Universität zu Köln

Heidenreich, Axel, Pfister, David and Paffenholz, Pia (2021). Salvage management of patients with relapsing testicular germ cell tumors. Curr. Opin. Urol., 31 (3). S. 206 - 214. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1473-6586

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Abstract

Purpose of review This review aims to summarize the latest evidence of medical and surgical treatment options for patients with relapsing testicular germ cell tumors. Recent findings Depending on International Germ Cell Cancer Classification Group risk classification 10-50% of patients with metastatic TGCT develop relapse which needs further multimodality treatment. With regard to therapy, early relapses are stratified according to their prognostic risk profile which results in a 3-year overall survival between 6% in the very high to 77% in the very low risk group. Prognostic risk score dictates systemic therapy which might be second line chemotherapy (TIP, PEI) or high dose chemotherapy. Any residual masses following salvage chemotherapy need to be completely resected due the presence of viable cancer and/or teratoma in more than 50% of cases. Targeted therapy in men with druggable mutations is for individualized cases only. Patients with late relapses developing more than 2 years after first-line chemotherapy are best managed by surgery. Desperation surgery is reserved for those patients with rising markers during or immediately after chemotherapy and good risk factors such as rising alpha-fetoprotein, <3 metastatic sites and complete resectability. Multimodality treatment will result in long-term cure of 25% to 60%. Due to the complexity of treatment, chemotherapy as well as surgery should be performed in highly experienced centres only. Multimodality treatment to salvage relapsing patients with metastatic testis cancer requires extensive experience for both systemic therapy and surgery. If done properly, it will result in moderate to high cure rates. Personalized therapeutic options are currently evaluated in clinical trials.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Paffenholz, Pia UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-571874
DOI:	10.1097/MOU.0000000000000875
Journal or Publication Title:	Curr. Opin. Urol.
Volume:	31
Number:	3
Page Range:	S. 206 - 214
Date:	2021
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1473-6586
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language HIGH-DOSE CHEMOTHERAPY; LYMPH-NODE DISSECTION; CISPLATIN-BASED CHEMOTHERAPY; IFOSFAMIDE PLUS CISPLATIN; PHASE-II; RETROPERITONEAL LYMPHADENECTOMY; COMBINATION CHEMOTHERAPY; PATHOLOGICAL FINDINGS; GEMCITABINE; CANCER Multiple languages Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57187