Beyond stage I germ cell tumors: Current status regarding treatment and long-term toxicities Journal Article

Authors: Haugnes, H. S.; Stephenson, A. J.; Feldman, D. R.
Article Title: Beyond stage I germ cell tumors: Current status regarding treatment and long-term toxicities
Abstract: Approximately 20% to 40% of patients with germ-cell tumors (GCT) will need advanced medical treatment because of relapse or initial metastatic disease. The survival and recommended treatment for men with metastatic disease varies according to histology, primary and metastatic sites, and the level of prechemotherapy tumor markers. For patients with a good prognosis, three cycles of bleomycin, etoposide, and cisplatin (BEP) or four cycles of etoposide, and cisplatin are recommended. For patients with intermediate- and poor prognosis, four cycles of bleomycin, etoposide, and cisplatin remains the preferred treatment option, although a switch to a more intensive regimen can be considered a new alternative. A major advance in salvage therapy for GCT in the last 5 years was the development of a new risk classification system. Initial salvage treatment includes both high-dose chemotherapy and standard-dose chemotherapy. There is clear consensus that patients with residual masses larger than 1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND); however, the role of PC-RPLND in patients with serologic and radiographic complete response to first-line chemotherapy is controversial. The rationale for PC-RPLND in patients with small residual masses is discussed, and only a small minority of advanced nonseminoma GCT (NSGCT) patients are suitable candidates for observation after first-line chemotherapy. Post-treatment long-term toxicity has emerged as an important issue for GCT survivors. Examples of late effects are secondary nongerm-cell cancers and cardiovascular disease, which represent the most severe and potentially life-threatening effects of cancer treatment. Follow-up of cancer survivors should include recommendations for maintaining a healthy lifestyle to reduce the risk of serious long-term and late effects of treatment.
Keywords: adolescent; adult; treatment outcome; young adult; antineoplastic agent; lymph node dissection; lymph node excision; neoplasm recurrence, local; antineoplastic combined chemotherapy protocols; pathology; neoplasms, germ cell and embryonal; retroperitoneal neoplasms; adverse effects; secondary; humans; human; male
Journal Title: American Society of Clinical Oncology Educational Book
Volume: 34
ISSN: 1548-8756
Publisher: American Society of Clinical Oncology  
Date Published: 2014-01-01
Start Page: e180
End Page: e190
Language: English
DOI: 10.14694/EdBook_AM.2014.34.e180
PUBMED: 24857101
PROVIDER: scopus
Notes: Review -- Export Date: 7 January 2016 -- Source: Scopus
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  1. Darren Richard Feldman
    172 Feldman