Evaluation of Demographic Status and Response to Treatment of Patients with Germ Cell Tumor at the Age of 35 or Older

Yıl 2008, Cilt: 2 Sayı: 2, 310 - 314, 27.07.2008

Süleyman Alici

Öz

In this retrospective study, 28 patients with germ cell tumor over 35 years of age fol-lowed-up in the Istanbul University, Institute of Oncology between years 1990 and 1998, were evaluated with regard to treatment morbidity and survival. The ages ranged from 35 to 61, with a median of 42 years. Four patients had pure seminoma with normal pretreatment AFP levels, and 24 patients had nonseminomatous tumors. Twenty-six patients with nonseminomatous tumors had a testis site, and two had an extragonadal primary site (mediastinum, rectum and bladder). According to International Consensus Prognostic Classification, 57% of patients had good-risk; 28% intermediate-risk, and 14% poor-risk disease. According to AJCC new TNM staging system, 14% of patients were stage la; 21% Ib, 7% stage 2a, 3% stage 2b, 10% stage 2c, 14% stage 3a, 14% stage 3b, and 10% stage 3c, respectively. 15 patients achieved complete response and 8 patients had partial response. The median follow-up was 28 months (range: 3-88 months). The median disease-free survival and overall survival were 29 months (range: 1-83 months) and 33 months (range: 3-88 months), respectively. Seven patients have died; the death was disease related in 4 patients. Grade 3/4 pulmonary toxicity was recorded in 4 (14%) patients. 4 (14%) patients had grade 3/4 mucositis. Neutropenic fever occurred in 2 (7%) patients. Grade 3/4 anemia and neutropenia occurred in 3 patients (10%) and 2 patients (7%), respectively. There were no toxic deaths. Dose reduction was done in one patient. In conclusion, patients with at the age of 35 or older with germ cell tumor (% 14 pulmonary toxicity and 25% mortality) were quite significant.

Anahtar Kelimeler

Germ cell tumors, age, mortality

Otuzbeş Yaş ve Üzeri Germ Hücre Tümörlü Hastaların Demografik Özellikleri ve Tedaviye Cevaplarının Değerlendirilmesi

Öz

Bu retrospektif çalışmada 1990 ve 1998 yıllan arasında İstanbul Üniversitesi Onkoloji Enstitüsünde takip edilmiş olan, 35 yaşının üzerinde germ hücre tümörlü 28 hasta tedavi morbiditesi ve sağkalım açısından değerlendirildi. Medyan yaş 41 (35-61 yaş) idi. Dört hastada tedavi öncesi normal alfa-feto protein (AFP) düzeyi ile seminom, 24 hastada da seminom-dışı tümör vardı. 26 hastada primer tümör yeri testis, 2 hastada ise ekstra-gonadal (mediyasten, rektum ve mesane) idi. Uluslararası konsensüs risk gruplanna göre, hastalann %57’si iyi riskli, %28’i orta riskli ve %14 u kötü riskli grupta yer alıyordu. AJCC yeni TNM evreleme sistemine göre, hastaların %14ü evre la, %21’i evre Ib, %7’si evre ila, %3 u evre Ilb, %10ü evre IIc, %14Ü evre Ula, %14ü evre Illb ve %10’u evre IIIc idi. Tedavi sonunda 15 hastada tam cevap, 8 hastada kısmi cevap elde edildi. Medyan takip süresi 28 ay (3-88 ay) idi. Medyan hastalıksız sağkalım ve genel sağkalım süresi 29 ay (1-83 ay) ile 33 ay (3-88 ay) idi. Takip sırasında 7 hasta öldü; 4 hastada ölüm sebebi germ hücreli tümördü. Grad 3/4 akciğer toksisitesi 4 (% 14) hastada görüldü. Grad 3/4 mukozit 4 (%14) hastada gelişti. Hastaların 2’sinde (%7) febril nötropeni meydana geldi. Grad 3/4 anemi 3 (%10) hastada, nötropeni 2 (%7) hastada meydana geldi. Tedavi toksisitesine bağlı ölüm olmadı. Bir hastada doz indirimi yapıldı. Sonuç olarak, germ hücre tümörlü 35 yaş ve üzeri hastalarda % 14 akciğer toksisitesi ve %25 mortalite oldukça anlamlı bulundu.

Anahtar Kelimeler

Germ hücreli tümör, yaş, mortalite

Kaynakça

• 1. DeVita VT, Hellmann S, Rosenberg SA. Cancer. In: Bosl GJ, Sheinfeld J, Bajorin DF, Motzer RJ, eds. Principles and Practice of Oncology. Cancer of the Testis. 5th ed. Philadelphia: JP Lippincott Co; 1998. p. 1397-425.
• 2. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics. CA Cancer J Clin 2007;57:43-66.
• 3. Einhorn LH. Treatment of testicular cancer: a new and improved model. J Clin Oncol 1990;8:1777-81.
• 4. Bosl GJ, Gluckman R, Geller NL, GolbeyRB, Whitmore WF Jr, Herr H, et al. VAP-6: An effective chemotherapy regimen for patirnts with germ cell tumors. J Clin Oncol 1986;4:1493-9.
• 5. Einhorn LH, Williams SD, Troner M, Birch R, Greco FA. The role of maintanence therapy in disseminated testicular cancer. N Engl J Med 1981 ;305:727-31.
• 6. Williams SD, Birch R, Einhorn LH, Irwin L, Greco FA, Loehrer PJ. Treatment of dissemi- nated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med 1987;316:1435-40.
• 7. Vogelzang NJ, Bosl GJ, Johnson K, Kennedy BJ. Raynaud’s phenomenon: A common toxicity after combination chemotherapy for testicular cancer. Ann Intern Med 1981;95: 288-92.
• 8. Bajorin D, Katz A, Chan E, Geller N, Vogelzang N, Bosl GJ. Comparison of criteria for assigning germ cell tumor patients to “good risk” and “poor risk" studies. J Clin Oncol 1988;6:786-92.
• 9. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer chemother Rep 1996;50:163-70.
• 10. Testis. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. Philadelphia, Pa: Lippincott-Raven Publishers; 5th ed., 1997. p.225-30.
• 11. Bosl GJ. Germ cell tumors: There is still plenty to learn. J Clin Oncol 1998; 16; 1244-6.
• 12. Culine S, Kerbrat P, Kramar A, Theodore C, Chevreau C, Geoffrois L, et al. Refining the optimal chemotherapy regimen for good-risk metastatic nonseminomatous germ-cell tumors: a randomized trial of the Genito-Urinary Group of the French Federation of Cancer Centers (GETUG T93BP). Ann Oncol 2007;18:917-24.
• 13. Xiao H, Mazumdar M, Bajorin DF, Sarosdy M, Vlamis V, Spicer J, et al. Long-term followup of patients with good-risk germ cell tumors treated with etoposide and cisplatin. J Clin Oncol1997;15; 2553-8.
• 14. Cora LR, Hanks GE. Complications from large field intermediate dose infradiaphragmatic radiation: An analysis of the patterns of care outcome studies for Hodgkin’s Disease and seminoma. Int J Radiat Oncol Biol Phys 1988;64:29-35.
• 15. Borke MB, Wilkers GM, Berg D, Bean CK, In-gwersen K. Cancer chemotherapy. A nursing process approach. 1st ed. Boston: Jones&Bar-lett Publishers; 1991.