Bulky Seminoma Research Articles

Persistent Positron Emission Tomography–Positive Liver Lesions After Successful Chemotherapy in Mediastinal Seminoma

Persistent Positron Emission Tomography–Positive Liver Lesions After Successful Chemotherapy in Mediastinal Seminoma

Combination chemotherapy with vinblastine, ifosfamide and cisplatin in bulky seminoma.

Since 1982, 24 patients with bulky seminoma were treated with the VIP-regimen consisting of vinblastine 6 mg/m2 days 1+2, ifosfamide 1.5 g/m2 days 1-5, cisplatin 20 mg/m2 days 1-5. One patient showed primary progression, another patient partial remission, and one patient died during the first cycle. All the other patients had complete remission (21/24 = 87%), which was documented histologically in 9 patients. One patient relapsed but obtained complete remission after repeated treatment. Thus 21 patients are currently living without disease after a median observation time of 30+ months. Bone marrow toxicity was severe, leading to dose reduction in more than 50% of the patients. No other severe side effects were observed. We conclude that the regimen is highly effective in bulky seminoma. Reduction of the vinblastine dose is recommended because of bone marrow toxicity.

Vinblastine-ifosfamide-cisplatin treatment of bulky seminoma.

Eighteen patients with pure seminoma in advanced Stages IIC-IV of disease were treated with VIP combination chemotherapy consisting of vinblastine (6 mg/m2, days 1 and 2), ifosfamide (1.5 g/m2, days 1 to 5), and cisplatin (20 mg/m2, days 1 to 5). Eleven patients had Stage IIC, four had Stage III, three had Stage IV, and two had primary extragonadal seminoma. Primary histologic diagnoses were typical seminoma in 15 patients and anaplastic seminoma in three patients. Human chorionic gonadotropin (HCG) levels were elevated to 350 U/1 in eight patients; alpha-fetoprotein (AFP) levels were always normal. No primary lymphadenectomy was carried out. Seven of 18 patients had prior radiotherapy and were treated because of relapse or progression. There was one early death and one patient has not yet completed therapy. Of 16 evaluable patients, 14 reached complete remission (CR) (88%), which was documented surgically in six cases, whereas in the non-pretreated group, all nine patients reached CR and in the pretreated group, CR could be induced in five of seven patients (71%). The remission duration ranged from 6+ to 41+ months (median, 29+ months). No relapse has occurred. The bone marrow toxicity of VIP was remarkable. Because of leukopenia below 1000/mm3 and/or thrombopenia below 50,000/mm3, dose reduction and interval prolongation were necessary in 10 of 16 patients, especially in all those who were pretreated. Even though it is not superior to other platin-based regimens, VIP chemotherapy is highly effective in bulky seminoma with and without prior radiotherapy.

Malignant testicular tumors. Recommendations on diagnosis, therapy and aftercare

This manual contains recommendations for early detection, diagnostic procedures, treatment modalities and follow-up in testicular cancer as a working formulation set up by the "Testicular cancer"-group of the Tumorcenter Munich. The different histological classifications and the tumor staging are described as well as treatment strategies dependent on tumor stage and histology. For nonseminomatous testicular cancer the surgical approach as primary or secondary intervention and the indication for adjuvant, curative or palliative chemotherapy are discussed, followed by details on regimens, application and side effects of chemotherapy. For seminomas particular recommendations on radiation therapy in non-bulky disease and on chemotherapy in bulky seminoma are given. For follow-up special follow-up-programs for periodical patient examination are presented.

Radiation therapy in bulky seminoma

Between 1969 and 1980. 17 patients with bulky retroperitoneal seminoma and 1 patient with bulky mediastinal seminoma were treated with radiation therapy. One patient had resection of gross retroperitoneal disease, and 1 patient had resection of gross mediastinal disease. Fifteen patients received adjuvant irradiation to the mediastinum and paraclavicular lymph nodes, and 1 patient received adjuvant chemotherapy. At last follow-up, 17 of 18 patients (94%) remain free of disease. No patient has sustained treatment-related morbidity or mortality.

The Management of Testicular Seminomas, 1979.

The reported results from throughout the world of modern treatment of testicular seminoma are reviewed for the various clinical stages of disease. The three-year survival rate for 1,346 patients with Stage 1 and 2 disease is 91%. Since the review reveals considerable differences in staging methods, a clinically useful staging system is proposed. Treatment methods are described and discussed. Recommendations are made assuming that patients so treated are clinically evaluated for extent of disease before treatment with currently available techniques, including lymphangiography, CT scanning, perhaps ultrasonography, and serum marker determinations. Although the role of cytoreductive surgery in patients with seminoma, even bulky seminoma, now is limited, occasionally when laparotomy is done, debulking may also be helpful. Effective combination chemotherapy regimens have not been identified. The 28% three-year survival rate of patients with Stage 3 disease establishes the real need to identify such therapy. Finally, anaplastic seminoma is considered; a recent review by Percarpio indicates that this subtype perhaps is not unlike classical seminoma as far as stage distribution and prognosis is concerned.