Ondrus D, Hornák M, Matoska J
Department of Urology, Comenius University Medical School, Dérer Hospital, Bratislava, Slovakia.
Neoplasma. 1993;40(3):189-92.
A total of 13 patients with advanced germ cell testicular cancer underwent initial PVB chemotherapy without previous orchiectomy. Complete response (CR) of metastases was observed in 5 patients following chemotherapy alone. The residual mass persisted in 8 patients (in 5 of them in the retroperitoneum, in two patients in the lungs only and in one patient in both localizations). The residual masses were removed surgically. There were no viable malignant tumors in the removed tissue on histological examination. Delayed orchiectomy was performed simultaneously with surgical removal of the residual mass in the retroperitoneum or in the lungs in 8 patients, and in 5 patients as a separate procedure in complete responders following chemotherapy alone. Residual viable tumor in the testis was found in three patients, necrotic or fibrotic tissue in 5 patients, and mature teratoma in 5 patients. In patients with advanced germ cell testicular cancer preference must be given to early beginning of intensive chemotherapy without tissue diagnosis of primary tumor by orchiectomy. Benefit of this therapeutic approach is the timely management of acute abdominal and/or pulmonary symptoms of life-threatening distant metastases.
共有13例晚期睾丸生殖细胞癌患者在未先行睾丸切除术的情况下接受了初始PVB化疗。仅化疗后，5例患者的转移灶达到完全缓解（CR）。8例患者的残留肿块持续存在（其中5例位于腹膜后，2例仅位于肺部，1例在两个部位均有）。残留肿块通过手术切除。组织学检查显示切除组织中无存活的恶性肿瘤。8例患者在手术切除腹膜后或肺部残留肿块的同时进行了延迟睾丸切除术，5例患者在单纯化疗后作为完全缓解者的单独手术进行了延迟睾丸切除术。3例患者睾丸中发现残留的存活肿瘤，5例患者为坏死或纤维化组织，5例患者为成熟畸胎瘤。对于晚期睾丸生殖细胞癌患者，必须优先在不通过睾丸切除术对原发性肿瘤进行组织诊断的情况下尽早开始强化化疗。这种治疗方法的益处在于及时处理危及生命的远处转移的急性腹部和/或肺部症状。
