ABSTRACT
No existe consenso respecto del manejo de los pacientes con tumor de células germinales no seminomatoso (TCGNS) en estadio I, pudiendo ofrecerles linfadenectomía lumboaórtica, quimioterapia u observación. Presentamos la experiencia del Servicio de Urología del Hospital San Juan de Dios en el manejo de los TCGNS en estadio I. Material y método: Se realizó estudio descriptivo retrospectivo. Se analizaron las historias clínicas de todos los pacientes con tumores testiculares que acuden a control al policlínico de testículo, seleccionando a los pacientes con TCGNS en estadio I. Entre septiembre de 1990 y junio de 2004, se diagnosticaron 48 pacientes con una edad promedio, al momento del diagnóstico, de 28,4 años (15-71). Se analizaron las siguientes variables: lateralidad, tipo histológico, agrupándolos según variedad en pura o mixta, marcadores tumorales, factores de riesgo histológico, tratamiento, número y tipo de controles, periodo de seguimiento y recaída. Resultados: 28 (58,3 pr ciento) tumores fueron derechos; 11 (22,9 por ciento) pacientes presentaron TCGNS puro (6 carcinoma embrionario, 4 teratocarcinoma, 1 tumor de saco vitelino), de los 37 (77,1 por ciento) pacientes con TCGNS mixtos, 23 (47,9 por ciento) presentaban algún grado de carcinoma embrionario; 28 (58,3 por ciento) pacientes tuvieron marcadores tumorales positivos, todos los cuales se negativizaron tras la orquiectomía radical; 18 pacientes tuvieron factor de riesgo en sus biopsias (permeación vascular o linfática, invasión de rete testis o de cordón espermático o de albugínea). A los pacientes con factor de riesgo y a aquellos con un riesgo social de poca adhesión al seguimiento se les sometió a 2 ciclos de quimioterapia con PEB, completando un total de 28 pacientes (58,3 por ciento). A los pacientes se les controló un promedio de 10,4 veces (3-36) con un promedio de 5,1 radiografías de tórax (1-17), 4 ecografías (1-13) y 2,5 TAC (1-11). Presentaron recaída 2 pacientes (4,2 por ciento), ambo...
Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Lymph Node Excision , Germinoma/drug therapy , Testicular Neoplasms/drug therapy , Epidemiology, Descriptive , Retrospective Studies , Follow-Up StudiesABSTRACT
PURPOSE: to determine the role of RPLND for residual masses following chiotherapy in patients with non-siinomatous germ cell tumors (NSGCT) stage T1N2 and T1N3 (IIB and IIC). MATERIALS AND METHODS: We have preformed retrospective analysis of 11 patients who underwent RPLND for residual masses following chiotherapy in an oncologic reference center between January 1997 and Deciber 2002. All patients harbored either pure nonsiinomatous or mixed tumors in the testis tissue and had undergone 4 cycles of primary chiotherapy with bleomycin, etoposide and cisplatin. The residual masses were assessed by abdominal computed tomography preoperatively. RESULTS: There were perioperative complications in 3 cases owing to vascular iatrogenic lesion. One of who died in the early postoperative period due to extensive iliac thrombosis. The other 2 patients had an inferior vena cava injury owing to the difficulty in rioving the attached lymph nodes. The injuries were repaired by continuous suture with Prolene 5-0. All patients had tumors in the final pathological report and were referred to other 2 cycles of chiotherapy with the same drugs. Seven patients (63.3 percent) had complete response and riained free of the disease in a mean follow up of 38.3 months (ranging from 12 to 72). The riaining 3 patients had disease progression, 2 of which died 6 and 12 months after surgery, respectively, and one patient missed the follow-up after salvage chiotherapy. CONCLUSION: Retroperitoneal lymph node dissection for residual masses after chiotherapy is a high-morbidity procedure, even by experienced surgeons, although it riains an efficient modality of treatment in advanced germ cell carcinoma. The high frequency of tumor found in the RPLFN following chiotherapy might have been caused by the small number of patients in this study.
Subject(s)
Adult , Humans , Male , Germinoma/drug therapy , Germinoma/pathology , Testicular Neoplasms/drug therapy , Testicular Neoplasms/pathology , Germinoma/secondary , Germinoma/surgery , Lymph Node Excision , Lymphatic Metastasis , Neoplasm, Residual , Retroperitoneal Space , Retrospective Studies , Testicular Neoplasms/surgeryABSTRACT
Genéricamente, el cáncer de ovario representa enfermedades con comportamientos clínicos distintos. Así, los tumores poco frecuentes de células germinales son tratados con éxito en la gran mayoría de las pacientes, mediante regímenes convencionales de quimioterapia. En contraste, en el cáncer epitelial, que representa el 90 por ciento de los casos, a pesar de que muestra sensibilidad a la quimioterapia, no se ha logrado alcanzar resultados satisfactorios. En la búsqueda de mejores respuestas para el tratamiento de la neoplasia epitelial de ovario, recientemente se han investigado nuevos fármacos como paclitaxel, doxorrubicina liposomal, docetaxel, topotecan, gemcitabina y combinaciones de diferentes drogas, así como tratamientos con base en anticuerpos monoclonales que ofrecen una nueva esperanza. El objetivo de este trabajo es revisar y difundir las tácticas de tratamiento citotóxico disponibles para esta neoplasia.
Subject(s)
Carcinoma/drug therapy , Germinoma/drug therapy , Germinoma/surgery , Ovarian Neoplasms/drug therapy , Ovary/pathology , Cisplatin/therapeutic use , Risk FactorsABSTRACT
Genéricamente el cáncer de ovario representa enfermedades con comportamientos clínicos distintos. Así, los tumores poco frecuentes de células germinales son tratados con éxito en la gran mayoría de las pacientes, mediante regímenes convencionales de quimioterapia. En contraste, en el cáncer epitelial, que representa 90 por ciento de los casos, a pesar de que muestra sensibilidad a la quimioterapia aún no se ha logrado alcanzar resultados satisfactorios. En la búsqueda de mejores respuestas para el tratamiento de la neoplasia epitelial de ovario, recientemente se han investigado nuevos fármacos como docetaxel, topotecan, gemcitabina y combinaciones de diferentes drogas así como tratamientos con base en anticuerpos monoclonales que ofrecen una nueva esperanza.
Subject(s)
Drug Therapy , Ovarian Neoplasms/drug therapy , Cisplatin/therapeutic use , Germinoma/drug therapy , Vincristine/therapeutic useABSTRACT
Testicular germ cell tumor [TGCT] is the most solid tumor in 20 - 40 years old man. TGCT account for 95% of testicular tumors and represent a unique type of human cancer from several different perspectives. TGCT arise by transformation of germ cells. The Transformed germ cells exhibit ploripotentially to differentiate into embryonic. Extra-embryonic, and somatic tissue types, and are highly sensitive to cisplatin-based chemotherapy. Investigation into the genetics of TGCT can provide methods of molecular diagnosis and help to the understanding of molecular basis of transformation, differentiation and sensitivity/resistance. The molecular basis for the chemosensitivity of these tumors is poorly understood, although initial studies suggest that wild-type p53 might play a central role, further studies will provide insights into why other solid tumors remain far from curable. The following review will provide information about genetic altration and chromosomal aberration occur in TGCT. These studies have identified multiplication of 12p, manifested in I [12p] or tandem duplication of 12p. As a unique change in TGCT which serves as a diagnostic marker. These data also indicate that multiple genetic events play a role in distinct pathways in the development of TGCT, and further elucidation of the underlying genetic and biochemical mechanisms is central to unraveling biology and improving treatment of TGCT
Subject(s)
Humans , Male , Germinoma/diagnosis , Germinoma/drug therapy , Tumor Suppressor Protein p53 , Chromosome AberrationsABSTRACT
An intracranial mixed germ cell tumour with germinoma and teratoma components is reported. The patient presented with parinaud's syndrome and precocious puberty. The treatment involved partial surgical debulking followed by whole brain radiotherapy (4500 cGY in 25 fraction over 5 weeks) and chemotherapy (consisting of cisplatin and etoposide). Post treatment MRI showed no residual lesion. The controversies in the management are discussed.
Subject(s)
Adolescent , Antineoplastic Agents, Phytogenic/therapeutic use , Cisplatin/therapeutic use , Combined Modality Therapy , Etoposide/therapeutic use , Germinoma/drug therapy , Humans , Male , Pinealoma/drug therapy , Radiation-Sensitizing Agents/therapeutic use , Treatment OutcomeABSTRACT
Germ cell tumour, though rare, represents most common malignancy among young men aged between 15 to 35 years. In 1990's dramatic improvement has taken place in survival rate of testicular tumours (from 10% in 1970's and 90% in 1990's). This has been possible because of effective diagnostic techniques, accurate monitoring with biological markers and use of effective platinum based combination chemotherapy in its management. The most significant improvement in survival rate has occurred in advanced stage germ-cell tumours. Seminomas are sensitive to radiation therapy and NSGCT (Non Seminomatous Germ Cell Tumours). are effectively treated by combination chemotherapy of 3 drugs of which Bleomycin is most expensive and many patient can not afford it and so compliance is poor. In the present series we have tried only 2 drug regimen consisting of Platinum and Etoposide (PE). Since January 1992 to December 1994, 40 cases of testicular tumours were treated. 16 cases received PEB regimen and 24 cases were treated by PE regimen of which only 6 cases in the former and 20 cases in the later group completed the scheduled course. Patients were given 6 cycles of PE regimen (inj. Platinum 20 mg/m2 D1-D5, VP-16 (ETOPOSIDE), 100 MG/M2 1.V. D1-D5) repeated every three weeks. Final evaluation was done in June 1996. 17/20 (85%) patients on PE regiment exhibited complete regression of the disease by the end of June 1996, I was lost to follow up, and 2 of them had the disease in progressive stage and were considered for another regimen. 18 months disease free survival was 85%. Table I. Royal Marsden Staging System Stage I: Disease econfined to testes Stage II: Intradiaphragmatic node involvement A: Less than 2 cm B: 2-5 cm C: Greater than 5 cm Stage III: Supradiaphragmatic node involvement Stage IV: Extralymphatic disease Lung, Liver, Bone etc.
Subject(s)
Adolescent , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/administration & dosage , Cisplatin/administration & dosage , Etoposide/administration & dosage , Germinoma/drug therapy , Humans , Male , Testicular Neoplasms/drug therapyABSTRACT
La demostración de una relación dosis/efecto en el tratamiento de diferentes neoplasias, tanto en tumores sólidos, como en neoplasias hematológicas y en particular el vencimiento de la resistencia a la quimioterapia con dosis mieloablativas, ha aumentado el interés de las altas dosis de quimioterapia en los últimos años. El advenimiento de los factores estimulantes de colonias, granulocitario y granulocito-macrofágico, así como las técnicas modernas para la cosecha de progenitores hematopoyéticos periféricos, cuya reinfusión posterior al tratamiento mieloablativo, permite una aceleración de la recuperación hematopoyética y con ello una disminución de las complicaciones postransplante, ha sido fundamental. En el presente trabajo, los autores hacen una revisión de las indicaciones de altas dosis de quimioterapia, seguido de transplante autólogo hematopoyético, en tumores sólidos, linfomas no Hodgkin y mieloma múltiple
Subject(s)
Humans , Lymphoma, Non-Hodgkin/drug therapy , Breast Neoplasms/drug therapy , Germinoma/drug therapy , Hematopoietic Stem Cell Transplantation , Transplantation, Autologous , Sarcoma, Ewing/drug therapy , Neuroblastoma/drug therapy , Multiple Myeloma/drug therapySubject(s)
Bleomycin/administration & dosage , Child , Cisplatin/administration & dosage , Combined Modality Therapy , Dexamethasone/administration & dosage , Drug Therapy , Endodermal Sinus Tumor/drug therapy , Female , Germinoma/drug therapy , Humans , Magnetic Resonance Imaging , Neoplasm Metastasis , Spinal Cord/pathology , Spinal Cord Neoplasms/pathology , Vinblastine/administration & dosageABSTRACT
Os autores estudaram 25 casos de pacientes com tumor germinativo de ovário tratados com quimioterapia à base de cisplatina. Säo descritos os tipos histológicos encontrados, estádio da doença e quantidade de resíduo tumoral após a primeira cirurgia. Os casos foram separados em três grupos para estudo da sobrevida: sete pacientes estádio I, cinco delas estäo livres de doença e em observaçäo de 16 a 86 meses; cinco pacientes com disgerminoma avançado, estando três em remissäo completa, 10 a 54 meses após tratamento; 13 pacientes com tumor que näo o disgerminona e com doença residual após a primeira cirurgia. Foram obtidas sete respostas objetivas e quatro pacientes estäo vivas e bem, 26 a 91 meses após término da quimioterapia. De nove casos com doença muito avançada, duas estäo vivas e bem. Os autores concluem que o esquema foi adequado para os casos menos graves e pouco eficaz para as pacientes com doença maciça, com sete falhas terapêuticas claras. Os resultados sugerem que pacientes com estádio clínico I, com doenças residual após a primeira cirurgia menor que 5 cm e com histologia de disgerminoma, melhoram o prognóstico.