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Biomedical subjects

A Gerl

Publications and source records attributed to A Gerl.

At least 55 records · Page 3Linked to original sources
PubMed1994

Central nervous system as sanctuary site of relapse in patients treated with chemotherapy for metastatic testicular cancer.

Isolated central nervous system relapse in patients treated successfully with cisplatin-based chemotherapy for testicular cancer has been described infrequently. In a retrospective analysis we identified this complication in six of 417 patients. Five of the six patients had advanced pulmonary dissemination at onset of chemotherapy, and post-chemotherapy surgery did not reveal viable tumour tissue in any of these cases. All six patients developed a single cerebral metastasis during complete remission a median four months after discontinuation of chemotherapy. Five patients were treated with surgery and subsequent radiotherapy, one patient with irradiation alone. Three patients are alive relapse-free 19, 62 and 86 months after diagnosis of cerebral relapse. One patient was alive with cerebral disease for 12 months without evidence of systemic recurrence. Our data demonstrate that the brain may act as a sanctuary site in chemotherapy-treated testicular cancer. A review of the literature shows that an isolated cerebral relapse is an extremely rare complication, but carries a relatively favourable prognosis.

Adult↗
PubMed1994

Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic non-seminomatous germ cell tumours.

Thirty-eight patients with advanced non-seminomatous germ cell tumours (NSGCTs) underwent multiple surgical interventions (two in 33 patients, three in four patients, four in one patient) after cisplatin-based chemotherapy. All patients had normal serum tumour markers but persistent radiographic masses. The larger mass was routinely resected first. Fifteen patients (39%) had dissimilar histological findings at sequential surgical procedures, 12 of whom demonstrated less favourable pathological features during the first operation and three at the second. Patients who underwent both retroperitoneal lymph node dissection (RPLND) and lung resection showed less favourable histological features in the retroperitoneum in nine cases and in the lung in three cases. Eight of 16 patients (50%) without mature teratoma in their primary tumours showed complete necrosis/fibrosis at all surgical interventions, whereas all patients whose primary tumour was classified as malignant teratoma intermediate demonstrated mature teratoma at least at one anatomical site. As histology of post-chemotherapy residual masses cannot be extrapolated from one anatomical site to another, patients usually are properly managed by excision of all residual masses. In particular, in patients with necrosis/fibrosis at lung resection omission of RPLND is not advised.

Abdominal Neoplasms↗
PubMed1994

Vascular toxicity associated with chemotherapy for testicular cancer.

Cisplatin-based chemotherapy considerably improved the outcome of patients with metastatic germ cell tumors. Apart from Raynaud's phenomenon, a frequent side effect, vascular toxicity associated with chemotherapy for testicular cancer, has not been described precisely. Although major vascular complications such as myocardial infarction, stroke and pulmonary embolism seem to occur infrequently, they raise concern with regard to the safety of chemotherapy. Also, potential late vascular toxicity has to be taken into account. Whereas a cause and effect relationship is probable for some vascular events following chemotherapy, some cases may represent coincidence or may be disease related. Presently, the very low incidence of major vascular events should not enter into therapeutic decisions.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Testicular tumor after cisplatin-based chemotherapy for germ cell malignancy.

Among 417 patients treated with cisplatin-based chemotherapy for germ cell malignancy (median follow-up 7 years) we observed 6 patients who developed a second tumor of the testis. In 3 cases the first tumor was of testicular origin, whereas in the other cases the initial tumor presented in the retroperitoneal space. Although cisplatin-based chemotherapy may reduce or delay the development of a contralateral testicular tumor, the risk apparently is not completely eliminated. Patients with primary retroperitoneal germ cell tumors need a close and careful follow-up, as they appear to be at an increased risk for developing a testicular tumor.

Adult↗
PubMed1993

Testicular cancer and Hodgkin disease in the same patient.

BACKGROUND: Although testicular cancer and Hodgkin disease are the neoplasms with the highest incidence in young men, only 13 cases of metachronous and 2 cases of synchronous occurrence in the same person were reported before 1991. METHODS: A 30-year-old man is described, in whom, 2 years after radiation therapy for Stage IIIA Hodgkin disease, a testicular nonseminomatous germ cell tumor developed with metastatic spread to the retroperitoneal lymph nodes, lung, and left supraclavicular fossa. The second case report describes a 31-year-old man in whom a metastasizing nonseminomatous testicular cancer, with elevation of levels of the serum tumor markers alpha-fetoprotein and human chorionic gonadotropin, developed simultaneously with axillary lymphadenopathy that was histologically confirmed Hodgkin disease. RESULTS: After five cycles of cisplatin-based chemotherapy and secondary retroperitoneal lymphadenectomy, the patient with metachronous disease has remained in complete remission for 8 years. The patient with synchronous occurrence has been disease-free for 14 months after five cycles of chemotherapy consisting of cisplatin, etoposide, and doxorubicin (Adriamycin, Adria Laboratories, Columbus, OH). CONCLUSIONS: The metachronous and synchronous occurrence of testicular cancer and Hodgkin disease is a rare association of two curable neoplasms. The presence of both malignant neoplasms should be taken into consideration in young male patients, especially if disease distribution diverges from a regular pattern.

Adult↗
PubMed1993

Prognostic implications of tumour marker analysis in non-seminomatous germ cell tumours with poor prognosis metastatic disease.

86 unselected patients with poor risk metastatic non-seminomatous germ cell tumours (NSGCT) treated from 1979 to 1990 at a single institution were reviewed with regard to the prognostic relevance of tumour marker analysis. The number of elevated tumour markers was not able to distinguish patients into prognostic subgroups. Pretreatment levels of human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) did not have a significant influence on clinical outcome. HCG and AFP half-life analysis during the first chemotherapy cycles also failed to define prognostic subgroups. If early deaths within 90 days after the onset of chemotherapy were excluded, patients with a half-life of HCG decline greater than 3.5 days tended to have a poorer prognosis which did not reach significance.

Adult↗
PubMed1993

Etoposide, cisplatin, bleomycin, and cyclophosphamide (ECBC) as first-line chemotherapy for poor-risk non-seminomatous germ cell tumors.

Sixty-one patients with advanced metastatic non-seminomatous germ cell tumors were treated with etoposide 120 mg/m2, cisplatin 30 mg/m2, bleomycin 12 mg/m2, and cyclophosphamide 300 mg/m2 daily for four days; and additional bleomycin bolus injection of 15 mg was given on day 1. Fifty patients (82%) were treated with four to six courses at 3-week intervals. Forty patients (66%) attained complete remission, and further 7 patients (11%) achieved a marker-negative partial remission accounting for a favorable response rate of 77%. Hematologic toxicity was considerable and there were two treatment-related deaths. After a median observation time of 47 months (range 12 to 108 months), 43 patients were alive, of which 38 had continuous complete remission, one a second complete remission, two marker-negative stable disease and two progressive disease. Our results are similar to those reported by other investigators for poor-risk metastatic non-seminomatous germ cell tumors treated with dose-intensified regimens.

Adolescent↗
PubMed1993

[Current status of therapy of CNS metastases of germ cell tumors].

The incidence of CNS metastases in germ cell tumors is 2-5% and in very advanced disease over 20%. We report on 37 patients in whom CNS metastases were diagnosed with the CAT scanner. Twenty-nine patients were subsequently treated. In 19 cases, treatment consisted of radiotherapy, 1 patient was only operated on, and in 9 cases patients received combined surgery and radiotherapy. Two patients had seminomatous germ cell tumors, 27 patients non-seminomatous tumors. HCG levels were high in 11 cases. In 31 patients the disease was in the advanced stages; in 6 the disease was at the early stage. If there was just a solitary tumor, operation was the preferred mode of treatment. Radiotherapy consisted of 50 GY whole-brain irradiation, with a tumor saturation up to 60 GY. In 2 cases we suspected radiogenic necrosis. There were no other severe side effects. Of the 37 patients, 4 obtained a long-term cure (observation time 34-90 months). Therapy must take all methods of treatment into consideration and should only be carried out in fully equipped medical centers. Only then can we hope to obtain long-term cures in individuals with this usually fatal disease.

Adult↗