Nichtseminom im klinischen Stadium I

Der Onkologe - Tập 19 - Trang 557-563 - 2013
C. Winter1, P. Albers2
1Klinik für Kinderurologie und Urologie, Malteser-Krankenhaus St. Josefshospital Uerdingen, Krefeld, Deutschland
2Urologische Klinik, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland

Tóm tắt

Bei Patienten mit nichtseminomatösen Hodentumoren im klinischen Stadium I ist entweder eine risikoadaptierte adjuvante Therapie oder eine Überwachungsstrategie nach Ablatio testis indiziert. Recherche der Literatur und Auswertung klinischer Studien. Hauptrisikofaktor für eine lymphogene retroperitoneale Metastasierung ist die Tumorinvasion des testikulären Primärtumors in Blut- bzw. Lymphgefäße. Patienten ohne Nachweis einer „vaskulären Invasion“ („low risk“, V0/L0) sollten überwacht werden. Bei definitivem Therapiewunsch des Patienten wäre eine Chemotherapie mit 2 Zyklen PEB (Cisplatin, Etoposid, Bleomycin) als Alternative zur Surveillance zu diskutieren. Nichtseminompatienten mit Nachweis einer vaskulären Invasion („high risk“, V1/L1) sollten mit 2 Zyklen PEB-Chemotherapie adjuvant behandelt werden. Es existieren Hinweise, dass eine Reduktion der Zyklenzahl von 2 auf 1 Zyklus PEB bei Hochrisikopatienten das Rezidivrisiko in gleicher Weise reduziert, aber möglicherweise die dosisabhängigen Langzeitfolgen der Chemotherapie wie die Entstehung eines Sekundärmalignoms oder die Kardiotoxizität reduzieren könnte. Darüber sollten die Patienten informiert sein. Aufgrund einer effektiven Rezidivtherapie können grundsätzlich alle Patienten in diesem Stadium auch lediglich überwacht werden. Die Rezidivrate für High-Risk-Patienten liegt allerdings bei etwa 50 %. Die nervenerhaltende retroperitoneale Lymphadenektomie (NS-RLA) wird im Frühstadium nur in Ausnahmefällen (z. B. auf Wunsch des Patienten) empfohlen.

Tài liệu tham khảo

Rübben H (2008) Uroonkologie, Aufl. 4. Springer, Berlin Travis LB, Curtis RE, Storm H et al (1997) Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst 89:1429–1439 Bokemeyer C, Schmoll HJ (1993) Secondary neoplasms following treatment of malignant germ cell tumors. J Clin Oncol 11:1703–1709 Bokemeyer C, Berger CC, Kuczyk MA, Schmoll HJ (1996) Evaluation of long-term toxicity after chemotherapy for testicular cancer. J Clin Oncol 14:2923–2932 Kollmannsberger C, Beyer J, Droz JP et al (1998) Secondary leukemia following high cumulative doses of etoposide in patients treated for advanced germ cell tumors. J Clin Oncol 16:3386–3391 Belt-Dusebout AW van den, Wit R de, Gietema JA et al (2007) Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol 25:4370–4378 Wood L, Kollmannsberger C, Jewett M et al (2010) Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J 4:e19–e38 Leibovitch I, Foster RS, Kopecky KK et al (1998) Identification of clinical stage a nonseminomatous testis cancer patients at extremely low risk for metastatic disease: a combined approach using quantitive immunohistochemical, histopathologic, and radiologic assessment. J Clin Oncol 16:261–268 Freedman LS, Parkinson MC, Jones WG et al (1987) Histopathology in the prediction of relapse of patients with stage I testicular teratoma treated by orchidectomy alone. Lancet 2:294–298 Albers P, Siener R, Kliesch S et al (2003) Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group Trial. J Clin Oncol 21:1505–1512 Albers P, Bierhoff E, Neu D et al (1997) Mib-1 immunohistochemistry in clinical stage I nonseminomatous testicular germ cell tumors predicts patients at low risk for metastasis. Cancer 79:1710–1716 Cullen MH, Stenning SP, Parkinson MC et al (1996) Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council Report. J Clin Oncol 14:1106–1113 Ulbright TM, Orazi A, Riese W de et al (1994) The correlation of P53 protein expression with proliferative activity and occult metastases in clinical stage I non-seminomatous germ cell tumors of the testis. Mod Pathol 7:64–68 Heidenreich A, Sesterhenn IA, Mostofi FK, Moul JW (1998) Prognostic risk factors that identify patients with clinical stage I nonseminomatous germ cell tumors at low risk and high risk for metastasis. Cancer 83:1002–1011 Krege S, Beyer J, Souchon R et al (2008) European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part I. Eur Urol 53:478–496 Winter C, Albers P (2010) Testicular germ cell tumors: pathogenesis, diagnosis and treatment. Nat Rev Endocrinol 7:43–53 Read G, Stenning SP, Cullen MH et al (1992) Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party. J Clin Oncol 10:1762–1768 Duran I SJ, Jewett MA, Anson-Cartwright L et al (2007) Initial versus recent outcomes with a non-risk adapted surveillance policy in stage I Non-Seminomatous Germ Cell Tumors (NSGCT). J Clin Oncol 25:5021 Sturgeon JF, Moore MJ, Kakiashvili DM et al (2010) Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital’s experience. Eur Urol 59:556–562 Kollmannsberger C, Moore C, Chi KN et al (2009) Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy. Ann Oncol Oliver RT, Raja MA, Ong J, Gallagher CJ (1992) Pilot study to evaluate impact of a policy of adjuvant chemotherapy for high risk stage 1 malignant teratoma on overall relapse rate of stage 1 cancer patients. J Urol 148:1453–1455 (discussion 1455–1456) Studer UE, Fey MF, Calderoni A et al (1993) Adjuvant chemotherapy after orchiectomy in high-risk patients with clinical stage I non-seminomatous testicular cancer. Eur Urol 23:444–449 Bohlen D, Borner M, Sonntag RW et al (1999) Long-term results following adjuvant chemotherapy in patients with clinical stage I testicular nonseminomatous malignant germ cell tumors with high risk factors. J Urol 161:1148–1152 Chevreau C, Mazerolles C, Soulie M et al (2004) Long-term efficacy of two cycles of bep regimen in high-risk stage I nonseminomatous testicular germ cell tumors with embryonal carcinoma and/or vascular invasion. Eur Urol 46:209–214 (discussion 214–205) Nuver J, Smit AJ, Wolffenbuttel BH et al (2005) The metabolic syndrome and disturbances in hormone levels in long-term survivors of disseminated testicular cancer. J Clin Oncol 23:3718–3725 Travis LB, Fossa SD, Schonfeld SJ et al (2005) Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst 97:1354–1365 Albers P, Siener R, Krege S et al (2008) Randomized phase iii trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: Auo Trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol 26:2966–2972 Westermann DH, Schefer H, Thalmann GN et al (2008) Long-term followup results of 1 cycle of adjuvant bleomycin, etoposide and cisplatin chemotherapy for high risk clinical stage I nonseminomatous germ cell tumors of the testis. J Urol 179:163–166 Tandstad T, Dahl O, Cohn-Cedermark G et al (2009) Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the swenoteca management program. J Clin Oncol 27:2122–2128 Baniel J, Foster RS, Rowland RG et al (1994) Complications of primary retroperitoneal lymph node dissection. J Urol 152:424–427 Donohue JP, Thornhill JA, Foster RS et al (1993) Primary retroperitoneal lymph node dissection in clinical stage a non-seminomatous germ cell testis cancer. Review of the Indiana University experience 1965–1989. Br J Urol 71:326–335 Sharir S, Jewett MA, Sturgeon JF et al (1999) Progression detection of stage I nonseminomatous testis cancer on surveillance: implications for the followup protocol. J Urol 161:472–475 (discussion 475–476) Heidenreich A, Albers P, Hartmann M et al (2003) Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. J Urol 169:1710–1714 Nelson JB, Chen RN, Bishoff JT et al (1999) Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular tumors. Urology 54:1064–1067 Nielsen ME, Lima G, Schaeffer EM et al (2007) Oncologic efficacy of laparoscopic RPLND in treatment of clinical stage I nonseminomatous germ cell testicular cancer. Urology 70:1168–1172 Rassweiler JJ, Frede T, Lenz E et al (2000) Long-term experience with laparoscopic retroperitoneal lymph node dissection in the management of low-stage testis cancer. Eur Urol 37:251–260 Janetschek G, Hobisch A, Peschel R et al (2000) Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular carcinoma: long-term outcome. J Urol 163:1793–1796 Williams SB, Lau CS, Josephson DY (2011) Initial series of robot-assisted laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer. Eur Urol 60:1299–1302 Cathomas R, Hartmann M, Krege S et al (2011) Interdisciplinary evidence-based recommendations for the follow-up of testicular germ cell cancer patients. Onkologie 34:59–64 Albers P, Albrecht W, Algaba F et al (2011) EAU guidelines on testicular cancer: 2011 update. Eur Urol 60:304–319 Rustin GJ, Mead GM, Stenning SP et al (2007) Randomized trial of two or five computed tomography scans in the surveillance of patients with stage I nonseminomatous germ cell tumors of the testis: medical research council trial TE08, ISRCTN56475197 – the National Cancer Research Institute Testis Cancer Clinical Studies Group. J Clin Oncol 25:1310–1315