Kopp Hans-Georg, Kuczyk Markus, Classen Johannes, Stenzl Arnulf, Kanz Lothar, Mayer Frank, Bamberg Michael, Hartmann Jörg Thomas
Department of Medical Oncology, Medical Center II, Hematology, Rheumatology, Pneumology and Immunology, South West German Cancer Center, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany.
Drugs. 2006;66(5):641-59. doi: 10.2165/00003495-200666050-00005.
Testicular cancer is the most common solid tumour in young men, and the treatment of testicular germ cell tumours (TGCT) has been called a success story of medical oncology, germ cell cancer being regarded as the "model of a curable neoplasm". Even with metastatic disease, high cure rates can be achieved: the overall 5-year survival for all stages of TGCT is approximately 80%. Today, elaborate systems for prognostic evaluation for gonadal and extragonadal germ cell tumours facilitate the choice of the most appropriate therapy for individual patients. In doing so, the ultimate goal of treatment is tumour-free survival for any patient with TGCT. This goal has already been reached for >99% of the patients with early-stage tumours, as well as for the majority of patients with advanced disease (56% of patients with metastases are considered to have a good prognosis at the time of diagnosis; the 5-year survival rate for this group is 90%). However, patients with 'intermediate' or 'poor' prognosis at the time of diagnosis, as well as patients with relapsed disease after cisplatin-containing therapy, still have an unsatisfactorily low 5-year survival rate after standard therapy with PEB (cisplatin, etoposide, bleomycin) of only 80%, 45-55% and 20-25%, respectively.Therefore, our goals must be (i) to limit acute and chronic toxicity by avoiding overtreatment for patients with localised disease and/or good prognosis with advanced disease; and (ii) to identify patients with poor prognosis and treat them in specialised centres, where not only is optimal interdisciplinary care available but new treatment strategies are being applied. For example, tandem high-dose chemotherapy regimens might be effective in achieving higher cure rates in these patients.
睾丸癌是年轻男性中最常见的实体瘤，睾丸生殖细胞肿瘤（TGCT）的治疗堪称医学肿瘤学的成功范例，生殖细胞癌被视为“可治愈肿瘤的典范”。即便患有转移性疾病，也能实现高治愈率：TGCT各阶段的总体5年生存率约为80%。如今，针对性腺和性腺外生殖细胞肿瘤的详尽预后评估系统有助于为个体患者选择最合适的治疗方法。在此过程中，治疗的最终目标是让任何TGCT患者实现无瘤生存。对于超过99%的早期肿瘤患者以及大多数晚期疾病患者（56%的转移患者在诊断时被认为预后良好；该组的5年生存率为90%）而言，这一目标已经达成。然而，诊断时预后为“中等”或“较差”的患者，以及含顺铂治疗后复发的患者，在接受PEB（顺铂、依托泊苷、博来霉素）标准治疗后的5年生存率仍低得令人不满意，分别仅为80%、45 - 55%和20 - 25%。因此，我们的目标必须是：（i）通过避免对局部疾病患者和/或晚期疾病预后良好的患者进行过度治疗来限制急性和慢性毒性；（ii）识别预后不良的患者，并在专门的中心对他们进行治疗，在这些中心不仅能提供最佳的多学科护理，还能应用新的治疗策略。例如，串联高剂量化疗方案可能对提高这些患者的治愈率有效。
