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1.
Bull Cancer ; 107(2): 215-223, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-31882267

RESUMO

A residual mass (RM) is an abnormal image with a transverse axis of more than 1cm trans that remains visible on the CT scan performed after chemotherapy for metastatic germ cell tumors. Their management depends on the histology of the initial tumor. In the case of a non-seminomatous germ cell tumor, all residual lesions must be resected if the tumor markers are negative. The surgery usually begins with a retroperitoneal lymphadenectomy. This lymphadenectomy is a programed regional surgery and not the only resection of visible masses. All RM must be resected, regardless of their location, and may require successive actions. In order to limit its morbidity, modifications on the extent of the lymphadenectomy and the use of minimally invasive approaches are proposed by some center. When the initial tumor is a pure seminoma the attitude is different: the decay of the masses in post chemotherapy is often postponed. If lesions less than 3cm can be monitored, the others benefit from 18FDG PET at the end of chemotherapy: a positive attachment to PET is suspected of the presence of residual active tissue. The surgery of these RM is curative. If its extent is precise in the case of non-seminomatous tumor, it is more controversial in the case of seminoma. In the case of residual markers, surgery has a place in very specific situations.


Assuntos
Excisão de Linfonodo , Neoplasias Embrionárias de Células Germinativas/cirurgia , Seminoma/cirurgia , Neoplasias Testiculares/cirurgia , Biomarcadores Tumorais , Fluordesoxiglucose F18 , Humanos , Masculino , Neoplasia Residual , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Compostos Radiofarmacêuticos , Seminoma/diagnóstico por imagem , Seminoma/tratamento farmacológico , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/tratamento farmacológico
2.
Crit Rev Oncol Hematol ; 143: 130-138, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31634730

RESUMO

Germ cell tumors (GCTs) are the most common type of solid tumor amongst patients between 15 and 35 years of age. They are also one of the types of tumor with the highest cure rate, due to their high sensitivity to cisplatin based chemotherapy. Nonetheless, around 15-20% of metastatic patients will not have curative options after a relapse on the first and second line. This proves that new therapeutic options for these refractory GCTs patients need to be developed. This article offers a bibliographic review of all studies using targeted treatment or immunotherapy for refractory GCTs patients.


Assuntos
Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adolescente , Adulto , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/administração & dosagem , Humanos , Masculino , Terapia de Alvo Molecular , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Seminoma/tratamento farmacológico , Seminoma/patologia , Teratoma/tratamento farmacológico , Teratoma/patologia , Neoplasias Testiculares/patologia , Adulto Jovem
3.
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
4.
Medwave ; 19(4): e7625, 2019 May 06.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31075095

RESUMO

INTRODUCTION: The use of PET-CT could select a subgroup of advanced testicular seminoma patients that display post-chemotherapy residual masses measuring >3 cm and could be managed with surveillance, avoiding unnecessary surgical resection of unviable tumor masses. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews that included eleven primary studies; none of these were randomized trials. We concluded the assessment of postchemotherapy residual masses by PET-CT in testicular seminoma patients may prevent unnecessary surgeries, but the certainty of the evidence is low. Furthermore, PET-CT could also offer a favorable risk/benefit and cost/benefit ratio for the management of testicular seminoma patients. However, systematic reviews and primary studies assessing the direct diagnostic impact of PET-CT are required.


Assuntos
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Seminoma/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Antineoplásicos/administração & dosagem , Bases de Dados Factuais , Humanos , Masculino , Seminoma/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico
5.
Am J Pathol ; 189(3): 687-698, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30610844

RESUMO

Although in past decades the adipokine leptin and its own receptor have been considered as significant cancer biomarkers, their potential involvement in human testicular seminoma growth and progression remains unexplored. Here, we showed that the expression of leptin and its receptor was significantly higher in human testicular seminoma compared with normal adult testis. Human seminoma cell line TCam-2 also expressed leptin along with the long and short isoforms of leptin receptor, and in response to leptin treatment showed enhanced activation of its downstream effectors. In line with these results, leptin stimulation significantly increased the proliferation and migration of TCam-2 cells. Treatment of TCam-2 cells with the peptide Leu-Asp-Phe-Ile (LDFI), a full leptin-receptor antagonist, completely reversed the leptin-mediated effects on cell growth and motility as well as reduced the expression of several leptin-induced target genes. More importantly, the in vivo xenograft experiments showed that LDFI treatment markedly decreased seminoma tumor growth. Interestingly, LDFI-treated tumors showed reduced levels of the proliferation marker Ki-67 as well as decreased expression of leptin-regulated genes. Taken together, these data identify, for the first time, leptin as a key factor able to affect testicular seminoma behavior, highlighting leptin receptor as a potential target for novel potential treatments in this type of cancer.


Assuntos
Leptina/farmacocinética , Proteínas de Neoplasias/agonistas , Peptídeos/farmacologia , Receptores para Leptina/agonistas , Seminoma/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adulto , Animais , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Humanos , Leptina/química , Masculino , Camundongos , Camundongos Nus , Proteínas de Neoplasias/metabolismo , Peptídeos/química , Receptores para Leptina/metabolismo , Seminoma/metabolismo , Seminoma/patologia , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/patologia , Ensaios Antitumorais Modelo de Xenoenxerto
8.
In Vivo ; 33(1): 233-237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30587629

RESUMO

BACKGROUND: Single-agent carboplatin at area under the curve 10 (AUC10) is an effective treatment for metastatic seminoma. As far as we are aware of, there have been no studies reporting its effects on short-term quality of life. The objective was to study the efficacy, safety and tolerability, using health-related quality of life, of carboplatin AUC10 chemotherapy in patients with metastatic seminoma. PATIENTS AND METHODS: Forty-four patients with metastatic seminoma treated at Mount Vernon Cancer Centre with carboplatin AUC10 were included in this study. Response to treatment was determined by radiological imaging (Response Evaluation Criteria in Solid Tumors v 1.1) and serum tumour markers. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events Version 4.0. Quality of life treatment-related toxicities were assessed during treatment at pre-chemotherapy assessments. After treatment, toxicity was assessed using a defined telephone questionnaire consisting of four questions relating to hair loss, hearing impairment, days absent from work, and neuropathy. RESULTS: At a median follow-up of 27.5 (range=4-84) months, no patient had experienced relapse. Grade 3/4 neutropenia was seen in 15 (35%) patients, nine (21%) required prophylactic granulocyte colony-stimulating factor, 13 (30%) patients had grade 3/4 thrombocytopenia. Commonest non-haematological toxicities were fatigue in 28 (65%) and nausea 14 (33%) patients. They were grade 1 in 82% and 92% of cases, respectively. Six out of 44 (14%) had residual tinnitus. One patient had residual grade 1 peripheral neuropathy. Ten patients continued to work throughout treatment and two patients were retired. Of the remaining patients, 16 (37%), took fewer than 5 days off work. CONCLUSION: Carboplatin AUC10 is a safe and effective treatment for stage II/III seminoma with better health-related quality of life than experienced with combination cisplatin-based chemotherapy.


Assuntos
Carboplatina/administração & dosagem , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Recidiva Local de Neoplasia/tratamento farmacológico , Seminoma/tratamento farmacológico , Adulto , Idoso , Medula Óssea/efeitos dos fármacos , Carboplatina/efeitos adversos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Intervalo Livre de Doença , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/patologia , Neutropenia/induzido quimicamente , Neutropenia/diagnóstico por imagem , Neutropenia/patologia , Qualidade de Vida , Seminoma/sangue , Seminoma/patologia , Trombocitopenia/induzido quimicamente , Trombocitopenia/patologia , Resultado do Tratamento
9.
Cancer Med ; 7(12): 6247-6257, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30430771

RESUMO

The role of TDRG1 in tumorigenesis and the progression of seminoma, as well as its role in regulating chemosensitivity of seminoma to cisplatin through the PI3K/Akt/mTOR signaling pathway, has been previously defined. However, the detailed mechanism underlying TDRG1 expression and concomitant chemoresistance conditions are unknown. Furthermore, it has been reported that non-protein-coding RNAs play an important role in a variety of vital processes including cellular chemosensitivity. However, the role of non-protein-coding RNAs in regulating the chemosensitivity of seminoma remains unknown. In this study, using microarray analysis, we found that long non-coding RNA H19 was upregulated while miRNA-106b-5p was downregulated in an established cisplatin-resistant TCam-2 cell line. Moreover, H19 acts as a miRNA-106b-5p sponge and thus impairs the function of miRNA-106b-5p on its target gene, TDRG1. Based on these findings, we propose that H19 promotes the expression of TDRG1 by sequestering miRNA-106b-5p and uses this mechanism to facilitate cell survival in cisplatin-based chemotherapeutic conditions. These findings elucidate the mechanisms, at least partially, applied to deregulate TDRG1 and cisplatin sensitivity, and may provide new therapeutic possibilities for chemoresistant seminoma.


Assuntos
Resistencia a Medicamentos Antineoplásicos/genética , MicroRNAs , Proteínas/genética , RNA Longo não Codificante , Seminoma/genética , Neoplasias Testiculares/genética , Animais , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Cisplatino/farmacologia , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Camundongos Endogâmicos BALB C , Camundongos Nus , Seminoma/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico
10.
Curr Urol Rep ; 19(12): 110, 2018 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-30413968

RESUMO

PURPOSE OF REVIEW: Determining the metastatic viability of suspicious retroperitoneal nodes in testicular cancer with conventional imaging is challenging. The aim of this report is to review recent evidence in the utilization of novel imaging modalities to assess viable testicular cancer nodal metastases. RECENT EVIDENCE: Testicular germ cell tumors (TCGTs) follow a predictable lymphatic metastatic spread to the retroperitoneum. Accordingly, retroperitoneal imaging is critical in staging, assessing treatment response, and evaluating for recurrence. Conventional computed tomography (CT) imaging is effective in diagnosing pathologically enlarged lymph nodes but lacks the molecular information to determine if suspicious nodes harbor viable tumor. Positron emission tomography (PET) with the metabolic radiotracer 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG or FDG) has been shown to be useful in determining the presence of or absence of viable tumor after chemotherapy for seminoma, but its role with non-seminomatous germ cell tumors (NSGCTs) and other clinical scenarios is limited. Patients with residual masses after chemotherapy for NSGCT present a difficult challenge because surgical resection carries a high degree of morbidity despite many patients only harboring fibrosis on final pathology. Current imaging modalities are unable to effectively differentiate fibrosis from viable tumor on preoperative imaging. Novel molecular imaging techniques present promising opportunities to improve diagnosis in these patients. Novel imaging platforms have potential to improve the ability to determine viable nodal metastases regardless of size and structure but confirmatory studies are currently lacking.


Assuntos
Metástase Linfática/diagnóstico por imagem , Imagem Molecular , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/patologia , Fluordesoxiglucose F18 , Humanos , Linfonodos/patologia , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Espaço Retroperitoneal/patologia , Seminoma/diagnóstico por imagem , Seminoma/tratamento farmacológico , Seminoma/patologia , Neoplasias Testiculares/tratamento farmacológico
11.
Rev Port Cir Cardiotorac Vasc ; 25(1-2): 87-89, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30317718

RESUMO

Primary mediastinal tumours with chest wall involvement represent technical challenges that may offer a survival benefit. Reconstruction with osteossynthesis material, bioprosthesis and muscle flaps is indicated to re-establish the excised component function. We report a case of a 30-year-old male with a primary mediastinal seminoma operated after chemotherapy with need for en bloc resection of the residual mass and manubrium with chest wall reconstruction. This type of surgery is rare and represents a technical challenge. Therefore, it should be performed in referral centers and with a multidisciliplinary approach.


Assuntos
Manúbrio/cirurgia , Neoplasias do Mediastino/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Seminoma/cirurgia , Esternotomia/métodos , Parede Torácica/cirurgia , Adulto , Humanos , Masculino , Neoplasias do Mediastino/tratamento farmacológico , Terapia Neoadjuvante , Seminoma/tratamento farmacológico
12.
Curr Opin Urol ; 28(5): 485-490, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30044319

RESUMO

PURPOSE OF REVIEW: Although platinum-based chemotherapy (CHT) remains the cornerstone of clinical stage I testicular germ cell tumor (GCT) treatment, its long-term toxicity and complications in cancer survivors are unclear. RECENT FINDINGS: Cardiovascular disease and secondary malignancies represent the most life-threatening long-term complications and typically occur 10 years after treatment. Other potential intermediate deleterious effects include pulmonary toxicity, ototoxicity, neurotoxicity, hypogonadism and infertility. The incidence and time to onset vary according to patients' genetic susceptibility, CHT regimen and cumulative dosage. Genetic variability may play an important role as a harbinger of future disease and the development of biomarkers may help predict organ damage. Efforts should be concentrated in developing individualized strategies to identify patients who are at high risk of developing long-term complications after CHT for testicular GCTs. SUMMARY: The treatment of clinical stage I testicular GCTs represents the paradigm of a curable malignancy and one of the greatest oncological advances of the twentieth century. Since the introduction of platinum-based CHT in the late 1970s, the 10-year survival rates exceed 95% today and patients can expect to live decades after being successfully treated. The curative nature of GCT treatment, however, is a double-edged sword and is hindered by an increased risk of potential intermediate and long-term complications. The recent focus of clinical research has thus shifted into the prevention of treatment-related long-term effects.


Assuntos
Antineoplásicos/uso terapêutico , Carboplatina/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Cisplatino/uso terapêutico , Perda Auditiva/epidemiologia , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Seminoma/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Quimioterapia Adjuvante , Humanos , Hipogonadismo/epidemiologia , Infertilidade Masculina/epidemiologia , Pneumopatias/epidemiologia , Masculino , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/patologia , Segunda Neoplasia Primária/epidemiologia , Variantes Farmacogenômicos , Seminoma/patologia , Neoplasias Testiculares/patologia
13.
Med Oncol ; 35(6): 80, 2018 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-29700638

RESUMO

Bleomycin pulmonary toxicity (BPT) has been well described in patients with germ cell tumors treated with bleomycin etoposide and cisplatin chemotherapy (BEP). To assess the prognostic impact of BPT, we retrospectively identified 52 patients who underwent bleomycin etoposide and cisplatin chemotherapy from 2008 to 2017 in our institution, and evaluated the risk factors of BPT and its effect on prognosis. Patients who had received chemotherapy at another institution were excluded. BPT was defined as bleomycin discontinuation in response to pulmonary function test decline, pulmonary symptoms, or interstitial pneumonia on computed tomography without infection. We divided the patients into two groups according to this definition: BPT and non-BPT. Their median age was 34.2 years, and their median body mass index was 22.8 kg/m2. Twenty patients had a smoking history, 37 were diagnosed with non-seminoma, and 20 had lung metastasis. The median cumulative bleomycin dose was 270 mg/body. Fifteen patients were classified into the BPT group and 37 into the non-BPT group. Only body mass index < 22 was identified as a predictor of BPT in multivariable logistic models. Age or use of granulocyte-colony stimulating factor did not have a significant impact. Kaplan-Meier analysis revealed that the presence of BPT had no significant impact on either 5-year overall survival or progression-free survival. Lower body mass index can increase the risk of BPT in patients with germ cell tumors undergoing BEP. However, discontinuation of bleomycin with BPT does not adversely influence the survival outcomes.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/efeitos adversos , Pneumopatias/induzido quimicamente , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Humanos , Pulmão/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Seminoma/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
14.
Int Braz J Urol ; 44(3): 452-460, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29522295

RESUMO

PURPOSE: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown. MATERIALS AND METHODS: We surveyed practicing US ROs via an online questionnaire. Respondent's characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations. RESULTS: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likelihood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher's exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels. CONCLUSIONS: Many US ROs over-estimate the likelihood that stage I testicular seminoma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an opportunity for improved physician education on evidence-based management of stage I testicular seminoma.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Seminoma/radioterapia , Neoplasias Testiculares/radioterapia , Conduta Expectante/métodos , Quimioterapia Adjuvante , Progressão da Doença , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Estadiamento de Neoplasias , Vigilância da População/métodos , Seminoma/tratamento farmacológico , Seminoma/patologia , Inquéritos e Questionários , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Estados Unidos
15.
Oncology ; 95(1): 8-12, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29587278

RESUMO

OBJECTIVE: The aim of this study was to assess a risk-adapted strategy for stage I seminoma guided by the presence of rete testis invasion. METHODS: Between January 2013 and December 2015, a total of 135 consecutive patients with stage I seminoma from 18 Spanish tertiary hospitals were included in a prospective multicenter study. Median patient age was 38 years (range 22-60). Preoperative beta-human chorionic gonadotropin was elevated in 9.6% of patients. Rete testis invasion was present in 47.4% of patients. After orchiectomy, subjects with rete testis invasion were treated with 2 courses of adjuvant carboplatin (area under the curve of 7, with 21-day interval). Those without this risk factor were managed by surveillance. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method. RESULTS: After a median follow-up time of 33 months, only 6 relapses were recorded (5 on surveillance, 1 after carboplatin). These cases were rescued with BEP or EP chemotherapy, and all 135 patients are currently disease free without sequelae. Three-year DFS was 92.0 and 98.2% for patients on surveillance and after carboplatin, respectively. Three-year OS was 100%. CONCLUSION: A risk-adapted approach based on rete testis invasion as a single risk factor is feasible and yielded an excellent outcome with a 3-year DFS of 94.9%.


Assuntos
Antineoplásicos/uso terapêutico , Carboplatina/uso terapêutico , Rede do Testículo/patologia , Seminoma/tratamento farmacológico , Seminoma/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Adulto , Gonadotropina Coriônica/sangue , Terapia Combinada , Intervalo Livre de Doença , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Orquiectomia , Estudos Prospectivos , Seminoma/cirurgia , Espanha , Neoplasias Testiculares/cirurgia , Adulto Jovem
17.
Clin Genitourin Cancer ; 16(3): 240-244, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29336917

RESUMO

BACKGROUND: Stage 1 seminoma is frequently cured by radical orchiectomy; however, the management strategies after this diagnosis vary in terms of the use of adjuvant treatment and the nature of the follow-up protocols. We analyzed stage 1 seminomas treated in the Thames Valley Cancer Network for outcomes to determine whether any factors are predictive of recurrence. We also studied relapses to determine the optimal follow-up schedule and protocol. MATERIALS AND METHODS: Data were obtained from centers within the Thames Valley Cancer Network for a 12-year period from 2004 to 2016. We identified 501 patients with stage 1 seminoma. RESULTS: Relapses occurred in 6.2% of the patients receiving adjuvant treatment and 6.1% of those who did not. The only statistically significant predictive factor identified for relapse was rete testis invasion, and the risk was greater when only stromal rete invasion was included, rather than pagetoid as well. A trend was seen toward an increased risk with increased tumor size, but the difference was not statistically significant. Recurrences developed within the first 2 years after surgery in nearly 75% of cases and were identified through surveillance computed tomography scans in 54.8% of the patients. All relapses were treated curatively. CONCLUSION: Active surveillance leads to excellent outcomes for stage 1 seminoma; however, adjuvant treatment should be reserved for those with high-risk disease. Follow-up schedules should include computed tomography imaging during the first 3 years, long-term measurement of tumor markers, and mechanisms for patients to be seen promptly should symptoms of tumor recurrence occur.


Assuntos
Recidiva Local de Neoplasia/epidemiologia , Seminoma/tratamento farmacológico , Neoplasias Testiculares/cirurgia , Conduta Expectante/métodos , Adulto , Quimioterapia Adjuvante , Humanos , Masculino , Orquiectomia , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Radioterapia Adjuvante , Análise de Sobrevida , Neoplasias Testiculares/tratamento farmacológico , Tomografia Computadorizada por Raios X , Carga Tumoral
18.
Int J Urol ; 25(4): 337-344, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29345008

RESUMO

The development of the human gonads is tightly regulated by the correct sequential expression of many genes and hormonal activity. Disturbance of this regulation does not only prevent proper development of the gonads, but it also contributes to the development of testicular germ cell tumors. Recent genetic studies, especially genome-wide association studies, have made great progress in understanding genetic susceptibility. Although there is strong evidence of inherited risks, many environmental factors also contribute to the development of testicular germ cell tumors. Histopathological studies have shown that most testicular germ cell tumors arise from germ cell neoplasia in situ, which is thought to be arrested and transformed primordial germ cells. Seminoma has features identical to germ cell neoplasia in situ or primordial germ cells, whereas non-seminoma shows varied differentiation. Seminomas and embryonic cell carcinomas have the feature of pluripotency, which is thought to be the cause of histological heterogeneity and mixed pathology in testicular germ cell tumors. Testicular germ cell tumors show high sensitivity to chemotherapies, but 20-30% of patients show resistance to standard chemotherapy. In the present review, the current knowledge of the epidemiological and genomic factors for the development of testicular germ cell tumors is reviewed, and the mechanisms of resistance to chemotherapies are briefly mentioned.


Assuntos
Antineoplásicos Hormonais/farmacologia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Seminoma/epidemiologia , Neoplasias Testiculares/epidemiologia , Testículo/crescimento & desenvolvimento , Antineoplásicos Hormonais/uso terapêutico , Resistencia a Medicamentos Antineoplásicos/genética , Regulação da Expressão Gênica no Desenvolvimento , Regulação Neoplásica da Expressão Gênica , Estudo de Associação Genômica Ampla , Humanos , Incidência , Masculino , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/genética , Neoplasias Embrionárias de Células Germinativas/patologia , Fatores de Risco , Seminoma/tratamento farmacológico , Seminoma/genética , Seminoma/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/genética , Neoplasias Testiculares/patologia , Testículo/citologia , Testículo/patologia , Resultado do Tratamento
19.
Auris Nasus Larynx ; 45(3): 626-629, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28807530

RESUMO

The authors reported a case of a 27-year-old man with a nontender left neck mass that had grown quite rapidly within few weeks. FNAB and CT were not consistent to establish the definite diagnosis. After excisional biopsy, the histopathological examination and the immunohistochemical study of the specimen revealed a cervical metastasis of seminoma. The patient was treated with chemotherapy with a complete clinical remission. This uncommon case-report can represent a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of every cervical masses occurring in young males patients. Diagnostic delays are unfortunately common and may lead to metastatic spread and worse prognosis.


Assuntos
Linfonodos/patologia , Seminoma/secundário , Neoplasias Testiculares/patologia , Adulto , Antineoplásicos/uso terapêutico , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Masculino , Pescoço , Metástase Neoplásica , Tomografia por Emissão de Pósitrons , Seminoma/diagnóstico por imagem , Seminoma/tratamento farmacológico , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/tratamento farmacológico , Tomografia Computadorizada por Raios X , Ultrassonografia
20.
Tumori ; 104(2): 83-87, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27791233

RESUMO

PURPOSE: Among the adjuvant options to be proposed to patients with stage I seminoma after orchiectomy, the administration of a single cycle of carboplatin, at the dosage reaching an area under the curve of 7 mg/mL/min (AUC7), is a relatively recent introduction in clinical practice. METHODS: On April 1, 2016, we performed a systematic review of the literature to identify studies on the use of AUC7 carboplatin in the adjuvant setting for stage I seminoma patients. The studies were identified by searching the PubMed electronic database from July 2005 up to April 2016. The aim of this review is to clarify the state of art of this adjuvant option. RESULTS: Adjuvant AUC7 carboplatin is an effective adjuvant treatment, able to reduce relapse rate in stage I seminoma patients. The heterogeneity of the methods for estimation and measurement of glomerular filtration rate represents an important issue in the administration of the optimal dose of carboplatin. Even with the lack of validated prognostic factors for relapses, a risk-adapted choice is commonly used to identify the optimal patient to be proposed this treatment. CONCLUSIONS: One cycle of AUC7 carboplatin is an effective, feasible, and safe adjuvant option to be discussed with stage I seminoma patients.


Assuntos
Antineoplásicos/administração & dosagem , Carboplatina/administração & dosagem , Seminoma/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adulto , Antineoplásicos/farmacocinética , Área Sob a Curva , Quimioterapia Adjuvante/métodos , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias/métodos , Orquiectomia/métodos , Seminoma/patologia , Resultado do Tratamento
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