Testicular Cancer; Investigation and Management : Alan Horwich: 9780412612107: Book: Medical: eCampus.com

The Royal Marsden NHS Trust, Surrey, U.K. Text on testicular germ cell tumors, for oncologists and urologists. New chapters discuss the clinical relevance of current research and controversies such as management of Stage II non-seminoma. Previous edition 1991. 38 contributors, 11 U.S.

Contributors

xiii

Preface to the first edition

xvii

Preface

xix

Testicular germ cell tumors: an introductory overview

(18)

A. Horwich

Introduction

(2)

Epidemiology

(1)

Etiological factors

(2)

Pathology

(2)

Clinical presentation

(3)

An overview of the management of germ cell tumors

(3)

Staging

(5)

Advances in tumor imaging

(16)

J. Husband

Introduction

(1)

Diagnosis

(1)

Staging

(5)

Accuracy and role of imaging techniques

(4)

Monitoring treatment response

(2)

Biopsy techniques

(1)

Effect of treatment on normal tissue

(1)

Conclusions

(3)

Tumor markers

(18)

M. D. Mason

Introduction

(1)

The cellular origins of alpha-fetoprotein and human chorionic gonadotrophin in testicular tumors

(1)

Basis and interpretation of marker assays

(4)

The role of tumor markers in diagnosis and staging

(2)

The prognostic significance of tumor marker elevation

(1)

The kinetics of serum alpha-fetoprotein and human chorionic gonadotrophin

(1)

The use of serum markers in estimating marker production

(1)

Testicular tumor markers in imaging

(1)

Other markers of testicular cancer

(2)

Future prospects

(6)

Molecular biology of male germ cell tumors

(8)

R.S.K. Chaganti

G.J. Bosl

Introduction

(1)

Pathobiology of germ cell tumors

(1)

Chromosomal changes in germ cell tumors

(1)

Molecular changes in germ cell tumors

(3)

A genetic model for germ cell tumor development

(1)

A genetic model for germ cell tumor differentiation

(3)

Differentiation in germ cell tumors

(12)

J.W. Oosterhuis

P.W. Andrews

Introduction

(1)

Clustering according to developmental potential

(5)

Developmental clusters by site and age

(1)

Genomic imprinting

(1)

Human GCT in culture

(2)

Conclusions

(3)

Prognostic classification of metastatic seminoma

(12)

R.T.D. Oliver

Introduction

(1)

Relevance of modern views on pathology of germ cell cancer to prognostication of metastatic seminoma

(2)

HIV and prognosis of germ cell tumors

(1)

Prognostication of metastatic seminoma on the basis of response to therapy

(2)

Prognostic factors and single agent platinum for lymph node metastatic Stage II and III seminoma

(1)

Relevance of prognostic classification of germ cell cancer to future trials in metastatic seminoma

(1)

Summary and conclusions

(4)

Prognostic classification in metastatic non-seminoma

(14)

D.F. Bajorin

Introduction

(2)

Factors influencing prognostic modeling

(2)

Multivariate analyses

(4)

Comparisons of eligibility criteria for good and poor risk trials

(2)

Conclusions

(4)

Management of Stage I seminoma: radiotherapy

(24)

G. K. Zagars

Introduction

(1)

Rationale for radiotherapy

100

(1)

Investigation and staging evaluation

100

(2)

Radiotherapy

102

(6)

Results

108

(4)

Complications

112

(5)

Conclusions

117

(6)

Surveillance for Stage I seminoma of the testis

123

(10)

A. Horwich

Introduction

123

(2)

The surveillance management policy for Stage I seminoma

125

(1)

Results of surveillance for Stage I seminoma

126

(3)

Conclusions

129

(4)

Radiotherapy in the management of metastatic seminoma

133

(14)

G.M. Thomas

Introduction

133

(1)

Stage II

134

(8)

Marker-positive pure seminoma

142

(1)

Residual masses after chemotherapy

142

(1)

Stages III and IV

143

(1)

Metastatic disease

144

(1)

Conclusions

144

(3)

Chemotherapy for metastatic seminoma

147

(8)

L.Y. Dirix

A.T. Van Oosterom

Introduction

147

(1)

History of chemotherapy in metastatic seminoma

147

(1)

Single agent data with cisplatin

148

(1)

Single agent data with carboplatin

149

(1)

Cisplatin-based combination chemotherapy

149

(3)

Conclusions

152

(3)

Response evaluation in seminoma

155

(10)

S.D. Fossa

Introduction

155

(1)

Biochemical response

155

(3)

Clinical response

158

(1)

Histopathological response

158

(3)

Progression-free survival and overall survival

161

(4)

Management of Stage I non-seminoma: surveillance

165

(16)

M.H. Cullen

J.-P. Droz

Historical introduction

165

(1)

Radiotherapy

165

(1)

Surveillance

166

(1)

Medical Research Council studies

166

(4)

Other studies of surveillance

170

(2)

Prognostic factors in Stage 1 non-seminomatous germ cell tumors of the testis

172

(1)

Medical Research Council studies of prognostic factors

173

(5)

Conclusions

178

(3)

Adjuvant chemotherapy in high risk Stage I non-seminomatous germ cell tumors of the testis

181

(12)

M.H. Cullen

Introduction

181

(1)

Drawbacks of surveillance

181

(1)

Alternatives to surveillance

182

(1)

MRC adjuvant chemotherapy study

182

(4)

Other studies of adjuvant chemotherapy

186

(1)

Options Project

186

(3)

Conclusions

189

(4)

Rationale for lymphadenectomy in Stage T non-seminoma

193

(8)

G. Pizzocaro

Introduction

193

(1)

Pathological verification of clinical staging

193

(2)

Therapeutic value of lymphadenectomy

195

(1)

Evolution of surgical skill

195

(1)

Comparison of medical treatments and lymphadenectomy

196

(1)

Conclusions

197

(4)

Retroperitoneal lymphadenectomy in staging and treatment: the development of nerve-sparing techniques

201

(12)

J.P. Donohue

J.A. Thornhill

Background to developments in retroperitoneal lymphadenectomy

201

(1)

Sequential modifications in operative techniques

202

(3)

The surgical technique of nerve-sparing modified retroperitoneal lymph node dissection

205

(3)

The results of nerve-sparing modified retroperitoneal lymph node dissection

208

(1)

The contribution of nerve-sparing modified retroperitoneal lymph node dissection

209

(4)

Role of lymph node dissection in clinical Stage II non-seminoma

213

(10)

M.A.S. Jewett

E.D. Hirshberg

Introduction

213

(1)

Risk of overstaging

214

(1)

Treatment with retroperitoneal lymphadenectomy

215

(2)

Our results of retroperitoneal lymphadenectomy (RPL) for Stage II non-seminoma

217

(1)

Model for stratifying patients for treatment

218

(5)

Primary chemotherapy for Stage II non-seminoma

223

(4)

A. Horwich

Introduction

223

(1)

The Royal Marsden Hospital series

223

(1)

RMH series - toxicity

224

(1)

Medical Research Council series

225

(1)

Discussion

225

(2)

Chemotherapy for metastatic non-seminoma

227

(24)

C.R. Nichols

B.J. Roth

Introduction

227

(1)

Early single agent activity

227

(2)

Early combination chemotherapy regimens

229

(2)

Bleomycin

231

(1)

Vinblastine/bleomycin

231

(2)

Cisplatin

233

(1)

Vinblastine/actinomycin-D/bleomycin regimens 1-6

233

(1)

Trials at Indiana University

234

(4)

Treatment of patients with `good risk' disseminated disease

238

(1)

Treatment of patients with `poor risk' disseminated disease

239

(2)

Late effects of treatment

241

(1)

Standard management of germ cell tumors at Indiana University

242

(2)

Conclusions

244

(7)

Management of metastatic germ cell tumors: toxicity reduction and the use of bleomycin

251

(8)

G. J. Bosl

Introduction

251

(1)

Toxicity reduction in good risk patients

252

(3)

Discussion and recommendations

255

(4)

Dose escalation of cisplatin in the chemotherapy of poor risk germ cell tumor patients

259

(12)

M. Rørth

Introduction

259

(1)

Rationale for, and feasibilty of, dose escalation

260

(1)

Selection of poor risk patients

260

(3)

Results of trials employing high cisplatin doses

263

(2)

Toxicity

265

(2)

Future aspects

267

(4)

Intensive induction chemotherapy for poor risk tumors

271

(16)

D.P. Dearnaley

Introduction

271

(1)

Rationale for intensive induction chemotherapy

271

(2)

Design of intensive induction chemotherapy schedule

273

(1)

Patients and methods

274

(2)

Results

276

(1)

Toxicity of treatment (Table 22.3)

276

(2)

Discussion

278

(9)

Alternating regimens to overcome drug resistance in poor risk germ cell tumor patients

287

(8)

R. de Wit

G. Stoter

Introduction

287

(1)

Phase II studies

288

(2)

Phase III studies

290

(1)

Discussion

291

(4)

The role of hematopoietic growth factors in the chemotherapy of germ cell tumors

295

(12)

H.-J. Schmoll

C. Bokemeyer

Introduction

295

(1)

Biological interactions between HGF and malignant germ cell tumors

295

(1)

Clinical use of HGF in standard dose combination chemotherapy

296

(3)

The role of HGF for experimental high dose treatment approaches

299

(8)

Salvage therapy and autologous bone marrow transplantation

307

(12)

A. Sandler

P. Loehrer

Introduction

307

(1)

Pitfalls in salvage chemotherapy

307

(1)

Salvage chemotherapy

308

(6)

Bone marrow transplantation

314

(2)

Conclusions

316

(3)

Abdominal surgery postchemotherapy in metastatic non-seminoma

319

(16)

W. F. Hendry

Introduction

319

(1)

Planning and preparation

320

(3)

The operation

323

(3)

Postoperative care

326

(1)

Results and prognostic factors

326

(3)

Complications

329

(2)

Conclusions

331

(4)

Thoracotomy postchemotherapy in non-seminoma patients

335

(10)

P. Goldstraw

Introduction

335

(1)

Personal experience

336

(5)

Conclusions

341

(4)

Malignant extragonadal germ cell tumors in adults

345

(24)

D. Raghavan

M. Boyer

Introduction

345

(2)

Malignant germ cell tumors of mediastinum

347

(6)

Malignant germ cell tumors of the retroperitoneum

353

(3)

Intracranial germ cell tumors

356

(6)

Atypical teratoma syndrome

362

(1)

Conclusions

363

(6)

Diagnosis and management of carcinoma in situ of the testis

369

(12)

H. von der Maase

Introduction

369

(1)

Histopathology

369

(1)

Diagnosis

370

(1)

Incidence

371

(2)

Treatment

373

(8)

Toxicities of chemotherapy for metastatic testicular cancer

381

(22)

J. Vogelzang

Introduction

381

(1)

Toxicities of single agents

382

(13)

Toxicities of combinations

395

(2)

Conclusions

397

(6)

Psychosocial assessments and counseling of the patient with testicular cancer

403

(18)

C. Moynihan

Introduction

403

(2)

Psychological morbidity

405

(2)

Sexual dysfunction and infertility distress

407

(4)

Social issues

411

(2)

Suggestions for counseling intervention

413

(2)

Discussion

415

(6)

Index

421


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