Decline In Alpha-fetoprotein Level Research Articles

Treated Non Seminomatous Germ Cell Tumor of Testes Post Resection of Teratomatous Lung Nodule

Background: Testicular tumors are relatively rare, accounting for only 1% of all malignancies in men. Among the different types of testicular tumors, germ cell tumors are the most common. They are very sensitive to chemotherapy and are curable even when metastatic. Cure rates approximates 90%-95% in good risk and early stage tumors. Earlier on, metastatic testicular cancer was usually incurable and fatal, but newer treatments including high-dose chemotherapy and stem cell rescue have changed the scenario. Case Presentation: This case report presents a case of a 30-year-old male with a large testicular tumor, diagnosed as a mixed germ cell tumor consisting of a yolk sac tumor, teratoma with immature elements, and seminoma with germ cell neoplasia in situ. After undergoing radical orchiectomy, the patient experienced a postoperative decline in alpha-fetoprotein levels and was placed on surveillance. Subsequent imaging revealed the development of a lung nodule, accompanied by an increase in alpha-fetoprotein levels. The patient received chemotherapy with three cycles of BEP (bleomycin, etoposide, platinum), resulting in a partial response. Due to the patient's COVID-19 infection, the final cycle of chemotherapy was modified. Further imaging showed a marginal decrease in the size of the lung nodule, prompting surgical resection. The lung nodule was found to be a post-pubertal teratoma without significant immature elements. Following surgery, the patient's alpha-fetoprotein levels decreased to a baseline nadir. Close follow-up continues, demonstrating no evidence of disease recurrence. Conclusion: This case emphasizes the importance of a multidisciplinary approach, including surgery and chemotherapy, in managing testicular germ cell tumors with metastasis, leading to favorable outcomes and long-term disease control.

Advanced extragonadal yolk sac tumor serially followed up with 18F-fluorodexyglucose-positoron emission tomography and computerized tomography and serum alpha-fetoprotein

Although yolk sac tumors (YSTs) are the second most common malignant germ cell tumor of the ovary, those arising from the omentum or pelvic peritoneum are extremely rare and have no established treatment guidelines. We report a case of a primary YST disseminated throughout the abdomen and associated with a high serum alpha-fetoprotein (AFP) elevation (441 611 ng/ml). Optimal cytoreduction was not achieved in order to preserve the patient's fertility and avoid adjacent organ injury. Residual tumor responded to adjuvant chemotherapy with a sharp decline in AFP levels, and confirmed remission was documented by serial (18)F-fluorodexyglucose-positoron emission tomography and computerized tomography (FDG-PET/CT). In cases of advanced YST with unresectable residual disease, AFP levels combined with FDG-PET/CT scans may be a helpful way to monitor treatment response and assist in treatment planning for a disease that primarily affects young women who may desire to preserve fertility.

Author reply: Alpha-fetoprotein levels in the neonatal period

First of all we would like to thank you for your interest in our paper. Several studies have been published attempting to define normal concentrations of alpha-fetoprotein (AFP) throughout the neonatal period. Thanks to these reports we know that there is a wide variation in AFP concentrations in newborn infants. In the study of Bader et al. [1] mean normal AFP concentrations were found to be 61,000±48,000 ng/ml at birth and 43,000±32,500 ng/ml at 60±24 h of life, with SD values that were almost three quarters of the means. Taking into account that the decline in AFP levels in early postnatal life is exponential, we underline that the AFP concentration of the infant described in our report [2] was 35,000 ng/ml at 7 days of life, in the presence of a hepatic mass-like lesion. In this circumstance we could not state with light-heartedness that this AFP value was normal. In fact, due to a wide range of AFP concentrations in healthy newborn infants, special precaution is required in interpreting levels of AFP in the early neonatal period. We believe that observation of AFP trend levels is more important than an absolute value. However, the study of Bader et al. as well as some of the others studies provide only limited data about the kinetics of the decline in AFP concentrations, which are not sufficient to provide some useful clinical guidelines for interpretation of AFP levels. In our patient, the follow-up of both AFP level decline and reduction of hepatic lesion size confirmed the soundness of our conservative management.

Timing and magnitude of decline in alpha-fetoprotein levels in treated children with unresectable or metastatic hepatoblastoma are predictors of outcome: a report from the Children's Cancer Group.

We analyzed data on 31 children with primary unresectable or metastatic hepatoblastoma (HB) to investigate possible prognostic correlations between the serum level of alpha-fetoprotein (AFP), its changes during treatment, and outcome. Patients were treated according to the Children's Cancer Group (CCG) protocol 823F, which included an initial surgery before eight courses of chemotherapy that consisted of cisplatin immediately followed by a continuous infusion of doxorubicin. Four courses were given before and four after the second surgery. AFP levels were measured before treatment, before and after second surgery, and at the end of treatment. Twenty-four of 31 patients showed a decline of > or = 1 log in AFP levels before second surgery (early responders). By the end of treatment, there were 16 patients, all early responders, without clinical or radiographic evidence of tumor and with normal AFP levels. Fifteen of those 16 had a decline of > or = 2 logs in AFP before second surgery (large early response). Of the 15 patients who failed to respond to treatment, 10 died, among whom only one patient had a large early response. A large early response was the strongest independent predictor of outcome in a univariate and multivariate Cox regression model, and patients with such a response had the best survival (P < .0001). For children with unresectable or metastatic HB, early changes in AFP levels are a reliable predictor of outcome and can be used for identification of poor responders to treatment, ie, patients whose AFP level fails to decrease 2 logs before second surgery should be considered for alternative treatment.