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1.
Anticancer Res ; 39(10): 5589-5596, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570454

RESUMO

BACKGROUND/AIM: To quantify the prognostic impact of age on relapse and mortality in patients with metastatic testicular germ cell tumors (TGCT). PATIENTS AND METHODS: Electronical medical records of 1,225 TGCT patients who were treated at a single academic center between 1994 and 2015 were reviewed. RESULTS: Higher age did not predict for worse progression-free survival (PFS) or for higher progression risk. The corresponding 5-year PFS estimates were 85% in patients younger than 40 years and 83% in the elderly population. Although not statistically significant, higher age was numerically associated with worse overall survival (OS) (univariate HR per five years increase in age=1.18, 95%CI=0.99-1.41). This was explained in regression analysis where age predicted for significantly higher risk of treatment-related death (p=0.022). CONCLUSION: Elderly patients with metastatic TGCT can achieve high cure rates similar to younger patients if they tolerate risk-adapted chemotherapy.


Assuntos
Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Adulto , Fatores Etários , Progressão da Doença , Humanos , Masculino , Prognóstico , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
2.
Bull Cancer ; 106(10): 903-914, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31495441

RESUMO

Germ-cell tumors are the most common solid tumors in young men. The follow-up of these patients is very important in their management. In stage I testicular cancer, surveillance is the standard for low-risk disease. In addition to the early detection of relapse, follow-up should be directed towards prevention, detection and treatment of late toxicity, and secondary malignancies. Follow up consists in physical examination, laboratory analysis and radiological imaging. Recently, guidelines recommend risk-adapted surveillance strategy, with a reduction of CT scans numbers, due to the recognition of the risk of ionizing radiation exposure. However, efforts to maintain adequate compliance with follow up are required.


Assuntos
Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Embrionárias de Células Germinativas/prevenção & controle , Segunda Neoplasia Primária/diagnóstico , Neoplasias Testiculares/prevenção & controle , Adulto , Humanos , Masculino , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Induzidas por Radiação/diagnóstico , Neoplasias Induzidas por Radiação/prevenção & controle , Cooperação do Paciente , Exposição à Radiação/prevenção & controle , Prevenção Secundária , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
Bull Cancer ; 106(10): 896-902, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31466695

RESUMO

Metastatic testicular germ cell tumors are rare entities with a high cure rate owing to their major chemosensitivity. Current guidelines should be strictly followed to ensure maximal cure rate. Germ cell tumor treatment requires multidisciplinary skills and is based on cisplatin-based chemotherapy. The current challenge for these patients with favorable prognosis is to limit over- or under-treatment. Centralization of care for patients with these rare cancers is a key point to achieve the best chance of cure.


Assuntos
Neoplasias Embrionárias de Células Germinativas/secundário , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Testiculares/secundário , Neoplasias Testiculares/terapia , Antineoplásicos/uso terapêutico , Cisplatino/uso terapêutico , Terapia Combinada/métodos , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/classificação , Neoplasias Embrionárias de Células Germinativas/patologia , Orquiectomia , Prognóstico , Neoplasias Testiculares/classificação , Neoplasias Testiculares/patologia
4.
Pan Afr Med J ; 33: 55, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448017

RESUMO

Paratesticular rhabdomyosarcoma is a rare tumor. Treatment is based on multimodal therapy as well as on surgery, chemotherapy and radiotherapy. This study and literature review highlight the diagnostic and therapeutic approaches to treat paratesticular rhabdomyosarcoma.


Assuntos
Rabdomiossarcoma/diagnóstico , Neoplasias Testiculares/diagnóstico , Terapia Combinada , Humanos , Masculino , Rabdomiossarcoma/patologia , Rabdomiossarcoma/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Adulto Jovem
5.
Bull Cancer ; 106(10): 868-874, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31350015

RESUMO

OBJECTIVES: To describe the epidemiological, clinical and therapeutic aspects of primary urological cancers in semi-urban areas in Burkina Faso. PATIENTS AND METHOD: A descriptive study was conducted over the period from 1 January 2008 to 31 December 2017 in the General Surgery Department of the Tenkodogo Regional Hospital, located in the east of Burkina Faso. All patients over 15 years of age who were diagnosed with primary urological cancer were included. RESULTS: A total of 160 patients were included. One hundred and thirty-one patients were male (81.9%). The sex ratio was 4.5. The average age of the patients was 58.9 years (standard deviation: 18 years). We found 73 cases of prostate cancers (45.6%), 53 bladder cancers (33.1%), 17 kidney cancers (10.6%), 11 testicular cancers (6.9%) and 6 cancers of the male external genitalia (3.7%). The histological types of prostate cancer were adenocarcinoma (88%) and neuroendocrine carcinoma (12%). Thirty-seven prostate cancers (50.7%) were diagnosed at the T3 stage and 12 others (16.4%) at the T4 stage. Prostate cancer treatment was only medical in 23 patients; surgical treatment was indicated in 50 other patients. The 5-year survival was 85%. Sixteen patients (30.2%) had metastatic bladder cancer at the time of diagnosis. The treatment of vesical cancers has been palliative in 50 cases.


Assuntos
Recursos em Saúde , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/terapia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Burkina Faso/epidemiologia , Países em Desenvolvimento , Neoplasias das Glândulas Endócrinas/epidemiologia , Neoplasias das Glândulas Endócrinas/patologia , Neoplasias das Glândulas Endócrinas/terapia , Feminino , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Distribuição por Sexo , Taxa de Sobrevida , Neoplasias Testiculares/epidemiologia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Neoplasias Urológicas/patologia , Adulto Jovem
6.
Clin Nucl Med ; 44(9): e517-e518, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31348093

RESUMO

Paratesticular paragangliomas are a rare occurrence. We present the case of a 43-year-old man who presented with paresthesia and paraparesis and was found to have pathologic fracture involving D1 vertebra as a manifestation of metastasis from a nonsecretory right paratesticular paraganglioma.


Assuntos
Paraganglioma/diagnóstico por imagem , Paraganglioma/patologia , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/patologia , Adulto , Humanos , Imagem por Ressonância Magnética , Masculino , Metástase Neoplásica
8.
J Cancer Res Clin Oncol ; 145(9): 2335-2342, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31286241

RESUMO

PURPOSE: Clinical stage (CS) 1 testicular seminoma is cured in almost 100% of cases following either retroperitoneal radiotherapy, carboplatin monotherapy, or surveillance strategies. Little is known about potential long-term effects of carboplatin. We, therefore, examined late sequelae of this drug in seminoma patients. PATIENTS AND METHODS: We retrospectively identified 451 patients with CS1 testicular seminoma treated between 1994 and 2014, of whom 243 underwent carboplatin therapy [median follow-up (F/U) 96 months], 81 received radiotherapy (median F/U 142 months), and 127 underwent surveillance (median F/U 40 months). Satisfaction regarding management, as well as the following events during F/U, were analysed by questionnaire: subsequent malignant neoplasms (SMNs), cardiovascular events, arterial hypertension, peptic ulcer, tinnitus, peripheral neuropathy, hypogonadism, and infertility. The relative frequencies of the events were analysed using descriptive statistics. The frequency of observed SMNs was compared with the expected number. RESULTS: Patients receiving carboplatin tolerated the treatment less well (71.2%) than those under surveillance (81.9%). After carboplatin, 12 SMNs (5.0%) were noted vis-a-vis 5.0 expected. There were three cases of prostatic cancer and 3 melanomas among the SMNs. Half of these SMNs occurred early after treatment. Among the other health events, only reported hypogonadism (13.2%) appeared to be marginally increased in frequency. CONCLUSIONS: This study found a 2.4-fold higher than expected rate of SMN-and a slightly increased rate of hypogonadism-in the long-term period following carboplatin treatment. Although further studies are needed to confirm these preliminary findings, these results are probably informative for clinicians caring for seminoma patients.


Assuntos
Carboplatina/administração & dosagem , Seminoma/tratamento farmacológico , Seminoma/radioterapia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/radioterapia , Adolescente , Adulto , Idoso , Carboplatina/efeitos adversos , Quimioterapia Adjuvante , Terapia Combinada , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Humanos , Transtornos de Início Tardio/induzido quimicamente , Transtornos de Início Tardio/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Segunda Neoplasia Primária/epidemiologia , Radioterapia Adjuvante , Estudos Retrospectivos , Seminoma/patologia , Neoplasias Testiculares/patologia , Resultado do Tratamento , Conduta Expectante , Adulto Jovem
9.
Urol Clin North Am ; 46(3): 315-331, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277727

RESUMO

Germ cell tumors (GCTs) of the testis are cured with the successful integration of surgery, chemotherapy, and/or radiation therapy in most cases. The favorable results are a consequence of improved risk stratification, risk-adapted chemotherapy, reduced morbidity of treatment, and appropriate integration of multimodal therapy. The success of these approaches depends on accurate staging with imaging studies of the testis, retroperitoneum, and thorax. This article reviews the indications for imaging and performance characteristics of modalities in the diagnosis, staging, surveillance, and follow-up of patients with GCTs. We also highlight the current guideline recommendations for imaging in treatment of patients with GCTs.


Assuntos
Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Biomarcadores Tumorais/sangue , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Vigilância da População , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia
10.
Urol Clin North Am ; 46(3): 333-339, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277728

RESUMO

In any man with a solid testicular mass, cancer should be considered until proven otherwise. Radical inguinal orchiectomy is the treatment of choice in patients with testis mass. Placement of a testicular prosthesis is safe with a very low complication rate and should be offered to all patients undergoing radical orchiectomy. In patients with widespread or life-threatening advanced disease, delayed orchiectomy following chemotherapy is recommended. Testis-sparing surgery can be performed in highly selected patients with solitary testicle mass, bilateral testicular tumors, or strong suspicion of a benign lesion.


Assuntos
Neoplasias Testiculares/cirurgia , Humanos , Masculino , Orquiectomia , Tratamentos com Preservação do Órgão , Próteses e Implantes , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia
11.
Urol Clin North Am ; 46(3): 353-362, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277730

RESUMO

Experience demonstrates multiple paths to cure for patients with clinical stage I testicular cancer. Because all options should provide a long-term disease-free rate near 100%, overall survival is no longer relevant in decision making, allowing practitioners to factor in quality of life, toxicity, cost, and impact on compliance. Surveillance for clinical stage I seminoma and clinical stage I nonseminoma has become the preferred option. The contrarian view is that a risk-adapted approach should persist, with surveillance for low-risk individuals and active therapy high-risk individuals. However, results obtained in unselected patients provide a strong argument against the need for such an approach.


Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Biomarcadores Tumorais/metabolismo , Intervalo Livre de Doença , Custos de Cuidados de Saúde , Humanos , Masculino , Estadiamento de Neoplasias , Qualidade de Vida
12.
Urol Clin North Am ; 46(3): 363-376, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277731

RESUMO

There are several treatment approaches for stage II germ cell tumors (GCTs), and a thorough understanding of the staging classification and histologic differences in tumor biology and therapeutic responsiveness is critical to determine an effective, multimodal management strategy that involves urologists, medical oncologists, and radiation oncologists. This article discusses contemporary management strategies for stage II GCTs, including chemotherapy, radiotherapy, retroperitoneal lymph node dissection (RPLND), and surveillance. Patient selection, histology, and extent of lymphadenopathy drive management, and, as both treatment and detection strategies continue to emerge and be refined, the management of patients with stage II GCT continues to evolve.


Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Intervalo Livre de Doença , Custos de Cuidados de Saúde , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Qualidade de Vida
13.
Urol Clin North Am ; 46(3): 377-388, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277732

RESUMO

The modern treatment of disseminated germ cell tumors (GCT) relies largely on cisplatin-based regimens, particularly combination chemotherapy with bleomycin, etoposide, and cisplatin. This article reviews the evidence supporting its use as well as common alterations based on prognostic grouping or contraindications to bleomycin. Special topics around the management of intermediate/poor prognosis choriocarcinoma and brain metastases are included. The management of residual masses for both seminoma and nonseminoma is discussed as well as long-term follow-up care of patients. Finally, the management of relapsed disseminated GCT is addressed.


Assuntos
Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica , Biomarcadores Tumorais/análise , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Etoposídeo/administração & dosagem , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/patologia , Guias de Prática Clínica como Assunto , Prognóstico , Neoplasias Testiculares/patologia
14.
Urol Clin North Am ; 46(3): 399-407, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277734

RESUMO

Seminoma is commonly diagnosed in young men, and it has therefore become a disease of long-term survivors. As the late toxic effects of radiation and chemotherapy are better understood, it is becoming imperative to focus management advancements on reducing exposure to toxic agents. Retroperitoneal lymph node dissection (RPLND) currently is indicated as a salvage procedure in postchemotherapy patients with residual masses. Primary RPLND currently is being further explored in patients with clinical stage IA and clinical stage IB disease in 2 prospective studies.


Assuntos
Neoplasia Residual/cirurgia , Seminoma/cirurgia , Neoplasias Testiculares/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Terapia de Salvação , Seminoma/patologia , Neoplasias Testiculares/patologia
15.
Urol Clin North Am ; 46(3): 409-417, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277735

RESUMO

Retroperitoneal lymph node dissection (RPLND) is complex; however, recent advances in technology have allowed adoption of the robotic platform for highly select cases. Initial case series have shown improved cosmesis, less blood loss, and decreased length of stay compared with open RPLND. Our preference for performing robotic RPLND is via a transperitoneal approach with the patient in the supine position, thus facilitating a bilateral template dissection identical to that used in all our open procedures. Robotic RPLND should mimic the open approach with regard to oncologic principles and should only be performed by clinicians well versed in open RPLND.


Assuntos
Procedimentos Cirúrgicos Robóticos , Neoplasias Testiculares/cirurgia , Competência Clínica , Medicina Baseada em Evidências , Humanos , Excisão de Linfonodo/métodos , Masculino , Espaço Retroperitoneal/patologia , Decúbito Dorsal , Neoplasias Testiculares/patologia
16.
Urol Clin North Am ; 46(3): 419-427, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277736

RESUMO

Growing teratoma syndrome (GTS) is a rare clinical phenomenon in patients with nonseminomatous germ cell cancer defined by growing metastatic mass during ongoing or directly after completed chemotherapy with timely decreasing tumor markers and postpubertal teratoma exclusively after resection. GTS was first described in 1982, and few reports have been published. The limited number of studies and the resulting lack of exact knowledge about development, differentiation, and treatment of GTS leaves several clinical problems regarding treatment and follow-up unsolved. This review provides an overview of clinical diagnosis and disease management and an approach to explain the molecular development of GTS.


Assuntos
Teratoma/patologia , Teratoma/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Terapia Combinada , Diagnóstico Diferencial , Progressão da Doença , Humanos , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Neoplasia Residual/terapia , Prognóstico , Neoplasias Retroperitoneais/secundário , Neoplasias Retroperitoneais/terapia , Síndrome
17.
Urol Clin North Am ; 46(3): 429-437, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277737

RESUMO

Retroperitoneal lymph node dissection is an integral part of the management of testicular cancer. Surgical approach and outcomes have improved over the past decades. Several factors influence the complexity of the operation, including numerous patient characteristics and disease-related characteristics. An important consideration lies in the fact that this is largely a vascular operation, and techniques of vascular control should be comfortable for the urologic surgeon performing the procedure. This article discusses the known surgical complications related to this operation and their relative incidence reported throughout the literature.


Assuntos
Excisão de Linfonodo , Metástase Linfática/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Complicações Pós-Operatórias , Espaço Retroperitoneal/patologia , Neoplasias Testiculares/patologia , Humanos , Masculino , Recuperação de Função Fisiológica
18.
Urol Clin North Am ; 46(3): 439-448, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277738

RESUMO

Germ cell tumors (GCT) are the most common cancer in men between 15 and 35 years of age and the incidence has increased during the past several decades. This article reviews the current knowledge on high-dose chemotherapy (HDCT) and stem cell transplant for salvage treatment of patients with relapsed metastatic GCT. Furthermore, the authors attempt to dissect the controversy of using standard-dose versus high-dose therapy as initial salvage and identify patients who are most likely to benefit from HDCT and peripheral blood stem cell transplant.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Embrionárias de Células Germinativas/terapia , Transplante de Células-Tronco , Neoplasias Testiculares/terapia , Terapia Combinada , Humanos , Masculino , Recidiva Local de Neoplasia/terapia , Neoplasias Embrionárias de Células Germinativas/patologia , Terapia de Salvação , Neoplasias Testiculares/patologia , Transplante Autólogo
19.
Urol Clin North Am ; 46(3): 449-457, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277739

RESUMO

Two clusters of microRNAs have been discovered highly expressed by seminoma and nonseminoma germ cell tumors. They are secreted in blood of patients with testicular germ cell tumors and can be extracted from the serum or plasma and quantified by real-time-polymerase chain reaction. Results have confirmed the feasibility of the technique and demonstrated that sensitivity and specificity of those microRNAs in detecting viable germ cell tumors are higher than with current methods. If operation characteristics are confirmed in larger studies, those microRNAs will be valuable to manage equivocal clinical scenarios characterized by high uncertainty and high risk of over-treatment or under-treatment.


Assuntos
Biomarcadores Tumorais/sangue , MicroRNAs/sangue , Neoplasias Embrionárias de Células Germinativas/sangue , Neoplasias Testiculares/sangue , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Sensibilidade e Especificidade , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia
20.
Ann Hematol ; 98(10): 2463-2465, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31240468
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