Ondrus D, Hornák M, Schnorrer M, Mat'oska J
Urologická klinika LF UKo, Fakultná NsP akad. L. Dérera, Bratislava, Slovenská republika.
Rozhl Chir. 2001 Nov;80(11):612-4.
The therapeutic procedures in the management of testicular germ cell tumors (TGCT) are determined by histological findings in the removed testis and by the extent of the disease at the time of diagnosis. However, all advanced TGCT could be treated by primary chemotherapy (CHT) regardless of histological findings. The current imaging techniques (ultrasonography of the testis, abdominal and thoracic CT examination) and laboratory tests (determination of serum tumor markers AFP and hCG) provide sufficient evidence for the presence of TGCT. In cases of acute abdominal and/or pulmonary symptoms because of life-threatening distant metastases, when the diagnosis of advanced TGCT is evident, it is possible to start the treatment without primary orchiectomy (OE). The aim of this study was to evaluate the advantages of neo-adjuvant CHT with delayed OE in the management of advanced TGCT.
During last 12 years a total of 40 patients with advanced TGCT were treated by neo-adjuvant cisplatin-based combination CHT without previous OE. Eleven patients had bulky mass in the retroperitoneum (Stage IIC), three patients had enlarged retroperitoneal lymph nodes (Stage IIB), two patients had enlarged mediastinal lymph nodes (Stage III). Another 24 patients had pulmonary metastases (Stage IV), 15 of them had also bulky mass in the retroperitoneum and 6 of them in the mediastinum. Following the completion of CHT, OE was performed alone or simultaneously with retroperitoneal lymph node dissection (RPLND) and subsequent lung metastasectomy in cases with persistent residual mass.
Complete disappearance of metastases was observed in 13 (32.5%) patients following PVB or BEP CHT alone. The residual mass in the retroperitoneum was removed surgically in 27 patients. In three of them residual tumorous mass was removed also from the lungs without finding of viable tumor. Viable malignant tumor in the removed retroperitoneal tissue was identified in two patients (7.4%). Residual viable malignant tumor in the testis was found in 5 patients (12.5%). Overall survival was 29/40 patients--72.5% (by mean of 55.2 months since the start of the therapy).
The benefit of this therapeutic approach in the immediate management of acute abdominal and/or pulmonary symptoms of life-threatening distant metastases. Another advantage is the like hood of surgical treatment of residual metastatic masses simultaneously with delayed OE on the same day, under one anaesthesia.
睾丸生殖细胞肿瘤（TGCT）的治疗程序取决于切除睾丸的组织学检查结果以及诊断时疾病的范围。然而，所有晚期TGCT均可接受一线化疗（CHT），而无需考虑组织学检查结果。目前的成像技术（睾丸超声、腹部和胸部CT检查）以及实验室检查（血清肿瘤标志物甲胎蛋白和人绒毛膜促性腺激素的测定）为TGCT的存在提供了充分的证据。在因危及生命的远处转移而出现急性腹部和/或肺部症状的情况下，当晚期TGCT的诊断明确时，可以在不进行一期睾丸切除术（OE）的情况下开始治疗。本研究的目的是评估新辅助CHT联合延迟OE在晚期TGCT治疗中的优势。
在过去12年中，共有40例晚期TGCT患者接受了基于顺铂的新辅助联合CHT治疗，且未进行过先前的OE。11例患者腹膜后有巨大肿块（II期C），3例患者腹膜后淋巴结肿大（II期B），2例患者纵隔淋巴结肿大（III期）。另外24例患者有肺转移（IV期），其中15例腹膜后也有巨大肿块，6例纵隔有巨大肿块。CHT完成后，单独进行OE，或在有持续残留肿块的情况下与腹膜后淋巴结清扫术（RPLND）及随后的肺转移瘤切除术同时进行。
仅接受PVB或BEP CHT后，13例（32.5%）患者的转移灶完全消失。27例患者通过手术切除了腹膜后的残留肿块。其中3例患者还切除了肺部的残留肿瘤块，未发现存活肿瘤。在切除腹膜后组织中发现2例患者（7.4%）有存活的恶性肿瘤。5例患者（12.5%）睾丸中发现有存活的恶性肿瘤。40例患者中29例存活，总生存率为72.5%（自治疗开始平均55.2个月）。
这种治疗方法对于立即处理因危及生命的远处转移而出现的急性腹部和/或肺部症状有益。另一个优势是有可能在同一天、一次麻醉下，在延迟OE的同时对残留转移肿块进行手术治疗。
