ABSTRACT
BACKGROUND: Brain metastases of testicular germ cell tumor (TGCT) are a rare event. Prognostic is poor and there is not much evidence on optimal management of these patients. PATIENTS AND METHODS: A review of case records of germ cell tumor patients within the Spanish Germ Cell Cancer Group data base from 1994 to 2012 was conducted. RESULTS: Thirty-three out of 6,200 cases (0.5 %). Nineteen patients (57 %) group 1: synchronous, 13 (40 %) group 2: metachronous and only one developed brain metastasis during cisplatin-based chemotherapy (excluded from the analysis). Median serum BHCG levels at initial diagnosis was higher in group 1, whereas elevated AFP serum levels were more common in group 2. Histology in the primary tumor: chorionic carcinoma for group 1 versus embryonal carcinoma for group 2. Mainly solitary brain metastasis in group 2 (54 versus 21 %, respectively). The median overall survival from the diagnosis of central nervous system involvement was 16 months for group 1 (CI 95 % 13.9-18) and 23 months (95 % CI 0-165) for group 2 (log rank p = 0.84). Long-term survivors were practically identical in the two groups (38.9 % group 1 versus 38.5 % group 2). Regardless of the timing of brain metastasis, those patients that achieved complete response to the treatment had better survival (log rank p 0.003). CONCLUSION: Although some distinctive clinical characteristics have been found between patients with synchronous versus metachronous brain metastasis from TGCT, the timing of brain metastasis did not seem to have prognostic influence, but due to the retrospective nature of the analysis and the results should be interpreted with caution (AU)
No disponible
Subject(s)
Testicular Neoplasms , Brain Neoplasms/secondary , Neoplasms, Multiple Primary , Neoplasms, Second Primary , Testicular Neoplasms/epidemiologyABSTRACT
BACKGROUND: 2-¹8fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) has been recommended in international guidelines in the evaluation of postchemotherapy seminoma residuals. Our trial was designed to validate these recommendations in a larger group of patients. PATIENTS AND METHODS: FDG-PET studies in patients with metastatic seminoma and residual masses after platinum-containing chemotherapy were correlated with either the histology of the resected lesion(s) or the clinical outcome. RESULTS: One hundred and seventy seven FDG-PET results were contributed. Of 127 eligible PET studies, 69% were true negative, 11% true positive, 6% false negative, and 15% false positive. We compared PET scans carried out before and after a cut-off level of 6 weeks after the end of the last chemotherapy cycle. PET sensitivity, specificity, negative predictive value (NPV), and positive predictive value were 50%, 77%, 91%, and 25%, respectively, before the cut-off and 82%, 90%, 95%, and 69% after the cut-off. PET accuracy significantly improved from 73% before to 88% after the cut-off (P=0.032). CONCLUSION: Our study confirms the high specificity, sensitivity, and NPV of FDG-PET for evaluating postchemotherapy seminoma residuals. When carried out at an adequate time point, FDG-PET remains a valuable tool for clinical decision-making in this clinical setting and spares patients unnecessary therapy.
Subject(s)
Glucose-6-Phosphate/analogs & derivatives , Positron-Emission Tomography , Radiopharmaceuticals , Seminoma/diagnostic imaging , Testicular Neoplasms/diagnostic imaging , Humans , Male , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Cisplatin has been one of the principal chemotherapy agents for the last 30 years and is still used widely in the treatment of testicular, ovarian, lung, head and neck, bladder and several other tumours. Resistance to chemotherapeutic agents is a major obstacle for successful treatment. Treatment effect on germ cell tumours (GCTs) is more successful than in adults suffering from almost any other solid tumour, but resistance still appears in 20% of patients with metastatic disease. However, because of the young age of patients and few data regarding the process of becoming resistant, this situation is still a challenge. In this review we are going to analyse the published literature on cisplatin resistance in GCTs and explain the initiatives that the Spanish Germ Cell Cancer Group (GG) is taking to try to elucidate the molecular mechanisms behind this process (AU)
No disponible
Subject(s)
Humans , Animals , Male , Female , Adult , Drug Resistance, Neoplasm/genetics , Cisplatin/therapeutic use , Neoplasms, Germ Cell and Embryonal/drug therapy , Neoplasms, Germ Cell and Embryonal/genetics , Antineoplastic Agents/pharmacology , Antineoplastic Agents/therapeutic use , Cisplatin/pharmacology , Disease Models, Animal , Models, Biological , Neoplasms, Germ Cell and Embryonal/pathology , Signal Transduction , Signal Transduction/geneticsABSTRACT
El carcinoma ovárico de célula pequeña hipercalcémicoes un tumor raro y agresivo con mayor incidenciaen mujeres jóvenes.La hipercalcemia es una de sus características clínicas.El tratamiento multidisciplinar parece incrementarla supervivencia en un número pequeño de casos.Presentamos el caso de una mujer diagnosticadade este tipo de tumor, su evolución clínica y el tratamientoque recibió
The hypercalcemic ovarian small cell carcinomais a very rare aggressive tumor affecting young women.Hypercalcemia is among its clinical features.Prognosis is poor despite aggressive treatment,but combined treatment seems to increase survivalin a small subset of patients.We report a case of a woman diagnosed of hypercalcemicovary small cell cancer, her clinical evolution and the treatment she received (AU)
