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Chemotherapy of Metastatic Testicular Germ Cell Tumors: Relationship of Histologic Response to Size Reduction and Changes in Tumor Markers
Author(s) -
Koshida Kiyoshi,
Kadono Yoshifumi,
Konaka Hiroyuki,
Kitagawa Yasuhide,
Imao Tetsuya,
Kobayashi Tadahiro,
Kunimi Kazuto,
Uchibayashi Tadao,
Namiki Mikio
Publication year - 1998
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.1998.tb00243.x
Subject(s) - medicine , chemotherapy , germ cell tumors , teratoma , testicular cancer , human chorionic gonadotropin , tumor marker , placental alkaline phosphatase , immature teratoma , pathology , germ cell , cancer , seminoma , urology , alkaline phosphatase , oncology , biology , hormone , biochemistry , gene , enzyme
Background Although testicular germ cell tumor is one of the most curable cancers, approximately 20% of advanced cases remain incurable. In this study we investigate factors that may predict a poor response to standard chemotherapeutic regimens and thus allow earlier initiation of more aggressive measures. Methods We analyzed the records of 19 patients with metastatic testicular germ cell tumors (8 seminomas and 11 nonseminomas). Sixteen patients underwent surgical exploration for residual tumors following chemotherapy, and the histological findings on the resulting specimens were correlated with reductions in tumor size observed on computed tomography and with changes in tumor marker levels. Results Complete necrosis was obtained in 10 of 12 lesions that shrank by at least 80%, while continued existence of teratoma or cancer was confirmed in 9 of 11 lesions with smaller size reductions. An initial human chorionic gonadotropin‐ß subunit (HCG‐ß) level more than 100 times the upper limit of normal appeared to predict poor histological response (teratoma/cancer) to chemotherapy. Slow fall (prolonged half‐life) of tumor markers during chemotherapy also correlated with poor histological response. Conclusion Factors which predict poor histological response of tumors to chemotherapy include size reduction less than 80%, initial HCG‐ß levels more than 100 times the upper limit of normal, and prolonged half‐life of tumor markers (placental alkaline phosphatase, a‐fetoprotein and HCG‐ß).