Testis Kanseri Tedavisinde Güncel Yaklaşım

Öz

Testis kanseri 15-44 yaş arası genç erkekleri etkileyen en sık kanserdir. Sıklığı gelişmiş ülkelerde giderek artmaktadır. Testis kanserinin artan insidansına rağmen mortalitesi özellikle gelişmiş ülkelerde on yıllar boyunca düşmektedir. Gelişmiş ülkelerde evre I testis kanseri kür oranı %100’e ulaşmaktadır. Metastatik hastalıkta ise prognostik risk gruplarına göre kür oranı %90 ile %48 arasında değişmektedir. Testiste şüpheli kitlesi olan erkek orşiektomiye gitmeden önce alfa-fetoprotein (AFP), human koryonik gonadotropin (HCG) ve laktat dehidrogenazı (LDH) içeren serum tümör belirteçleri görülmelidir. Tanı için görüntülemede skrotal ultrasonografi yeterlidir. Testis kanserinin primer tedavisi inguinal kesi ile yapılan ve testis ile beraber spermatik kordun internal inguinal ring düzeyine dek tümüyle çıkarılmasından oluşan radikal orşiektomi operasyonudur. Testis kanserinde kemoterapi, özellikle sisplatin bazlı olanlar, testis kanserinin kemo-sensitivitesi nedeniyle mükemmel tedavi oranlarına sahiptir. Testis kanseri tedavisi kanserin evresi ve seminom patolojisinde olup olmamasına göre şekillendirilir.

Anahtar Kelimeler

• orşiektomi
• retroperitoneal lenf nodu diseksiyonu
• testis kanseri

Current Approach in Testicular Cancer Treatment

Öz

Testicular cancer is the most common cancer affecting young men aged 15-44. Its incidence is increasing in developed countries. Despite the increasing incidence of testicular cancer, its mortality has been decreasing for decades, especially in developed countries. In developed countries, the cure rate of stage I testicular cancer reaches 100%. In metastatic disease, the cure rate varies between 90% and 48%, depending on the prognostic risk groups. Serum tumor markers including alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) should be seen before a man with a suspicious mass in the testis undergoes orchiectomy. Scrotal ultrasonography is sufficient for diagnosis. The primary treatment of testicular cancer is a radical orchiectomy operation, which is performed with an inguinal incision and consists of the complete removal of the testis and the spermatic cord up to the level of the internal inguinal ring. Chemotherapy in testicular cancer, especially those based on cisplatin, has excellent cure rates because of the chemo-sensitivity of testicular cancer. Treatment of testicular cancer is shaped according to the stage of the cancer and whether it is in the pathology of seminoma.

Anahtar Kelimeler

• Testicular cancer
• orchiectomy
• retroperitoneal lymph node dissection

Kaynakça

1. Woldu SL, Bagrodia A. Update on epidemiologic considerations and treatment trends in testicular cancer. Curr Opin Urol. 2018;28(5):440-447.
2. Stephenson A, Eggener SE, Bass EB, Chelnick DM, Daneshmand S, Feldman D, et al. Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline. J Urol. 2019;202(2):272-281.
3. Vaz RM, Bordenali G, Bibancos M. Testicular Cancer-Surgical Treatment. Front Endocrinol (Lausanne). 2019;10:308.
4. Baird DC, Meyers GJ, Hu JS. Testicular Cancer: Diagnosis and Treatment. Am Fam Physician. 2018;97(4):261-268.
5. Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, et al. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol. 2018;29(8):1658-1686.
6. Ehrlich Y, Margel D, Lubin MA, Baniel J. Advances in the treatment of testicular cancer. Transl Androl Urol. 2015;4(3):381-390.
7. EAU Guidelines on Testicular Cancer [Internet]. 2020. Available from: https://uroweb.org/guideline/testicular-cancer/.
8. Tandstad T, Stahl O, Dahl O, Haugnes HS, Hakansson U, Karlsdottir A, et al. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol. 2016;27(7):1299-1304.

9. Melchior D, Hammer P, Fimmers R, Schuller H, Albers P. Long term results and morbidity of paraaortic compared with paraaortic and iliac adjuvant radiation in clinical stage I seminoma. Anticancer Res. 2001;21(4B):2989-93.
10. Zwahlen DR, Martin JM, Millar JL, Schneider U. Effect of radiotherapy volume and dose on secondary cancer risk in stage I testicular seminoma. Int J Radiat Oncol Biol Phys. 2008;70(3):853-858.
11. Bernard B, Sweeney CJ. Diagnosis and Treatment of Testicular Cancer: A Clinician's Perspective. Surg Pathol Clin. 2015;8(4):717-723.
12. Krege S, Boergermann C, Baschek R, Hinke A, Pottek T, Kliesch S, et al. Single agent carboplatin for CS IIA/B testicular seminoma. A phase II study of the German Testicular Cancer Study Group (GTCSG). Ann Oncol. 2006;17(2):276-280.
13. Tabakin AL, Shinder BM, Kim S, Rivera-Nunez Z, Polotti CF, Modi PK, et al. Retroperitoneal Lymph Node Dissection as Primary Treatment for Men With Testicular Seminoma: Utilization and Survival Analysis Using the National Cancer Data Base, 2004-2014. Clin Genitourin Cancer. 2019.
14. Weissbach L, Bussar-Maatz R, Flechtner H, Pichlmeier U, Hartmann M, Keller L. RPLND or primary chemotherapy in clinical stage IIA/B nonseminomatous germ cell tumors? Results of a prospective multicenter trial including quality of life assessment. Eur Urol. 2000;37(5):582-594.
15. Massard C, Plantade A, Gross-Goupil M, Loriot Y, Besse B, Raynard B, et al. Poor prognosis nonseminomatous germ-cell tumours (NSGCTs): should chemotherapy doses be reduced at first cycle to prevent acute respiratory distress syndrome in patients with multiple lung metastases? Ann Oncol. 2010;21(8):1585-1588.
16. De Santis M, Becherer A, Bokemeyer C, Stoiber F, Oechsle K, Sellner F, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004;22(6):1034-9.
17. Herr HW, Sheinfeld J, Puc HS, Heelan R, Bajorin DF, Mencel P, et al. Surgery for a post-chemotherapy residual mass in seminoma. J Urol. 1997;157(3):860-862.
18. Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Therapeutic Advances in Urology. 2012;4(4):187-205.
19. Miller KD, Loehrer PJ, Gonin R, Einhorn LH. Salvage chemotherapy with vinblastine, ifosfamide, and cisplatin in recurrent seminoma. J Clin Oncol. 1997;15(4):1427-1431.
20. Fizazi K, Gravis G, Flechon A, Geoffrois L, Chevreau C, Laguerre B, et al. Combining gemcitabine, cisplatin, and ifosfamide (GIP) is active in patients with relapsed metastatic germ-cell tumors (GCT): a prospective multicenter GETUG phase II trial. Ann Oncol. 2014;25(5):987-891.
21. Lorch A, Neubauer A, Hackenthal M, Dieing A, Hartmann JT, Rick O, et al. High-dose chemotherapy (HDCT) as second-salvage treatment in patients with multiple relapsed or refractory germ-cell tumors. Ann Oncol. 2010;21(4):820-5.
22. Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT, et al. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. 2004;22(1):108-114.
23. Oechsle K, Kollmannsberger C, Honecker F, Mayer F, Waller CF, Hartmann JT, et al. Long-term survival after treatment with gemcitabine and oxaliplatin with and without paclitaxel plus secondary surgery in patients with cisplatin-refractory and/or multiply relapsed germ cell tumors. Eur Urol. 2011;60(4):850-855.
24. Mego M, Svetlovska D, Miskovska V, Obertova J, Palacka P, Rajec J, et al. Phase II study of everolimus in refractory testicular germ cell tumors. Urol Oncol. 2016;34(3):122 e17-22.
25. Necchi A, Lo Vullo S, Giannatempo P, Raggi D, Calareso G, Togliardi E, et al. Pazopanib in advanced germ cell tumors after chemotherapy failure: results of the open-label, single-arm, phase 2 Pazotest trial. Ann Oncol. 2017;28(6):1346-1351.
26. Jain A, Brames MJ, Vaughn DJ, Einhorn LH. Phase II clinical trial of oxaliplatin and bevacizumab in refractory germ cell tumors. Am J Clin Oncol. 2014;37(5):450-453.
27. Albany C, Einhorn L, Garbo L, Boyd T, Josephson N, Feldman DR. Treatment of CD30-Expressing Germ Cell Tumors and Sex Cord Stromal Tumors with Brentuximab Vedotin: Identification and Report of Seven Cases. Oncologist. 2018;23(3):316-323.
28. Feldman DR, Lorch A, Kramar A, Albany C, Einhorn LH, Giannatempo P, et al. Brain Metastases in Patients With Germ Cell Tumors: Prognostic Factors and Treatment Options--An Analysis From the Global Germ Cell Cancer Group. J Clin Oncol. 2016;34(4):345-351.