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1.
Semin Oncol ; 30(3): 382-9, 2003 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12870140

RESUMEN

Patients diagnosed with germ cell tumors (GCT) are relatively young, and most are rendered disease-free by primary treatment. Also, second-line therapies in nearly all instances are potentially curative. Therefore, the schedule and modalities of follow-up testing are important issues in detecting recurrence of GCT and for detecting secondary malignancies and complications of therapy. Follow-up is usually based on the pattern and probability of recurrence following primary therapy according to stage and histology. The National Comprehensive Cancer Network has outlined guidelines (www.nccn.org/physician_gls/index.html). There is a paucity of randomized data regarding the follow-up regimens most effective in identifying relapsed disease. Optimal means of imaging and frequency of physician visits and serum marker level measurements need to be further addressed.


Asunto(s)
Continuidad de la Atención al Paciente/normas , Germinoma/diagnóstico , Germinoma/secundario , Tamizaje Masivo/normas , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Primarias Secundarias/diagnóstico , Germinoma/prevención & control , Germinoma/terapia , Humanos , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Neoplasias Primarias Secundarias/prevención & control , Guías de Práctica Clínica como Asunto
2.
Support Care Cancer ; 11(9): 575-80, 2003 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12783290

RESUMEN

GOALS: To describe an acute respiratory distress syndrome (ARDS) occurring after chemotherapy for non-seminomatous germ-cell tumors (NSGCT) with diffuse lung metastases, we conducted a retrospective study in a 15-bed intensive care unit (ICU) in a comprehensive cancer center. PATIENTS AND METHODS: During a 10-year period, 16 consecutive patients with diffuse lung metastases from a NSGCT were admitted to the ICU for respiratory distress and high-risk chemotherapy. MAIN RESULTS: Nine patients developed acute respiratory failure requiring mechanical ventilation (MV) within 3 days of the initiation of chemotherapy, while the respiratory status of the seven other patients improved. The evolution was independent of tumor marker levels and the type of chemotherapy regimen. The SAPS II score did not accurately describe the severity of this population. The only predictor of intubation was the initial PaO2/FiO2 ratio upon admission to the ICU. Six out of seven patients who did not require MV were discharged alive from the hospital, whereas all but one patient requiring MV died. Refractory hypoxemia and ventilator-associated pneumonia were the leading causes of death. CONCLUSIONS: Acute respiratory distress in patients with lung metastases from NSGCT is a rare cause of ARDS. Chemotherapy could be responsible for triggering the respiratory worsening. Patients with severe respiratory insufficiency (PaO2 <70 mmHg on room air) on admission to hospital should be promptly transferred to the ICU for the first chemotherapy course.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Germinoma/tratamiento farmacológico , Germinoma/secundario , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/secundario , Síndrome de Dificultad Respiratoria/inducido químicamente , Adulto , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Respiración Artificial , Síndrome de Dificultad Respiratoria/terapia , Estudios Retrospectivos , Factores de Tiempo
3.
World J Urol ; 19(2): 120-5, 2001 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-11374314

RESUMEN

With the use of cisplatin-based combination chemotherapy, metastatic testicular germ cell tumors can be cured in 70-80% of patients. Patients refractory to cisplatin-based chemotherapy have a very poor prognosis. Several mechanisms have been discussed for the development of platinum resistance such as a decreased intracellular concentration of the drug, increased repair of the drug induced damage, or an altered apoptotic response to this damage. Various chemotherapeutic agents have been evaluated in intensively pretreated or cisplatin-refractory patients. Neither the antracyclines nor vinorelbine, bendamustine, topotecan, nor biological agents such as suramin and retinoic acid have demonstrated clinical activity. Paclitaxel has been evaluated at different doses and schedules and yielded a response rate of 21% (range 11-30%) with individual patients achieving complete remissions. This has led to the inclusion of paclitaxel in salvage regimens in combination with cisplatin and/or ifosfamide. Two recent studies have evaluated gemcitabine in refractory germ cell tumors, demonstrating a response rate of 17% (95% CI: 7-28%) in 52 intensively pretreated patients, two-thirds of whom had relapsed after previous high-dose chemotherapy plus autologous stem cell transplantation. The nonhematologic toxicity of weekly gemcitabine at doses of 1000-1250 mg/m2 was tolerable and hematologic side effects included thrombocytopenia in approximately 20% of patients. Ongoing studies in refractory germ cell tumors performed by the German Testicular Cancer Study Group (GTCSG) are evaluating oxaliplatin, a platinum derivative with incomplete cross-resistance to cisplatin. Future trials combining new active agents may make it possible to test the use of alternating treatment strategies in patients with "poor prognostic" disease or as salvage treatment. It is hoped that the increase in knowledge of the molecular mechanism of testicular cancer may lead to the development of new therapeutic options.


Asunto(s)
Antineoplásicos/administración & dosificación , Germinoma/tratamiento farmacológico , Neoplasias Testiculares/tratamiento farmacológico , Germinoma/secundario , Humanos , Masculino , Recurrencia Local de Neoplasia , Neoplasias Testiculares/patología
4.
Oncol Rep ; 8(2): 219-23, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11182030

RESUMEN

Patients with brain metastases in disseminated non-seminomatous germ cell cancer of the testis are treated by combined modality, e.g., cisplatin-containing chemotherapy, whole brain irradiation and/or surgical excision. However, cure rates of patients refractory to that standard treatment are low (5-year survival rate <30%). Preclinical data on the use of hyperthermia combined with selected cytotoxic drugs clearly show increased tumor cell killing compared to chemotherapy alone with no increase in toxicity to normal tissue. These results are consistent with the concept that whole body hyperthermia (WBH) at 41.8 degrees C is non-myelosuppressive and can potentiate the tumoricidal effects of specific chemotherapeutic agents, thus improving the therapeutic index. We report on a patient with embryonal testicular cancer presenting with lung, liver and brain metastases who initially underwent orchiectomy, whole brain irradiation and cisplatin-containing chemotherapy. Restaging revealed minor regression of brain and lung metastases and no change of liver metastases. However, beta-HCG values dropped from initial 400000 mIU/ml to 12 mIU/ml with a normal alpha-fetoprotein all the time. Then, two cycles of whole body hyperthermia (WBH) plus chemotherapy were performed, followed by one cycle of chemotherapy without WBH. Radiotherapy, WBH and chemotherapy were well tolerated, especially no neurologic sequelae occurred. After more than 5 years of follow-up, the patient is still alive and disease-free. WBH plus chemotherapy seems to be feasible and may contribute to long-term survival in patients with advanced stages of non-seminomatous germ cell cancer refractory to standard treatment.


Asunto(s)
Neoplasias Encefálicas/secundario , Germinoma/terapia , Hipertermia Inducida , Neoplasias Testiculares/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/terapia , Terapia Combinada , Germinoma/patología , Germinoma/radioterapia , Germinoma/secundario , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Masculino , Estadificación de Neoplasias , Neoplasias Testiculares/patología , Neoplasias Testiculares/radioterapia , Factores de Tiempo , Resultado del Tratamiento
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