Biomedical subjects

D Ondrus

Publications and source records attributed to D Ondrus.

At least 37 records · Page 2Linked to original sources

PubMed1994

Orchiectomy alone for clinical stage I nonseminomatous germ cell tumors of the testis (NSGCTT): a minimum follow-up period of 5 years.

AIMS AND BACKGROUND: Surveillance after orchiectomy alone has gained great popularity in the management of stage I NSGCTT. Preliminary results were enthusiastic, but critical voices have been raised against general use of this option as routine management. In an effort to identify patients at high risk of relapse, there has been a search for adverse prognostic factors of stage I nonseminomatous germ cell testicular tumors (NSGCTT). The aim of the study was to identify those patients in whom a surveillance policy is less likely to be successful. METHODS: Eighty patients with stage I NSGCTT were followed for at least 5 years. They were assigned to their respective clinical stage on the basis of physical examination, chest X-ray, CT of the retroperitoneum and post-orchiectomy tumor markers. The criteria for inclusion in clinical stage I were normal results of these examinations. The policy of surveillance consisted of regular follow-up with tumor markers, chest X-ray and CT of the retroperitoneum. Patients who relapsed were treated with cisplatin-containing chemotherapy. In all patients, diagnostic delay, pre-orchiectomy tumor markers, T staging category, size, histopathology and vascular invasion in the primary tumor, and semen analysis were recorded. RESULTS: Follow-up revealed that 51 of the 80 patients (63.7%) were free of disease 61-110 months (mean, 83.1) after orchiectomy. Relapse was detected in 29 patients (36.3%) 3-58 months (mean, 13) after orchiectomy. The overall survival rate was 95%. The main risk factors of relapse were: vascular invasion, a major embryonal carcinoma and a minor teratoma component in the primary tumor, and low sperm count before orchiectomy. CONCLUSIONS: The authors recommend the following risk-adapted treatment procedures: retroperitoneal lymph node dissection in patients with vascular invasion and a major teratoma component, adjuvant chemotherapy in patients with vascular invasion and a major embryonal carcinoma component, and surveillance policy in patients without vascular invasion.

Adolescent↗

PubMed1994

Systemic chemotherapy for muscle invasive bladder cancer.

A total of 60 patients with muscle invasive transitional cell carcinoma of the bladder were entered into the nonrandomized study. The 1st group consisted of 30 patients treated by M-VAC neo-adjuvant chemotherapy followed by radical cystectomy when a residual tumor had been detected by biopsy made after the treatment. The overall clinical response was 70%. Fifteen (50%) out of 30 patients achieved clinical complete response (cCR). Objective pathologic response was attained in 6 (66.7%) of 9 evaluable patients who underwent radical cystectomy, pathologic complete response (pCR) was observed in two (22.2%) patients. Ten (33.3%) patients are still alive at a median follow-up of 22+ months. There were three (10%) drug-related deaths. The 2nd group consisted of 30 patients treated by CMV (with carboplatin) neo-adjuvant chemotherapy followed by radical pathologic response was attained in 9 (47.4%) of 19 evaluable patients, with pCR in 6 (31.6%) patients. Twenty four (80%) patients are still alive at a median follow-up of 13+ months. There was one (3.3%) drug-related death. The authors recommend immediate radical cystectomy following neo-adjuvant chemotherapy in all patients if their total status it allows.

Adult↗

PubMed1993

Chemotherapy of testicular cancer: 10-year experience.

A total of 250 patients with germ cell testicular tumors were treated by PVB chemotherapy between 1982 and 1992. Mean age of patients was 28.9 years (range 15-52). Thirty-four patients in clinical Stage II (11 patients IIA, 13 patients IIB, and 10 patients IIC) underwent primary retroperitoneal lymphadenectomy (RPL) with subsequent chemotherapy. They were followed-up for a mean of 106.3 months (range 85-125). CR was achieved in 30 patients (88.2%). Three patients relapsed. Twenty-seven patients (79.4%) are alive with no evidence of disease (NED) after a minimum of 5 years since the start of therapy. One hundred and twenty-two patients underwent primary chemotherapy for clinical Stages IM (15 patients), IIA (31 patients, IIB (48 patients) and IIC (28 patients) with RPL in cases with residual mass in the retroperitoneum. They were followed-up for a mean of 47.7 months (range 6-122). CR was achieved in 115 patients (92.7%) (75 of them received chemotherapy alone, 40 patients achieved CR following combined cytostatic-surgical treatment). Eleven patients relapsed. One hundred and nine patients (89.3%) are alive with NED. Ninety-four patients in Stages III and IV (8 patients III, 86 patients IV) underwent primary chemotherapy with additional surgical removal of residual metastases. They were followed-up for a mean of 50.5 months (range 6-125). CR was achieved in 65 patients (69.1%) (32 of them received chemotherapy alone, 33 patients achieved CR following combined cytostatic-surgical treatment). Eleven patients relapsed. Fifty-seven patients (60.6%) are alive NED. There were 11 patients with advanced germ cell testicular cancer (Stages IIC and IV) who underwent initial PVB chemotherapy without previous orchiectomy. Delayed orchiectomy was done simultaneously with surgical removal of residual mass in the retroperitoneum or in the lungs or at completion of chemotherapy alone. The toxicity of chemotherapy was moderate. There were drug-related deaths in ten patients (4%).

Adolescent↗

PubMed1993

Neo-adjuvant chemotherapy with delayed orchiectomy in patients with advanced germ cell testicular cancer.

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.

Adolescent↗

PubMed1993

[Postchemotherapy surgery in patients with non-seminomatous testicular tumors].

From 1982 to 1993, 220 patients with metastatic nonseminomatous germ cell testicular tumours were treated with a combination of cisplatin, vinblastine and bleomycin. Complete remission was achieved in 108 (49.1%) pts. on chemotherapy alone. Residual abdominal or pulmonary masses persisted on completion of chemotherapy in 85 (38.6%) pts. All of them had normal serum levels of tumour markers. In 13 (5.9%) pts tumour markers were positive. Fourteen (6.4%) pts died during primary chemotherapy. The pts with residual masses and normal tumour markers were treated by surgical exploration and masses removal. In 62 pts the masses were resected through laparotomy, in 19 pts through pulmonary surgery and in four pts laparotomy was followed later by pulmonary surgery. The masses removed at laparotomy consisted of necrotic and fibrotic tissue in 25.8%, mature teratoma in 61.3% and viable cancer was detected in 12.9% cases. In contrast, resected pulmonary masses consisted of necrotic and fibrotic tissue in 42.1%, mature teratoma in 26.3% and viable cancer in 31.6%. The total therapeutic outcome in 220 pts was as follows: 159 pts (72.3%) are alive and free of disease. Four pts (1.8%) live with the disease and 57 pts (25.9%) died from the disease. On the basis of their results the authors advocate: 1. Primary chemotherapy should be indicated for IIA and IIB stages of nonseminomatous testicular tumours. 2. Surgical exploration should be reserved for pts with residual abdominal and pulmonary masses bigger than 15 mm in diameter. 3. Operation should include a complete removal of all residual masses. 4. No reliable criteria indicating necrotic and fibrotic changes preoperatively were identified. (Tab. 4, Ref. 17.)

Adolescent↗

PubMed1993

Bilateral germ cell tumors of the testis.

In a retrospective study of 530 patients with testicular germ cell tumors treated between 1977 and 1993, a group of 12 patients (2.26%) with bilateral testicular tumors was analyzed. While bilateral tumors were simultaneously present in two cases (both with different histologic types), consecutive development of a tumor in the contralateral testis was observed in 10 patients 5.25 years (range, 3-13.5 years) after orchiectomy for the first tumor. The authors highlight the variability of histologic types in both testes, the need for an individual therapeutic approach with a view to previous therapy for the first tumor, the need for hormonal replacement as well as the possibility of testicular prosthesis implantation following bilateral orchiectomy.

Adult↗

PubMed1993

[Radical cystectomy in the therapy of bladder tumors].

Between January 1970 and December 1992, 100 patients (95 males and 5 females) underwent radical cystectomy for bladder cancer. Their mean age was 54.9 years (range, 34-74 years). Indications for radical surgery were multiple superficial tumors (pTa, pT1) in 24 patients and muscle invasive bladder cancer (pT2, pT3b) in 76 patients. Patients with invasive bladder cancer had received elective pre-operative radiotherapy (40 Gy in 20 pts, 20 Gy in 18 pts). Seven patients had undergone salvage cystectomy after full-dose irradiation (60 Gy); 20 pts received pre-operative (neo-adjuvant) chemotherapy (M-VAC or CMV combination) and 11 pts had had no therapy before cystectomy. In 5 pts urinary diversion was performed in advance; in 95 pts cystectomy and urinary diversion were done at the same time. The following methods of urinary diversion were used: ureteroileostomy (Wallace's modification) in 80 pts, Mainz pouch I (ileal conduit with intermittent catheterization) in 6 pts, Mainz pouch with ileourethral anastomosis in 3 pts, ureterosigmoidostomy in 5 pts and Mainz pouch II (continent rectosigmoidal reservoir) in 6 pts. Post-cystectomy mortality was 8.0%. Long-term survival (Kaplan-Meier) following cystectomy was 15-20% of pts with invasive bladder cancer and 30-40% of pts with superficial bladder cancer.

Adult↗

PubMed1992

Malignant granulosa cell tumor of the testis associated with gynecomastia and long survival.

A case is reported of classic granulosa cell tumor of the testis with metastases to the retroperitoneal lymph nodes occurring in a 26-year-old man. The patient had left-sided testicular enlargement and bilateral gynecomastia. He was treated by radical orchiectomy, retroperitoneal lymph node dissection, and radiation therapy and is well without evidence of disease 14 years after diagnosis. This is the first documented case of granulosa cell tumor of the testis with metastases and long remission after successful therapy to the authors' knowledge.

Adult↗

PubMed1992

Primary chemotherapy in the management of low stage (IIA and IIB) non-seminomatous germ cell testicular tumours.

In a prospective study a total of 65 patients in clinical stages IIA and IIB nonseminomatous testicular tumours were treated by primary chemotherapy followed by retroperitoneal lymphadenectomy in cases with residual disease. The patients were given a combination of cisplatin, vinblastine and bleomycin, or also etoposide. Sixty-two patients (95.4%) achieved complete response: 39 (60%) by chemotherapy alone and 23 (35.4%) following surgical removal of residual disease. Three patients died; there were two drug-related deaths during PVB chemotherapy, one patient had progression of disease following chemotherapy and died as a result of disease dissemination. Three patients relapsed from complete response following chemotherapy, two of them died within 19 and 29 months after the onset of therapy. The third patient received second-line chemotherapy and gained complete response again. Of the 65 patients, 60 (92.3%) survive with no evidence of disease. The follow-up period ranged from 6 to 79 months (mean 39.4 months, median 39 months).

Adolescent↗

PubMed1992

Germ cell testicular tumours with lung metastases: chemotherapy and surgical treatment.

Eighty patients with stage IV testicular germ cell tumours with lung metastases were treated with PVB chemotherapy and subsequent surgery in cases of residual disease. Out of 80 patients 28 (35%) achieved complete response following chemotherapy alone. Thirty-six patients (45%) with partial response underwent surgery: 17 had lymphadenectomy because of residual mass in the retroperitoneum, 15 had pulmonary surgery alone and 4 had both operations. Of these 36 patients 27 achieved complete response following cytostatic and surgical treatment. Sixteen patients died following PVB chemotherapy, 10 of them due to progression of disease, and there were six (7.5%) drug-related deaths. The authors refer to the importance of surgical treatment of residual metastatic mass in the lungs following PVB chemotherapy. Germ cell tumours of the testis are the most curable solid neoplasms treated by the oncologist. Advances in their management are due to the introduction of cisplatin-based combination chemotherapy and surgical removal of the residual mass [8]. Progress in chemotherapy of testicular tumours has changed the attitude towards thoracotomy and surgical removal of lung metastases. The aim of this study is to evaluate combined cytostatic and surgical treatment of disseminated testicular tumours with emphasis on surgical removal of residual lung metastases following chemotherapy.

Adolescent↗

PubMed1992

Monitoring of patients with non-seminomatous germ cell tumors of the testis by determination of alpha-fetoprotein and beta-human chorionic gonadotropin levels and by computed tomography.

The results of a 7-year monitoring of 230 patients with non-seminomatous testicular tumors are reported with respect to the employment of radioimmunoanalysis of alpha-fetoprotein and beta-human chorionic gonadotropin levels and CT examinations of retroperitoneum and lungs. Prior to orchiectomy, elevated levels of at least one of these markers were found in 79% of patients. After orchiectomy, tumor marker levels were in 70.4% of patients in agreement with the results of CT examinations. After the completion of chemotherapy, in more than a half of patients normal tumor marker levels and positive CT findings were observed. These results were most often due to the presence of mature teratoma. In Stage I patients the advantages of tumor marker determinations and CT examinations in the early detection of tumor progression have fully been confirmed.

Biomarkers, Tumor↗

PubMed1992

[Combined therapy in patients with testicular germ cell tumors in the dissemination stage (pulmonary metastasis)].

The efficacy of combined cytostatic-surgical treatment was evaluated in a prospective study involving 70 patients with germinal tumors of the testis metastasizing into the lungs. Complete remission was achieved in 50 (71.4%) patients, 30 of these received only chemotherapy. Thoracotomy was performed in 14 patients with residual pulmonary CT finding, 6 of them underwent bilateral operations. Of the total 21 operations of the lungs residual malignant tumor was found 4 times. After a mean follow up period of 29.8 months since onset of treatment 48 patients (68.6%) survived. Within a mean of 11.4 months after onset of treatment 22 patients (31.4%) died. The authors consider thoracotomy with resection of the metastatic focus to be the only method for determining reliably the biological nature of the residual pulmonary lesion after chemotherapy. The result of the procedure determines the further measures, i.e. sequential chemotherapy or regular check ups. (Tab. 1, Fig. 6, Ref. 15.).

Adolescent↗

PubMed1992

["Surveillance" of non-seminomatous testicular tumors. A prospective study of 100 patients in the first stage of illness].

In a prospective study, 100 patients with clinical stage I nonseminomatous testicular tumours were investigated by a surveillance policy, which consisted of regular follow-up after orchiectomy alone until disease progression was confirmed. Follow-up revealed that 65 of the 100 patients were free of disease at 25 to 90 months after orchiectomy. Disease progression was detected in 35 patients at 3 to 27 months following orchiectomy. Patients with progression were treated by PVB chemotherapy. Patients with non-seminomatous testicular tumours in clinical stage I represent a group which is not homogeneous and can therefore not be treated by means of a single modality. It is necessary to individually define optimal treatment based on prognostic factors. The surveillance policy is available in patients without risk factors and regular follow-up is mandatory. Multidisciplinary collaboration and cooperation with patients are essential.

Adolescent↗

PubMed1991

[Surgical treatment of residual pulmonary metastasis of testicular germ cell tumors after chemotherapy].

Advances in chemotherapy achieved a high percentage of complete remission after primary cytostatic treatment in germinal testicular tumours. In 30-40% of patients in the IVth stage of the disease supplementary surgery is, however, necessary--retroperitoneal lymphadenectomy or metastasectomy of the lungs. The authors give an account of initial results of surgical removal of metastases in the lungs in seven patients of 48 treated with cytostatics on account of a germinal testicular tumour. The low risk of thoracotomy, if correctly indicated, justifies us to describe this operation not only as auxiliary but therapeutic.

Adolescent↗

PubMed1991

[Is it necessary to begin therapy with orchiectomy in patients with advanced stage testicular tumors?].

Seven patients with germ cell tumours of the testis in advanced stages of the disease were treated by primary chemotherapy without previous orchidectomy. To achieve complete remission it was necessary to remove the residual tumour in five patients (in two from the lungs and in three from the retroperitoneal space). Two of the seven patients had a persisting vital tumour in the ectomized testis. Five patients survive in complete remission for an average period of 9.6 months (range 3-18 months) after termination of treatment. In patients with germ cell tumours of the testis in advanced stages of the disease primary chemotherapy should be preferred and treatment should not be started by orchidectomy. Contemporary methods of visualization and laboratory examinations provide adequate evidence of the presence of germ cell tumours and the asset of a rapid effect of chemotherapy on metastases is greater than the advantages of accurate histopathological classification of the tumour. After termination of chemotherapy orchidectomy is indicated because even in patients with complete remission of secondaries a vital malignant tumour may persist.

Adult↗

PubMed1989

[Factors affecting the recurrence of epithelial tumors of the urinary bladder].

Of the 178 patients with superficial tumors of the urinary bladder followed up over minimally three years from the onset of treatment, 137 (77%) developed relapse of the tumor. Comparison of anamnestic data and objective examination findings in patients with and without relapses yielded a statistically significant probability of relapses in patients with multiple tumors, in tumors with an increased number of cell layers, and in tumors with infiltration of the lamina propria. Patients presenting with any of these features are at risk of relapses and require prophylactic treatment.

Female↗

PubMed1988

Metastatic spermatocytic seminoma. A case report with light microscopic, ultrastructural, and immunohistochemical findings.

A case of metastatic spermatocytic seminoma with metastases to homolateral retroperitoneal paraaortic lymph nodes in a 50-year-old man is described. The metastases were detected 18 months after orchiectomy. A retroperitoneal biopsy with cytoreductive lymphadenectomy was performed followed by radiotherapy and consecutively by combination chemotherapy. The patient died 25 months after orchiectomy of complications arising after a second course of chemotherapy. No signs of further tumor spread were observed. Autopsy was not performed. The tissue of the metastases fulfilled the light microscopic criteria for spermatocytic seminoma and ultrastructurally showed intercellular communications with typical intercellular bridges. The absence of placental alkaline phosphatase in tumor cells is also consistent with this diagnosis. The metastases differed from the primary tumor in the presence of focal lymphocytic infiltration and granulomatous reaction. This patient represents the first fully documented case of a metastasizing spermatocytic seminoma.

Dysgerminoma↗

PubMed1988

Extragonadal germ cell tumours.

In a retrospective study of patients treated for germ cell tumours, the authors found seven patients with primary extragonadal tumours in the retroperitoneum. These tumours are, in terms of histology, identical with germ cell tumours of the testis. The disease manifests itself by pain in the kidney region, palpable abdominal mass, weight loss, fever, and gynaecomasty. The diagnosis was confirmed histologically by examining tissue specimens obtained by probatory laparotomy and from the supraclavicular lymph nodes. The choice of therapy and prognosis of disease depend on the histological evidence. Orchiectomy is unnecessary provided both testes are clinically unaltered.

Adult↗