrence.
  • We report a case of osteolytic bone metastasis appearing 23 years after the initial treatment of a metastatic testicular mixed tumour (choriocarcinoma and embryonal carcinoma).
  • This is one of the longest periods of recurrence reported for testicular germ cell tumours.
  • CASE PRESENTATION: A 52-year-old Caucasian man who underwent a right inguinal orchiectomy due to testicular tumour in 1984 presented to our outpatient clinic in a generally bad condition of health and with severe pain of his right hip joint and os ischii caused by osteolytic metastasis.
  • CONCLUSIONS: This case emphasizes the need for a life-long follow-up of patients with primary metastatic testicular cancer.

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  • (PMID = 19830236.001).
  • [ISSN] 1752-1947
  • [Journal-full-title] Journal of medical case reports
  • [ISO-abbreviation] J Med Case Rep
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC2737795
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6. Matveev VB, Volkova MI, Cherniev VA, Figurin KM, Mitin AV: [Retroperitoneal lymphadenectomy in disseminated non-seminoma germinogenic testicular tumors after chemotherapy in patients with elevated serum tumor markers]. Urologiia; 2010 May-Jun;(3):41-7
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  • [Title] [Retroperitoneal lymphadenectomy in disseminated non-seminoma germinogenic testicular tumors after chemotherapy in patients with elevated serum tumor markers].
  • Postchemotherapy retroperitoneal lymph node dissection (RLND) was performed in 70 testicular non-seminoma patients with elevated serum tumor markers (age median 27.0 +/- 8.1 years) from 1983 to 2008.
  • The prognostic group was not identified in 24 (34.3%) cases which started treatment in other hospitals.
  • All the patients received induction cisplatin-based chemotherapy following orchidectomy (first-line--24 (34.3%), second-line--46 (65.7%) which resulted in tumor shrinkage < 50% in 7 (10.0%), 51-90% in 23 (32.9%), > 90%--in 2 (2.9%) cases.
  • CT scan revealed residual retroperitoneal masses after chemotherapy in all the patients: < 2 cm--5 (7.1%), 2-5 cm--25 (35.7%), > 5 cm--40 (57.1%).
  • Further chemotherapy was not perspective in all 70 patients who further underwent retroperitoneal lymph node dissection (RLND).
  • Postoperative chemotherapy was given to 27 (38.6%) cases.
  • Complications developed in 12.9% (9/70) patients.
  • Histology revealed necrosis in 20 (28.6%), teratoma--in 26 (37.1%), cancer--in 24 (34.3%) specimens.
  • Prognostic factors for cancer in retroperitoneal pathology were the following: S > S1 (p = 0.013), intermediate or poor prognosis group IGCCCG (p = 0.014), absence of embryonal carcinoma (p = 0.003), the presence of choriocarcinoma in the testicular tumor (p = 0.028), second-line chemotherapy (p = 0.001), residual mass > 2 cm (p = 0.006).
  • Univariate analysis revealed an adverse impact on progressive-free survival of category S > S1 (p = 0.015), intermediate or poor prognostic group IGCCCG (p = 0.01), the presence of embryonal carcinoma (p = 0.020) and the absence of choriocarcinoma in the testicular tumor (p = 0.029), tumor shrinkage < 50% (p < 0.0001), incomplete RLND (p = 0.012), an incomplete effect of the combined treatment (p < 0.0001), cancer in the residual mass (p < 0.0001).
  • The multivariate analysis proved predictive value of an incomplete effect of the combined treatment (p < 0.0001).
  • Thus, selected testicular non-seminoma patients with elevated serum tumor markers are curable with surgery.
  • The best candidates for RLND in this group are patients without a tumor markers level increase during chemotherapy, with S1 category, good IGCCCG prognosis, tumor shrinkage > 50% and potentially respectable residual disease.
  • [MeSH-major] Biomarkers, Tumor / blood. Germinoma. Lymph Node Excision. Testicular Neoplasms

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  • (PMID = 20734877.001).
  • [ISSN] 1728-2985
  • [Journal-full-title] Urologii︠a︡ (Moscow, Russia : 1999)
  • [ISO-abbreviation] Urologiia
  • [Language] rus
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Russia (Federation)
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Biomarkers, Tumor; Q20Q21Q62J / Cisplatin
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7. Dimov ND, Zynger DL, Luan C, Kozlowski JM, Yang XJ: Topoisomerase II alpha expression in testicular germ cell tumors. Urology; 2007 May;69(5):955-61
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Topoisomerase II alpha expression in testicular germ cell tumors.
  • OBJECTIVES: Inhibitors of topoisomerase II alpha (TopoIIalpha), an enzyme with a crucial role in DNA maintenance, are included in the chemotherapy protocols for testicular germ cell tumors (GCTs).
  • Despite the success of current chemotherapy regimens, a significant number of patients experience relapse.
  • We analyzed TopoIIalpha expression in primary and metastatic testicular GCTs because this enzyme is a target for some antineoplastic agents.
  • METHODS: Primary GCT specimens from 109 patients, including 57 seminomas and 52 mixed GCTs (41 embryonal carcinomas, 23 yolk sac tumors, 19 seminomas, 8 choriocarcinomas, 17 teratomas with immature elements, and 16 teratomas with mature elements), were obtained from our archives.
  • The metastatic lesions from 11 of the patients with mixed GCTs included seven teratomas with mature components, five embryonal carcinomas, one yolk sac tumor, one choriocarcinoma, and one teratoma with immature components.
  • RESULTS: Most embryonal carcinoma (100%), yolk sac tumor (95%), seminoma (88%), and choriocarcinoma (62%) components of the GCTs were TopoIIalpha immunoreactive.
  • CONCLUSIONS: The results of our study have shown that TopoIIalpha is expressed in most seminomas, embryonal carcinomas, yolk sac tumors, and choriocarcinomas, suggesting a possible mechanism of sensitivity of these components to TopoIIalpha inhibitors.
  • These findings imply that the variable chemoresponsiveness of testicular GCTs could have an underlying molecular basis.
  • [MeSH-major] Antigens, Neoplasm / metabolism. Biomarkers, Tumor / analysis. DNA Topoisomerases, Type II / metabolism. DNA-Binding Proteins / antagonists & inhibitors. DNA-Binding Proteins / metabolism. Neoplasms, Germ Cell and Embryonal / enzymology. Testicular Neoplasms / enzymology. Topoisomerase II Inhibitors
  • [MeSH-minor] Adolescent. Adult. Biopsy, Needle. Carcinoma, Embryonal / drug therapy. Carcinoma, Embryonal / enzymology. Carcinoma, Embryonal / pathology. Choriocarcinoma / drug therapy. Choriocarcinoma / enzymology. Choriocarcinoma / pathology. Endodermal Sinus Tumor / drug therapy. Endodermal Sinus Tumor / enzymology. Endodermal Sinus Tumor / pathology. Gene Expression Regulation, Neoplastic. Humans. Immunohistochemistry. Male. Middle Aged. Prognosis. Sampling Studies. Seminoma / drug therapy. Seminoma / enzymology. Seminoma / pathology. Sensitivity and Specificity. Teratoma / drug therapy. Teratoma / enzymology. Teratoma / pathology. Treatment Outcome

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  • (PMID = 17482942.001).
  • [ISSN] 1527-9995
  • [Journal-full-title] Urology
  • [ISO-abbreviation] Urology
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antigens, Neoplasm; 0 / Biomarkers, Tumor; 0 / DNA-Binding Proteins; 0 / Topoisomerase II Inhibitors; EC 5.99.1.3 / DNA Topoisomerases, Type II; EC 5.99.1.3 / DNA topoisomerase II alpha
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8. 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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  • [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.
  • 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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9. van de Geijn GJ, Hersmus R, Looijenga LH: Recent developments in testicular germ cell tumor research. Birth Defects Res C Embryo Today; 2009 Mar;87(1):96-113
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  • [Title] Recent developments in testicular germ cell tumor research.
  • Testicular germ cell tumors of adolescents and adults (TGCTs; the so-called type II variant) are the most frequent malignancies found in Caucasian males between 20 and 40 years of age.
  • TGCTs are divided into seminomas and nonseminomas, the latter consisting of the subgroups embryonal carcinoma, yolk-sac tumor, teratoma, and choriocarcinoma.
  • The pathogenesis starts in utero, involving primordial germ cells/gonocytes that are blocked in their differentiation, and develops via the precursor lesion carcinoma in situ toward invasiveness.
  • Seminoma represents the germ cell lineage, and embryonal carcinoma is the undifferentiated component, being the stem cell population of the nonseminomas.
  • Somatic differentiation is seen in the teratomas (all lineages), whereas yolk-sac tumors and choriocarcinoma represent extra-embryonal differentiation.
  • Seminomas are highly sensitive to irradiation and (DNA damaging) chemotherapy, whereas most nonseminomatous elements are less susceptible to radiation, although still sensitive to chemotherapy, with the exception of teratoma.
  • [MeSH-major] Biomarkers, Tumor / metabolism. Neoplasms, Germ Cell and Embryonal / metabolism. Seminoma / metabolism. Testicular Neoplasms / metabolism

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  • (PMID = 19306344.001).
  • [ISSN] 1542-9768
  • [Journal-full-title] Birth defects research. Part C, Embryo today : reviews
  • [ISO-abbreviation] Birth Defects Res. C Embryo Today
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / MicroRNAs
  • [Number-of-references] 235
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10. Brandes AA, Pasetto LM, Monfardini S: The treatment of cranial germ cell tumours. Cancer Treat Rev; 2000 Aug;26(4):233-42
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  • [Title] The treatment of cranial germ cell tumours.
  • Germ cell tumours of the central nervous system (CNS) include many subtypes whose response to treatment varies, even though the symptoms and radiological appearances are similar.
  • Patients with choriocarcinoma, embryonal carcinoma, or yolk sac tumour have the lowest survival rates; patients with germinoma or mature teratoma have longer survival rates.
  • Beside the delayed injury induced by radiotherapy, the late injury induced by chemotherapy is becoming increasingly evident.
  • Cisplatin is considered an indispensable drug, but it may cause renal damage, ototoxicity, peripheral neuropathy and sterility, while etoposide is associated with an excess frequency of second neoplasms.
  • Taking into account all of the published literature, the following therapeutic options are suggested: in pure germinoma tumours (GT) radiotherapy alone will usually ensure adequate control of the disease, and the long-term sequelae may be limited by reducing the dose delivered, as was proposed for germ cell testicular tumours, to 30 Gy to limited fields plus 25-30 Gy to the spinal axis if there is disseminated disease.
  • In cases of recurrence, which should be uncommon, patients may be rescued with both radiotherapy and chemotherapy.
  • In NGGC tumours, the prognosis is more unfavourable and there is often dissemination to the spine at diagnosis; however, the tumour's high chemosensitivity suggests neoadjuvant treatment chemotherapy with cisplatin and etoposide for three cycles followed by consolidation radiotherapy with 40 Gy to the limited fields plus 30 Gy to the spinal axis if disseminated.
  • In our opinion, a higher dose of radiotherapy in cases in which chemotherapy does not achieve a radiological complete remission is not advisable, because very often the residual radiological abnormality does not represent biologically active tumour but differentiated forms such as mature teratoma.
  • The challenge for 2000 is to both cure these patients, and avoid the late and permanent sequelae of radiation and/or chemotherapy that may subsequently impair quality of life.
  • [MeSH-major] Brain Neoplasms / therapy. Neoplasms, Germ Cell and Embryonal / therapy
  • [MeSH-minor] Combined Modality Therapy. Cranial Irradiation. Drug Therapy. Humans. Neurosurgical Procedures. Prognosis. Radiotherapy Dosage. Survival Rate

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  • [Copyright] Copyright 2000 Harcourt Publishers Ltd.
  • (PMID = 10913379.001).
  • [ISSN] 0305-7372
  • [Journal-full-title] Cancer treatment reviews
  • [ISO-abbreviation] Cancer Treat. Rev.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] ENGLAND
  • [Number-of-references] 59
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11. Ando R, Yasui T, Tozawa K, Sasaki S, Hayashi Y, Kohri K: Testicular seminoma occurring 8 years after treatment of a metastatic extragonadal germ cell tumor. Int J Urol; 2007 Jan;14(1):85-6
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  • [Title] Testicular seminoma occurring 8 years after treatment of a metastatic extragonadal germ cell tumor.
  • A 30-year-old man was admitted with a chief complaint of left-sided scrotal enlargement, and was diagnosed as having testicular seminoma after orchiectomy.
  • Eight years earlier, he had been treated with chemotherapy for an extragonadal germ cell tumor, without orchiectomy, leading to complete remission.
  • His histological diagnosis at that time was a germ cell tumor, composed of choriocarcinoma and embryonal carcinoma.
  • He was followed up without testicular biopsy.
  • Routine pretreatment testicular biopsy in patients with extragonadal germ cell tumor is controversial, but regular long-term follow up and information on the risk of developing a metachronous testicular tumor are needed after treatment of extragonadal germ cell tumors, even when there seems to be a partial or complete clinical response.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / drug therapy. Neoplasms, Second Primary / diagnosis. Seminoma / diagnosis. Testicular Neoplasms / diagnosis. Testicular Neoplasms / drug therapy

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  • (PMID = 17199868.001).
  • [ISSN] 0919-8172
  • [Journal-full-title] International journal of urology : official journal of the Japanese Urological Association
  • [ISO-abbreviation] Int. J. Urol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Australia
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12. Stang A, Rusner C, Eisinger B, Stegmaier C, Kaatsch P: Subtype-specific incidence of testicular cancer in Germany: a pooled analysis of nine population-based cancer registries. Int J Androl; 2009 Aug;32(4):306-16
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  • [Title] Subtype-specific incidence of testicular cancer in Germany: a pooled analysis of nine population-based cancer registries.
  • Comparisons of incidence estimates of testicular cancer subtypes beyond seminoma and non-seminoma are virtually missing in the epidemiologic literature.
  • We analysed incidence data from population-based German cancer registries to provide subtype-specific incidences of testicular cancer.
  • We pooled data from nine cancer registries from 1998 to 2003.
  • We estimated incidence and mortality time trends of West and East Germany.
  • In 1998-2003, the seminoma incidence rate was 5.1 per 100,000; among non-seminomas, the rates were the highest for malignant teratoma (1.6 per 100,000), followed by embryonal carcinoma (1.2 per 100,000).
  • Testicular lymphomas were rare (0.1 per 100,000).
  • The incidence of testicular cancer among children aged 0-14 years was nearly constant from 1987 through 2004.
  • In East and West Germany, rates of embryonal carcinoma in the early periods were considerably lower than the rates of malignant teratoma.
  • In the most recent periods, rates of embryonal carcinoma became quite similar to the rates of malignant teratoma.
  • The later start of the mortality decline in East Germany may be because of a later introduction of platinum-based chemotherapy compared to West Germany.
  • [MeSH-major] Testicular Neoplasms / epidemiology
  • [MeSH-minor] Adolescent. Adult. Age Distribution. Aged. Aged, 80 and over. Carcinoma, Embryonal / epidemiology. Child. Child, Preschool. Choriocarcinoma / epidemiology. Germany / epidemiology. Humans. Incidence. Infant. Infant, Newborn. Male. Middle Aged. Population Surveillance. Registries. Seminoma / epidemiology. Teratoma / epidemiology. Time Factors. Young Adult

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  • (PMID = 18179558.001).
  • [ISSN] 1365-2605
  • [Journal-full-title] International journal of andrology
  • [ISO-abbreviation] Int. J. Androl.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
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13. Mikuz G: [WHO classification of testicular tumors]. Verh Dtsch Ges Pathol; 2002;86:67-75
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  • [Title] [WHO classification of testicular tumors].
  • Twenty years after the first edition (1977), the WHO has presented the updated version of the "Histological typing of testis tumours".
  • Such atypical cells appear in the tubules adjacent to the germ cell tumors, in some few cases (6%) also in the contra lateral healthy gonad and rarely in infertile men (1%).
  • The precursor lesion can progress to franc germ cell tumor starting probably with seminoma, which still maintain the capability of differentiation (pluripotente cells) in all other types of non-seminomatous germ cell tumors.
  • Seminoma with syncytiotrophoblastic cells is a variant which should not be confused with choriocarcinoma.
  • This is a harmless name for an extremely dangerous tumor in which one tissue overgrows the other and gives rise to somatic type sarcomas or carcinomas.
  • Such tumors do not respond like germ cell tumors to the usual chemotherapy.
  • Treatment should be tailored according to that used in standard management of the respective sarcoma or carcinoma.
  • In the comments it is mentioned that the testis carcinoid could be a part of teratoma, but the diagnosis is listed in the group of "miscellaneous" tumors together with tumors of ovarian epithelial type.
  • This is a very questionable decision because the normal testis does not contain neuroendocrine cells from which carcinoids would have to be able to develop.
  • The patients have cardiac myxomas, spotty skin pigmentation, hormone active nodular hyperplasia of the adrenals and soft tissue myxomas.
  • For the therapy of germ cell tumor an assessment of risk factors found by the pathologists is extremely important.
  • The most important independent predictors of relapse are tumor invasion of blood or lymph-vessels, absence of yolk sac elements and the presence of an embryonal carcinoma component.
  • In the absence of such predictors a surveillance policy allows some patients to forgo chemotherapy.
  • [MeSH-major] Testicular Neoplasms / classification

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  • (PMID = 12647353.001).
  • [ISSN] 0070-4113
  • [Journal-full-title] Verhandlungen der Deutschen Gesellschaft für Pathologie
  • [ISO-abbreviation] Verh Dtsch Ges Pathol
  • [Language] ger
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] Germany
  • [Number-of-references] 48
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14. 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).
  • 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).
  • 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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15. Maroto P, García del Muro X, Aparicio J, Paz-Ares L, Arranz JA, Guma J, Terrassa J, Barnadas J, Dorta J, Germà-Lluch JR: Multicentre risk-adapted management for stage I non-seminomatous germ cell tumours. Ann Oncol; 2005 Dec;16(12):1915-20
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  • Other patients (358/589; 61%) were kept on close follow-up (chest X-ray; serum tumour markers: first year every 2 months, second year every 3 months, third year every 4 months; abdominal computed tomography scans at every other outpatient control).
  • In the chemotherapy group, two patients relapsed at 12 and 14.5 months and they are presently free of disease.
  • Five (1.4%) patients died of their cancer.
  • Factors associated with relapse were embryonal carcinoma and vascular invasion in patients who refused chemotherapy.

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  • (PMID = 16126737.001).
  • [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] Journal Article; Multicenter Study
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide
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16. Roth LM, Talerman A: Recent advances in the pathology and classification of ovarian germ cell tumors. Int J Gynecol Pathol; 2006 Oct;25(4):305-20
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  • The introduction of cisplatin-based chemotherapy and the discovery of tumor markers, including alpha-fetoprotein and human chorionic gonadotropin, have dramatically changed the clinical outlook for most of these patients.
  • Where appropriate, comparisons are made with testicular germ cell tumors.
  • [MeSH-major] Neoplasms, Germ Cell and Embryonal / classification. Neoplasms, Germ Cell and Embryonal / pathology. Ovarian Neoplasms / classification. Ovarian Neoplasms / pathology
  • [MeSH-minor] Carcinoid Tumor / classification. Carcinoid Tumor / pathology. Carcinoma, Embryonal / classification. Carcinoma, Embryonal / pathology. Choriocarcinoma / classification. Choriocarcinoma / pathology. Dysgerminoma / classification. Dysgerminoma / pathology. Endodermal Sinus Tumor / classification. Endodermal Sinus Tumor / pathology. Female. Humans. Teratoma / classification. Teratoma / pathology

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  • (PMID = 16990705.001).
  • [ISSN] 0277-1691
  • [Journal-full-title] International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists
  • [ISO-abbreviation] Int. J. Gynecol. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 102
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17. Williams SB, Steele GS, Richie JP: Primary retroperitoneal lymph node dissection in patients with clinical stage IS testis cancer. J Urol; 2009 Dec;182(6):2716-20
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  • [Title] Primary retroperitoneal lymph node dissection in patients with clinical stage IS testis cancer.
  • PURPOSE: Initial management for clinical stage IS (persistently increased tumor markers) nonseminomatous germ cell tumor has evolved from primary retroperitoneal lymph node dissection to induction chemotherapy at most medical centers.
  • MATERIALS AND METHODS: We reviewed the charts of patients who underwent retroperitoneal lymph node dissection at Brigham and Women's Hospital, and Dana Farber Cancer Center from 1993 to 2008.
  • Histopathology revealed an embryonal carcinoma component in 24 orchiectomy specimens (100%) with associated teratoma in 15 (63%).
  • Positive lymph nodes were identified at retroperitoneal lymph node dissection in 9 patients (38%), including pure embryonal carcinoma in 6 (67%), combined embryonal carcinoma and teratoma in 1, embryonal carcinoma, choriocarcinoma and teratoma in 1, and only teratoma in 1.
  • Of the patients who underwent primary retroperitoneal lymph node dissection 5 (21%) also received chemotherapy postoperatively, which was due to persistently increased tumor markers in 3 (13%).
  • At surgery estimated blood loss was 175 cc, operative time was 3.1 hours and hospital stay was 3.9 days.
  • CONCLUSIONS: Patients with clinical stage IS are at significant risk for metastatic disease and can be successfully treated with primary retroperitoneal lymph node dissection, thereby sparing chemotherapy in most of them.
  • [MeSH-major] Lymph Node Excision / methods. Neoplasms, Germ Cell and Embryonal / surgery. Testicular Neoplasms / surgery

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  • [CommentIn] J Urol. 2009 Dec;182(6):2720 [19836765.001]
  • (PMID = 19836777.001).
  • [ISSN] 1527-3792
  • [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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18. Allan RW, Algood CB, Shih IeM: Metastatic epithelioid trophoblastic tumor in a male patient with mixed germ-cell tumor of the testis. Am J Surg Pathol; 2009 Dec;33(12):1902-5
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  • [Title] Metastatic epithelioid trophoblastic tumor in a male patient with mixed germ-cell tumor of the testis.
  • This report describes a rare case of a concurrent epithelioid trophoblastic tumor (ETT) and a teratoma in a para-aortic lymph node from a 39-year-old male patient with the initial diagnosis of testicular malignant mixed germ-cell tumor.
  • The metastatic lesion was excised 2 years after orchiectomy and chemotherapy.
  • Microscopically, the metastatic lesion contained a teratoma component and dispersed small nests of cohesive chorionic-type intermediate trophoblastic cells, closely resembling gestational ETT in female patients.
  • Demonstration of ETT as one of the histologic manifestations of recurrent testicular germ-cell tumors should encourage pathologists to recognize this unique feature in assessing posttreatment mixed germ-cell neoplasm.
  • [MeSH-major] Carcinoma, Embryonal / secondary. Choriocarcinoma, Non-gestational / secondary. Epithelioid Cells / pathology. Teratoma / secondary. Testicular Neoplasms / pathology. Trophoblastic Neoplasms / secondary
  • [MeSH-minor] Adult. Chemotherapy, Adjuvant. Female. Humans. Immunohistochemistry. Lymph Node Excision. Lymphatic Metastasis. Male. Orchiectomy. Treatment Outcome

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  • (PMID = 19898219.001).
  • [ISSN] 1532-0979
  • [Journal-full-title] The American journal of surgical pathology
  • [ISO-abbreviation] Am. J. Surg. Pathol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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19. 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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20. Mardiak J, Sálek T, Sycová-Milá Z, Obertová J, Recková M, Mego M, Hlavatá Z, Brozmanová K, Risnyovzská Z, Svetlovská D, Koza I: Paclitaxel, bleomycin, etoposide, and cisplatin (T-BEP) as initial treatment in patients with poor-prognosis germ cell tumors (GCT): a phase II study. Neoplasma; 2007;54(3):240-5
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  • [Title] Paclitaxel, bleomycin, etoposide, and cisplatin (T-BEP) as initial treatment in patients with poor-prognosis germ cell tumors (GCT): a phase II study.
  • First line treatment of patients pts with poor-prognosis GCT, using BEP, is unsatisfactory.
  • Twenty-four pts received T-BEP as initial therapy.
  • Four cycles of T-BEP were given 21 days apart.
  • Median survival was not achieved and median time-to-progression is 9.5 months.
  • There were two treatment-related deaths due to sepsis.
  • Patients treated with 1st line T-BEP didn't achieve higher response rate or time to progression.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Neoplasms, Germ Cell and Embryonal / drug therapy
  • [MeSH-minor] Adult. Bleomycin / administration & dosage. Carcinoma, Embryonal / drug therapy. Carcinoma, Embryonal / secondary. Choriocarcinoma / drug therapy. Choriocarcinoma / secondary. Cisplatin / administration & dosage. Etoposide / administration & dosage. Humans. Male. Middle Aged. Neoplasm Staging. Paclitaxel / administration & dosage. Prognosis. Prospective Studies. Teratocarcinoma / drug therapy. Teratocarcinoma / secondary. Testicular Neoplasms / drug therapy. Testicular Neoplasms / secondary

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  • (PMID = 17447857.001).
  • [ISSN] 0028-2685
  • [Journal-full-title] Neoplasma
  • [ISO-abbreviation] Neoplasma
  • [Language] eng
  • [Publication-type] Clinical Trial, Phase II; Journal Article
  • [Publication-country] Slovakia
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; P88XT4IS4D / Paclitaxel; Q20Q21Q62J / Cisplatin
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