scholarly journals PEDT-5 Problem for the guideline of CNS germ cell tumors

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi11-vi11
Author(s):  
Hideo Nakamura ◽  
Takaaki Yanagisawa ◽  
Toshinori Soejima ◽  
Hideaki Yokoo ◽  
Ryo Nishikawa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Germ Cell ◽  
Clinical Management ◽  
Medical Information ◽  
Task Force ◽  
Current Knowledge ◽  
Germ Cell Tumors ◽  
Serum Markers ◽  
Diagnostic Measures

Abstract Primary CNS germ cell tumors (GCTs) are rare neoplasms, therefore, a clinical guideline has not been established so far. While better management has been achieved over recent decades by modifying radiation coverage and selecting appropriate chemotherapy, standardization of treatment remains challenging, partly due to the low volume of cases encountered in each institution. As the incidence is higher in East Asia, including Japan, the Japan Society for Neuro-Oncology established a multidisciplinary task force to create an evidence-based guideline for CNS GCTs. The Medical Information Network Distribution Service (Minds) guideline was referred to and utilized in the course of creating this guideline. We chose 6 topics and 10 clinical questions. This guideline provides recommendations for multiple dimensions of clinical management for CNS GCTs, with particular focus on diagnostic measures including serum markers, treatment algorithms including surgery, radiotherapy and chemotherapy, and under-investigated but important areas such as treatment for recurrent cases, long-term follow-up protocols and long-term sequelae. International collaborations to set standards of clinical management for this rare tumor have proven fruitful, concurrently, many fields continue to show variance in clinical practice, partly due to the rarity of clinical encounters and the absence of documented standards. There still seem to be differences in the treatment concept between Japan and North America or Europe countries. This guideline serves the purpose of helping healthcare professionals keep up to date with current knowledge and standards of management for patients with this rare disease in daily clinical practice, as well as driving future translational and clinical research by recognizing unmet needs concerning this tumor. We discuss about the issues both already clarified and should be cleared in the future.

Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor.

1998 ◽  
Vol 16 (7) ◽  
pp. 2500-2504 ◽  
Author(s):  
P J Loehrer ◽  
R Gonin ◽  
C R Nichols ◽  
T Weathers ◽  
L H Einhorn
Keyword(s):  
Germ Cell ◽  
Performance Status ◽  
Cell Cancer ◽  
Germ Cell Tumors ◽  
Disease Free Survival ◽  
Previous Treatment ◽  
Serum Markers ◽  
Free Survival ◽  
Disease Free

PURPOSE This study was designed to assess the effectiveness of vinblastine, ifosfamide, and cisplatin (VeIP) as second-line therapy in patients with recurrent germ cell tumors with previous treatment with cisplatin plus etoposide, usually in combination with bleomycin. PATIENTS AND METHODS From July 1984 through December 1989, 135 patients with progressive, disseminated germ cell tumors after cisplatin-etoposide-based combination therapy induction chemotherapy were treated with VeIP. Patients who progressed within 3 weeks of previous cisplatin therapy were not eligible. Progression was documented by biopsy or increasing serum markers. No exclusion was made on the basis of metastatic site or performance status. The dosages were vinblastine 0.11 mg/kg/d (days 1 and 2), ifosfamide 1.2 gm/m2/d (days 1 through 5), and cisplatin 20 mg/m2/d (days 1 through 5), with courses repeated every 21 days for four cycles. RESULTS Sixty-seven (49.6%) patients achieved a disease-free status after chemotherapy with or without surgical resection of residual carcinoma or teratoma. Overall, 42 (32%) patients are alive and 32 (23.7%) are continuously free of disease. None of the 32 patients with nonseminomatous extragonadal tumors are disease-free compared with 30 of 100 patients with gonadal primaries. Two of three extragonadal seminomas are continuously disease-free. CONCLUSION VeIP is capable of producing durable complete remissions in patients with disseminated germ cell cancer who relapse after cisplatin-etoposide-based induction therapy. Long-term disease-free survival is not seen in those patients with extragonadal nonseminomatous germ cell tumors.

Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group.

1994 ◽  
Vol 12 (4) ◽  
pp. 701-706 ◽  
Author(s):  
S Williams ◽  
J A Blessing ◽  
S Y Liao ◽  
H Ball ◽  
P Hanjani
Keyword(s):  
Germ Cell ◽  
Gynecologic Oncology ◽  
Cell Cancer ◽  
Germ Cell Tumors ◽  
Germ Cell Cancer ◽  
Gynecologic Oncology Group ◽  
Long Term Follow Up ◽  
Acute Myelomonocytic Leukemia

PURPOSE This study was performed to determine the effectiveness of postoperative adjuvant chemotherapy in patients with surgically resected ovarian germ cell tumors. PATIENTS AND METHODS After tumor removal and thorough surgical staging, patients were enrolled on this study and treated with three courses of cisplatin, etoposide, and bleomycin (BEP). Reassessment laparotomy was required of consenting, appropriate patients initially, but became an optional procedure in 1989. RESULTS Of 93 patients assessable on this trial, 89 are continuously free of germ cell cancer. At second-look laparotomy, two other patients were found to have small foci of immature teratoma; both remain clinically free of recurrence. One received subsequent alternate chemotherapy and one did not. Thus, 91 of 93 patients are currently free of germ cell cancer. Follow-up duration ranges from 4.0 to 90.3 months, with 67 patients monitored for longer than 2 years. Acute toxicity was moderate. One patient developed acute myelomonocytic leukemia 22 months after diagnosis. Another patient was noted to have a malignant lymphoma 69 months after protocol treatment. CONCLUSION Three courses of BEP will nearly always prevent recurrence in well-staged patients with completely resected ovarian germ cell tumors and should be given to all such patients. The development of acute leukemia as a complication of treatment is disturbing and mandates careful long-term follow-up, but is unusual and does not alter the risk-to-benefit ratio of treatment.

scholarly journals Saudi Oncology Society clinical management guidelines for testicular germ cell tumors

2011 ◽  
Vol 3 (4) ◽  
pp. 17
Author(s):  
Mohammed Al Otaibi ◽  
Mohammed El-naghi ◽  
Khaled Balaraj ◽  
Shouki Bazarbashi ◽  
Dany Rabbah ◽  
...  
Keyword(s):  
Germ Cell ◽  
Clinical Management ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Management Guidelines

scholarly journals Modified cisplatin, etoposide (or vinblastine) and ifosfamide salvage therapy for male germ-cell tumors. Long-term results

1992 ◽  
Vol 3 (3) ◽  
pp. 211-216 ◽  
Author(s):  
G. Pizzocaro ◽  
R. Salvioni ◽  
L. Piva ◽  
M. Faustini ◽  
N. Nicolai ◽  
...  
Keyword(s):  
Germ Cell ◽  
Salvage Therapy ◽  
Germ Cell Tumors ◽  
Male Germ Cell ◽  
Long Term Results

scholarly journals High complete response rate in children with advanced germ cell tumors using cisplatin-containing combination chemotherapy.

1986 ◽  
Vol 4 (2) ◽  
pp. 194-199 ◽  
Author(s):  
C R Pinkerton ◽  
J Pritchard ◽  
L Spitz
Keyword(s):  
Germ Cell ◽  
Pulmonary Function Tests ◽  
Germ Cell Tumors ◽  
Stage Iv ◽  
Complete Response ◽  
Serum Markers ◽  
Consecutive Series ◽  
Close Monitoring ◽  
Subtotal Removal ◽  
Disease Free

A consecutive series of 13 children (five girls) with advanced malignant germ cell tumors (MGCTs) were treated with between four and seven (median, six) courses of cisplatin, bleomycin, and either vinblastine (BVP) or VP-16 (BEP). There were seven gonadal primaries (four testis, three ovary) and six at extragonadal sites (three sacrococcyx, two thoracic, one extradural). Total or subtotal removal of primary tumor was carried out in nine patients at diagnosis and two others after some chemotherapy. Clinical complete remission (CR) was achieved in nine of ten patients with measurable disease and serum markers returned to normal in all 13 patients. Eleven remain disease-free 17 to 48 months (median, 28 months) after diagnosis. One patient (stage IV sacrococcygeal tumor) relapsed at the primary site 3 months after completing treatment, but is disease-free after further surgery, radiotherapy, and chemotherapy. Serial glomerular filtration rates were performed during treatment. Audiometry and pulmonary function tests were carried out where possible. Toxicity led to alteration of drug scheduling in two cases, but there were no permanent clinical renal, auditory, or pulmonary sequelae. These encouraging results confirm that MGCTs in children are as responsive as those in adults to cisplatin-containing chemotherapy and indicate that they may be as curable. The regimens are relatively well-tolerated and, with close monitoring, clinically significant toxicity should be avoidable.

Adult primary extragonadal germ cell tumors: Treatment results and long-term follow-up

2003 ◽  
Vol 41 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Argon Andac ◽  
Basaran Mert ◽  
Bavbek Sevil ◽  
Sakar Burak ◽  
Onat Haluk
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Treatment Results ◽  
Long Term Follow Up ◽  
Extragonadal Germ Cell Tumors

Long-term neuroanatomical effects of germ cell tumors after cranial radiation therapy

2020 ◽  
Author(s):  
Sinchai Tsao ◽  
Niharika Gajawelli ◽  
Arthur Olch ◽  
Kenneth Wong ◽  
Nicholas Chapman ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Cranial Radiation

Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report.

1996 ◽  
Vol 14 (4) ◽  
pp. 1106-1113 ◽  
Author(s):  
M H Cullen ◽  
S P Stenning ◽  
M C Parkinson ◽  
S D Fossa ◽  
S B Kaye ◽  
...  
Keyword(s):  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Germ Cell ◽  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Nonseminomatous Germ Cell Tumors

PURPOSE This United Kingdom Medical Research Council (UK-MRC) study prospectively evaluated efficacy and long-term toxicity of adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis (NSGCTT). PATIENTS AND METHODS Eligible patients were those identified by the local histopathologist as having features confirmed in MRC surveillance studies to indicate an approximate 50% risk of relapse. Central histopathology review was undertaken. Chemotherapy consisted of two courses of cisplatin 100 mg/m2, bleomycin 30 mg weekly x 3, and etoposide 120 mg/m2 x 3, every 21 days (BEP). RESULTS One hundred fourteen eligible cases were enrolled. Median time of follow-up was 4 years, with 93 patients followed-up for at least 2 years. There have been two relapses, including one patient who did not have a germ cell tumor (GCT), according to the reference histopathologist. This patient is alive with active disease, the other has died. There was one death after a cerebrovascular accident during treatment. Assessment of fertility, lung function, and audiometry pretreatment and more than 9 months posttreatment indicated no clinically significant changes. A mean decrease in transfer factor coefficient (KCO) of 15% of the predicted value was noted, but no patient had symptomatic respiratory dysfunction. CONCLUSION There have been only two relapses among 114 cases of high-risk stage I NSGCTT treated with two courses of adjuvant BEP chemotherapy. The 95% confidence interval (CI) excludes a true relapse rate of more than 5%. Of 104 patients confirmed on histopathology review to have GCT, there has been only one relapse. Adjuvant chemotherapy is free from significant long-term toxicity, offering an effective alternative to surveillance or retroperitoneal lymph node dissection (RPLND) followed by surveillance, and may be preferred by some patients.

scholarly journals Impact of Teratoma on the Cumulative Incidence of Disease-Related Death in Patients With Advanced Germ Cell Tumors

2019 ◽  
Vol 37 (26) ◽  
pp. 2329-2337 ◽  
Author(s):  
Samuel A. Funt ◽  
Sujata Patil ◽  
Darren R. Feldman ◽  
Robert J. Motzer ◽  
Dean F. Bajorin ◽  
...  
Keyword(s):  
Germ Cell ◽  
Cumulative Incidence ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Adverse Outcomes ◽  
Term Survival ◽  
Risk Status ◽  
Primary Tumors ◽  
Platinum Based Chemotherapy

PURPOSE In men with metastatic germ cell tumors (GCTs), risk-directed treatment is determined, in part, by a distinction between seminoma and nonseminomatous GCT (NSGCT). The importance of NSGCT cell type is uncertain. We evaluated the long-term impact of teratoma on survival in patients with NSGCT. METHODS Prechemotherapy, primary tumors from patients who received platinum-based chemotherapy were studied, and the histology was confirmed by a genitourinary pathologist. The cumulative incidence of disease-related death (CIDD) was the primary end point, and a competing-risk analysis was performed. RESULTS Tumors were available from 232 patients, including 193 with NSGCT. An element of teratoma was present in 82 NSGCT primary tumors (42%). With a median follow-up of 17 years (range, 0.3 to 35 years), 58 patients with NSGCT died, 47 as a result of GCT and 11 as a result of other causes. Most GCT deaths occurred within the first 5 years and were associated with pretreatment risk status ( P < .001). Death as a result of other causes rose steadily after 15 years and was not associated with risk status ( P = .66). A higher CIDD was observed in patients who had NSGCT with teratoma than those with NSGCT without teratoma and seminoma (5-year CIDD rate, 27.4%, 17.4%, and 10.3%, respectively; P = .03). A higher CIDD was observed in patients who had NSGCT with mature teratoma compared with those with either NSGCT with immature teratoma or NSGCT without teratoma (5-year CIDD rate, 38.1%, 19.9%, and 17.4%, respectively; P = .01). CONCLUSION The presence of teratoma, particularly mature teratoma, in an NSGCT primary tumor is associated with a higher CIDD, consistent with the hypothesis that differentiation is associated with adverse outcomes. Death as a result of non-GCT causes is not associated with risk status and must be separated from GCT death when evaluating long-term survival.

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