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Diagnosis and Treatment of Patients with Testicular Germ Cell Cancer

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Abstract

Testicular germ cell tumours are a highly curable malignancy even in the presence of metastases, with an overall survival rate of approximately 90 to 95% when all stages are considered. Current therapeutic strategies aim at risk-adapted therapy, trying to maintain favourable overall results while reducing treatment-related toxicity, particularly in non-advanced disease.

In stage I disease, unilateral inguinal orchiectomy represents the standard diagnostic and therapeutic approach. For patients with clinical stage I seminoma, prophylactic para-aortic radiotherapy with 26Gy is commonly employed. In patients with nonseminomatous germ cell tumours (NSGCT) at clinical stage I, the 3 options are: (i) retroperitoneal lymphadenectomy; (ii) a wait-and-see strategy; or (iii) 2 cycles of adjuvant chemotherapy. The individual risk profile for tumour recurrence, mainly based on histopathological criteria such as vascular tumour invasion, should guide treatment decisions in this group of patients.

Radiotherapy is still the standard approach in clinical stage IIA/B seminoma, whereas in patients with a low tumour burden of NSGCT, retroperitoneal lymphadenectomy is frequently used followed by surveillance or adjuvant chemotherapy. Primary chemotherapy in these stages of disease may be at least equally successful.

Major progress has also been achieved in the treatment of NSGCT patients with metastatic disease greater than clinical stage IIB, for whom primary chemotherapy represents the standard approach. After cisplatin-based combination chemotherapy, between 70 and 90% of patients will achieve a durable remission. In patients with ‘good risk’ metastatic disease, 3 cycles of cisplatin, etoposide and bleomycin (PEB) remain the standard treatment, despite several randomised trials trying to avoid the lung-toxic bleomycin or substituting cisplatin by carboplatin. In patients with ‘intermediate’ and ‘poor prognosis’ disease, 4 cycles of PEB given at 3-week intervals are considered routine treatment.

The role of high dose chemotherapy with peripheral autologous blood stem cell transplantation is currently being investigated for patients presenting initially with advanced (poor prognosis) metastatic disease and for patients with relapse after previous chemotherapy, in whom conventional-dose salvage regimens will only result in 20% long-term survival.

Because of the large group of patients with metastatic disease being cured, the possible long-term adverse effects of treatment have become important. Only a slightly elevated risk for therapy-related secondary malignancies has been identified. Long-term adverse effects associated with cisplatin may affect a larger proportion of patients. Further research should focus on reducing the risk of chemotherapy-related chronic toxicity.

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References

  1. Osterlind A. Diverging trends in incidence and mortality of testicular cancer in Denmark, 1943–1982. Br J Cancer 1986; 53: 501–5

    Article  PubMed  CAS  Google Scholar 

  2. Hernes EH, Harstad K, Fossa SD. Changing incidence and delay of testicular cancer in southern Norway, 1981–1992. Eur Urol 1992; 30: 349–57

    Google Scholar 

  3. Stone J, Cruickshank D, Sandeman T, et al. Trebling of the incidence of testicular cancer in Victoria, Australia 1950–1985. Cancer 1991; 68: 211–9

    Article  PubMed  CAS  Google Scholar 

  4. Buetow SA. Epidemiology of testicular cancer. Epidemiol Rev 1995; 17: 433–49

    PubMed  CAS  Google Scholar 

  5. Batata M, Chu F, Hilaris B, et al. Testicular cancer in cryptorchids. Cancer 1982; 49: 1023–30

    Article  PubMed  CAS  Google Scholar 

  6. Satge D, Sasco AJ, Cure H, et al. An excess of testicular germ cell tumors in Down’s syndrome. Cancer 1997; 80: 929–35

    Article  PubMed  CAS  Google Scholar 

  7. Dieckmann K-P, Pichlmeier U. The prevalence of familial testicular cancer: an analysis of two patient populations and a review of the literature. Cancer 1997; 80: 1954–60

    Article  PubMed  CAS  Google Scholar 

  8. Mostofi FK, Sesterhenn IA. WHO classification of testicular cancer. 2nd ed. Berlin: Springer, 1998

    Google Scholar 

  9. Jacobsen G, Henriksen OB, von der Maase H. Carcinoma in situ of testicular tissue adjacent to malignant germ-cell tumors: a study of 105 cases. Cancer 1981; 47(11): 2660–2

    Article  PubMed  CAS  Google Scholar 

  10. Dieckmann KP, Loy V. Prevalence of contralateral testicular intraepithelial neoplasia in patients with germ cell neoplasia. J Clin Oncol 1996; 14: 3126–32

    PubMed  CAS  Google Scholar 

  11. Pryor JP, Cameron KM, Chilton CP, et al. Carcinoma in situ in testicular biopsies from men presenting with infertility. Br J Urol 1983; 55: 780–4

    Article  PubMed  CAS  Google Scholar 

  12. Chaganti RS, Rodriguez E, Bosl GJ. Cytogenetics of male germ cell tumors. Urol Clin North Am 1993; 20: 55–66

    PubMed  CAS  Google Scholar 

  13. Rodriguez E, Mathew S, Reuter V, et al. Cytogenetic analysis of 124 prospectively ascertained male germ cell tumors. Cancer Res 1992; 52: 2285–91

    PubMed  CAS  Google Scholar 

  14. Bosl GJ, Ilson DH, Rodriguez E, et al. Clinical relevance of the i(12p) marker chromosome in germ cell tumors. JNatl Cancer Inst 1994; 86: 349–55

    Article  CAS  Google Scholar 

  15. Mostert MMC, van de Pol M, Olde-Weghuis D, et al. Comparative genomic hybridization of germ cell tumors of the adult testis: confirmation of karyotypic findings and identification of a 12p-amplicon. Cancer Genet Cytogenet 1996; 89: 146–52

    Article  PubMed  CAS  Google Scholar 

  16. Vos A, Oosterhuis W, de Jong B, et al. Cytogenetics of carcinoma in situ of the testis. Cancer Genet Cytogenet 1990; 46: 75–81

    Article  PubMed  CAS  Google Scholar 

  17. Manivel J, Jessurun J, Wick M, et al. Placental alkaline phosphatase immunoreactivity in testicular germ-cell neoplasms. Am J Surg Pathol 1987; 11: 21–9

    Article  PubMed  CAS  Google Scholar 

  18. Cavalli F, Monfardini S, Pizzocaro G. Report on the international workshop on staging and treatment of testicular cancer. Eur J Cancer 1980; 16: 1367–72

    Article  PubMed  CAS  Google Scholar 

  19. Fleming ID, editor. Testis. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott-Raven, 1997: 225–30

    Google Scholar 

  20. Mead GM, Stenning SP, Cook P, et al. International germ cell consensus classification: a prognostic factor-erased staging system for metastatic germ cell cancers. J Clin Oncol 1997; 15: 594–603

    Google Scholar 

  21. Fossa S, Aass N, Kaalhus O. Radiotherapy for testicular seminoma stage I: treatment results and long-term post-irradiation morbidity in 365 patients. Int J Radiat Oncol Biol Phys 1989; 16: 383–8

    Article  PubMed  CAS  Google Scholar 

  22. Zagars GK, Babaian RJ. Stage I testicular seminoma: rationale for postorchidectomy radiation therapy. Int J Radiat Oncol Biol Phys 1987; 13: 155–62

    Article  PubMed  CAS  Google Scholar 

  23. van Leeuwen F, Stiggelbout A, van den Belt-Dusebout A, et al. Second cancer risk following testicular cancer: a follow up study of 1,909 patients. J Clin Oncol 1993; 11: 415–24

    PubMed  Google Scholar 

  24. Warde P, von der Maase H, Horwich A, et al. Stage I testicular seminoma: results of adjuvant irradiation and surveillance [abstract 1188]. Proc Am Soc Clin Oncol 1998; 17: 309a

    Google Scholar 

  25. Donohue JP, Thornhill JA, Foster RS, et al. Primary retroperitoneal lymph node dissection in clinical stage A non-seminomatous germ cell testis cancer: review of the Indiana University experience 1965–1989. Br JUrol 1993; 71: 326–35

    Article  CAS  Google Scholar 

  26. Pizzocaro G. Rationale for lymphadenectomy in stage I non-seminoma. In: Horwich A, editor. Testicular cancer. 2nd ed. London: Chapman and Hall Medical, 1996: 193–200

    Google Scholar 

  27. McLeod DG, Weiss RB, Stablein DM, et al. Staging relationships and outcome in early stage testicular cancer: a report from the Testicular Cancer Intergroup Study. J Urol 1991; 145: 1178–83

    PubMed  CAS  Google Scholar 

  28. Donohue JP, Thornhill JA, Foster-RS, et al. Stage I non-seminomatous germ-cell testicular cancer — management options and risk-benefit considerations. World J Urol 1994; 12: 170–6

    PubMed  CAS  Google Scholar 

  29. Droz JP, van Oosterom AT. Treatment options in clinical stage I non-seminomatous germ cell tumours of the testis: a wager on the future? Areview. Eur J Cancer 1993; 29A: 1038–44

    Article  PubMed  CAS  Google Scholar 

  30. Sesterhenn IA, Weiss RB, Mostofi FK, et al. Prognosis and other clinical correlates of pathologic review in stage I and II testicular carcinoma: a report from the Testicular Cancer Intergroup Study. J Clin Oncol 1992; 10(1): 69–78

    PubMed  CAS  Google Scholar 

  31. Donohue JP, Zachary JM, Maynard BR. Distribution of nodal metastases in nonseminomatous testis cancer. J Urol 1982; 128: 315–20

    PubMed  CAS  Google Scholar 

  32. Raghavan D, Vogelzang NJ, Bosl GJ, et al. Tumor classification and size in germ-cell testicular cancer: influence on the occurrence of metastases. Cancer 1982; 50: 1591–5

    Article  PubMed  CAS  Google Scholar 

  33. Donohue JP, Foster RS, Rowland RG, et al. Nerve-sparing retroperitoneal lymphadenectomy with preservation of ejaculation. J Urol 1990; 144: 287–91

    PubMed  CAS  Google Scholar 

  34. Peckham MJ, Barrett A, Husband JE, et al. Orchiectomy alone in testicular stage I nonseminomatous germ cell tumors. Lancet 1982; II(8300): 678–80

    Article  Google Scholar 

  35. Bokemeyer C, Schmoll H-J, Kuczyk MA, et al. Risk of secondary leukemia following high cumulative doses of etoposide during chemotherapy for testicular cancer. J Natl Cancer Inst 1995; 87: 58–60

    Article  PubMed  CAS  Google Scholar 

  36. Freedman LS, Parkinson MC, Jones WG, et al. Histopathology in the prediction of relapse of patients with stage I testicular teratoma treated by orchiectomy alone. Lancet 1987; JJ(8554): 294–8

    Article  Google Scholar 

  37. Cullen MH, Stenning SP, Parkinson MC, et al. Short course adjuvant chemotherapy in high risk stage I non-seminomatous germ cell tumours of the testis: a Medical Research Council report. J Clin Oncol 1996; 14: 1106–13

    PubMed  CAS  Google Scholar 

  38. Pont J, Albrecht W, Postner G, et al. Adjuvant chemotherapy for high-risk clinical stage I nonseminomatous testicular germ cell cancer: long-term results of a prospective trial. J Clin Oncol 1996; 14: 441–8

    PubMed  CAS  Google Scholar 

  39. Bokemeyer C, Kuczyk MA, Serth J, et al. Treatment of clinical stage I testicular and cancer and the possible role for new biological prognostic parameters. J Clin Oncol Res Clin Oncol 1996; 122: 575–84

    Article  CAS  Google Scholar 

  40. Albers P, Bierhoff E, Neu D, et al. MTB-1 immunohistochemistry in clinical stage I nonseminomatous testicular germ cell tumors predicts patients at low risk for metastasis. Cancer 1997; 79: 1710–6

    Article  PubMed  CAS  Google Scholar 

  41. Leibovitch I, Foster RS, Kopecky KK, et al. Identification of clinical stage a nonseminomatous testis cancer patients at extremely low risk for metastatic disease: a combined approach using quantitative immunohistochemical, histopathologic, and radiologic assessment. J Clin Oncol 1998; 16: 261–8

    PubMed  CAS  Google Scholar 

  42. Schmidberger H, Bamberg M, Meisner C, et al. Radiotherapy in Stage IIA and TIB testicular seminoma with reduced portals: a prospective multicenter study. Int J Radiat Oncol Biol Phys 1997; 39: 321–6

    Article  PubMed  CAS  Google Scholar 

  43. Motzer RJ, Sheinfeld J, Mazumdar M, et al. Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors. J Clin Oncol 1995; 13: 2700–4

    PubMed  CAS  Google Scholar 

  44. Williams SD, Stablein DM, Einhorn LH, et al. Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer. N Engl J Med 1987; 317: 1433–8

    Article  PubMed  CAS  Google Scholar 

  45. Albers P, Albers J, Cummings OW, et al. Flow cytometric and cytophotometric DNA analysis cannot predict subsequent tumour recurrence in pathological stage IIA/B non-seminomatous testicular germ cell tumour patients who do not receive adjuvant chemotherapy [letter]. Eur J Cancer 1995; 31A: 848–9

    Article  PubMed  CAS  Google Scholar 

  46. Willan B, McGowan D. Seminoma of the testis: a 22-year experience with radiation therapy. Int J Radiat Oncol Biol Phys 1985; 11: 1769–75

    Article  PubMed  CAS  Google Scholar 

  47. Gregory C, Peckham M. Results of radiotherapy for stage II testicular seminoma. Radiother Oncol 1986; 6: 285–92

    Article  PubMed  CAS  Google Scholar 

  48. Fossa SD, Droz JP, Stoter G, et al. Cisplatin, vincristine and ifosphamide combination chemotherapy of metastatic seminoma: results of EORTC trial 30874. EORTC GU Group. Br J Cancer 1995; 71: 619–24

    Article  CAS  Google Scholar 

  49. Logothetis CJ, Samuels ML, Ogden SL, et al. Cyclophosphamide and sequential cisplatin for advanced seminoma: long-term follow up in 52 patients. J Urol 1987; 138: 789–94

    PubMed  CAS  Google Scholar 

  50. Pizzocaro G, Salvioni R, Piva L, et al. Cisplatin combination chemotherapy in advanced seminoma. Cancer 1986; 58: 1625–9

    Article  PubMed  CAS  Google Scholar 

  51. Schmoll HJ, Harstrick A, Bokemeyer C, et al. Single-agent carboplatinum for advanced seminoma: a phase II study. Cancer 1993; 72: 237–42

    Article  PubMed  CAS  Google Scholar 

  52. Mencel PJ, Motzer RJ, Mazumdar M, et al. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. J Clin Oncol 1994; 12: 120–6

    PubMed  CAS  Google Scholar 

  53. Horwich A, Dearnaley DP, A’Hern R, et al. The activity of single-agent carboplatin in advanced seminoma. Eur J Cancer 1992; 28A: 1307–10

    Article  PubMed  CAS  Google Scholar 

  54. Sleijfer S, Willemse PHB, deVries EGE, et al. Treatment of advanced seminoma with cyclophosphamide, vincristine and carboplatin on an outpatient basis. Br J Cancer 1996; 74: 947–50

    Article  PubMed  CAS  Google Scholar 

  55. Jones DM, Amato LC, Pagliari R, et al. Carboplatin (CBDCA) and cyclophosphamide (CTX) and delayed consolidation in advanced seminoma [abstract 1149]. Proc Am Soc Clin Oncol 1997; 16: 323a

    Google Scholar 

  56. Fossa SD, Borge L, Ass N, et al. The treatment of advanced metastatic seminoma: experience in 55 cases. J Clin Oncol 1987; 5: 1071–7

    PubMed  CAS  Google Scholar 

  57. Loehrer PJ, Birch R, Williams SD, et al. Chemotherapy of metastatic seminoma: the Southeastern Cancer Study Group experience. J Clin Oncol 1987; 5: 1212–20

    PubMed  Google Scholar 

  58. Clemm C, Gerl A, Hentrich M, et al. Chemotherapy for far advanced seminoma [abstract 909]. Onkologie 1995; 18: 189

    Article  Google Scholar 

  59. Horwich A, Paluchowska B, Normann A, et al. Residual mass following chemotherapy of seminoma. Ann Oncol 1997; 8: 37–40

    Article  PubMed  CAS  Google Scholar 

  60. Bosl GJ, Geller NL, Cirricione C, et al. Multivariate analysis of prognostic variables in patients with metastatic cancer. Cancer Res 1983; 43: 3403–4

    PubMed  CAS  Google Scholar 

  61. Bajorin DF, Sarosdy MF, Pfister DG, et al. Randomized trial of etoposide and cisplatin versus etoposide and carboplatin in patients with good-risk germ cell tumors: a multiinstitutional study. J Clin Oncol 1993; 11: 598–606

    PubMed  CAS  Google Scholar 

  62. Horwich A, Oliver RTD, Fossa SD, et al. A randomised MRC trial comparing single agent carboplatin with the combination of etoposide, and cisplatin in patients with advanced metastatic seminoma [abstract no. 668]. Proc Am Soc Clin Oncol 1996; 15: 258

    Google Scholar 

  63. Williams S, Birch R, Einhorn LH, et al. Treatment of disseminated germ cell tumors with cisplatin, bleomycin and either vinblastine or etoposide. N Engl J Med 1987; 316: 1435–40

    Article  PubMed  CAS  Google Scholar 

  64. Birch R, Williams S, Cone A, et al. Prognostic factors for favourable outcome in disseminated germ cell tumors. J Clin Oncol 1986; 4: 400–7

    PubMed  CAS  Google Scholar 

  65. Saxman SB, Finch D, Gonin R, et al. Long-term follow-up of a phase III study of three versus four cycles of bleomycin, etoposide, and cisplatin in favorable-prognosis germ-cell tumors: the Indiana University experience. J Clin Oncol 1998; 15: 702–6

    Google Scholar 

  66. Loehrer Sr PJ, Johnson D, Elson P, et al. Importance of bleomycin in favorable-prognosis disseminated germ cell tumors: an Eastern Cooperative Oncology Group trial. J Clin Oncol 1995; 13: 470–6

    PubMed  Google Scholar 

  67. Xiao H, Mazumdar M, Bajorin DF, et al. Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin. J Clin Oncol 1997; 15: 2553–8

    PubMed  CAS  Google Scholar 

  68. de Wit R, Stoter G, Kaye SB, et al. Importance of bleomycin in combination chemotherapy for good-prognosis testicular nonseminoma: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group. J Clin Oncol 1997; 15: 1837–43

    PubMed  Google Scholar 

  69. Horwich A, Sleijfer DT, Fossa SD, et al. Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide and carboplatin in good-prognosis meta-static nonseminomatous germ cell cancer: a Multi-institutional Medical Research Council/European Organization for Research and Treatment of Cancer trial. J Clin Oncol 1997; 15: 1844–52

    PubMed  CAS  Google Scholar 

  70. Bokemeyer C, Köhrmann O, Tischler J, et al. A randomized trial of cisplatin, etoposide and bleomycin (PEB) versus carboplatin, etoposide and bleomycin (CEB) for patients with ‘good-risk’ metastatic non-seminomatous germ cell tumours. Ann Oncol 1996; 7: 1015–21

    Article  PubMed  CAS  Google Scholar 

  71. Bosl GJ, Geller NL, Bajorin D, et al. A randomized trial of etoposide + cisplatin versus vinblastine + bleomycin + cisplatin + cyclophosphamide + dactinomycin in patients with good-prognosis germ cell tumor. J Clin Oncol 1988;6: 1231–8

    PubMed  CAS  Google Scholar 

  72. Harstrick A, Caspar J, Guba R, et al. Comparison of the antitumor activity of cisplatin, carboplatin and iproplatin against established human testicular cancer cell lines in vivo and in vitro. Cancer 1989; 63: 1079–83

    Article  PubMed  CAS  Google Scholar 

  73. De Wit R, Stoter G, Sleijfer DT, et al. Four cycles of BEP vs four cycles of VTP in patients with intermediate-prognosis metastatic testicular non-seminoma: a randomized study of the EORTC Genitourinary Tract Cancer Cooperative Group. European Organization for Research and Treatment of Cancer. Br J Cancer 1998; 78: 828–32

    Google Scholar 

  74. de Wit R, Louwerens M, Mulder PMH, et al. A dose finding study of paclitaxel added to fixed doses of bleomycin, etoposide, cisplatin (BEP) in patients with adverse prognosis germ cell cancer or cancer of unknown primary (CUP) [abstract 1240]. Proc Am Soc Clin Oncol 1998; 17: 322a

    Google Scholar 

  75. Kaye SB, Mead GM, Fossa S, et al. Intensive induction-sequential chemotherapy with BOP/VIP-B compared with treatment with BEP/EPfor poor prognosis metastatic nonseminomatous germ cell tumor: a Randomized Medical Research Council/ European Organization for Research and Treatment of Cancer study. J Clin Oncol 1998: 16: 692–701

    PubMed  CAS  Google Scholar 

  76. de Wit R, Stoter G, Sleijfer DT, et al. Four cycles of BEP versus an alternating regime of PVB and BEP in patients with poor-prognosis metastatic testicular non-seminoma; a randomised study of the EORTC Genitourinary Tract Cancer Cooperative Group. Br J Cancer 1995; 71: 1311–4

    Article  PubMed  Google Scholar 

  77. Nichols CR, Catalano PJ, Crawford ED, et al. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia group B study. J Clin Oncol 1998; 16: 1287–93

    PubMed  CAS  Google Scholar 

  78. Nichols CR, Williams SD, Loehrer PJ, et al. Randomized study of cisplatin dose intensity in poor-risk germ cell tumors: a Southeastern Cancer Study Group and Southwest Oncology Group protocol. J Clin Oncol 1991; 7: 1163–72

    Google Scholar 

  79. Wozniak AJ, Samson MK, Shah NT, et al. A randomized trial of cisplatin, vinblastine, and bleomycin versus vinblastine, cisplatin, and etoposide in the treatment of advanced germ cell tumors of the testis: a Southwest Oncology Group study. J Clin Oncol 1991; 9: 70–6

    PubMed  CAS  Google Scholar 

  80. Ozols RF, Ihde DC, Linehan WM, et al. A randomized trial of standard chemotherapy v a high-dose chemotherapy regimen in the treatment of poor prognosis nonseminomatous germ-cell tumors. J Clin Oncol 1988; 6: 1031–40

    PubMed  CAS  Google Scholar 

  81. Schmoll EU. The role of ifosfamide in testicular cancer. Semin Oncol 1989; 16 (1 Suppl. 3): 82–95

    PubMed  CAS  Google Scholar 

  82. Blijham G. The treatment of advanced testicular carcinoma with high dose chemotherapy and autologous marrow support. Eur J Cancer Clin Oncol 1981; 17: 433–41

    CAS  Google Scholar 

  83. Wolff SN, Johnson DH, Hainsworth JD, et al. High dose VP-16–213 monotherapy for refractory germinal malignancies: a phase II study. J Clin Oncol 1984; 4: 271–4

    Google Scholar 

  84. Mulder POM, de Vries EG, Koops HS, et al. Chemotherapy with maximally tolerable doses of VP-16–123 and cyclophosphamide followed by autologous bone marrow transplantation for the treatment of relapsed or refractory germ cell tumors. Eur J Cancer Clin Oncol 1988; 24: 675–9

    Article  PubMed  CAS  Google Scholar 

  85. Chevreau C, Droz JP, Pico JC, et al. Early intensified chemotherapy with autologous bone marrow transplantation in first line treatment of poor risk non-seminomatous germ cell tumors. Eur Urol 1993; 23: 213–8

    PubMed  CAS  Google Scholar 

  86. Bokemeyer C, Harstrick A, Beyer C, et al. The use of dose-intensified chemotherapy in the treatment of metastatic nonseminomatous testicular germ cell tumors. Semin Oncol 1998; 25 (4 Suppl.): 24–32

    PubMed  CAS  Google Scholar 

  87. Steyerberg EW, Keizer HJ, Stoter G, et al. Predictors of residual mass histology following chemotherapy for metastatic nonseminomatous testicular cancer: a quantitative overview of 996 resections. Eur J Cancer 1994; 30: 1231–9

    Article  Google Scholar 

  88. Hartmann JT, Schmoll H-J, Kuczyk MA, et al. Postchemo-therapy resections of residual masses from metastatic nonseminomatous testicular germ cell tumors. Ann Oncol 1997; 8: 531–8

    Article  PubMed  CAS  Google Scholar 

  89. Logothetis CJ, Samuels ML, Trindade A, et al. The growing teratoma syndrome. Cancer 1982; 50: 1629–35

    Article  PubMed  CAS  Google Scholar 

  90. Molenaar WM, Oosterhuis JW, Meiring A, et al. Histology and DNA contents of a secondary malignancy arising in a mature residual lesion six years after chemotherapy for a disseminated nonseminomatous testicular tumor. Cancer 1986; 58: 264–8

    Article  PubMed  CAS  Google Scholar 

  91. Ahlgren AD, Simrell CR, Triche TJ, et al. Sarcoma arising in a residual testicular teratoma after cytoreductive chemotherapy. Cancer 1984; 54: 2015–18

    Article  PubMed  CAS  Google Scholar 

  92. Einhorn L, Williams S, Mandelbaum I, et al. Surgical resection in disseminated testicular cancer following chemotherapeutic cytoreduction. Cancer 1981; 48: 904–8

    Article  PubMed  CAS  Google Scholar 

  93. Steyerberg EW, Keizer HJ, Fossa SD, et al. Prediction of residual retroperitoneal mass histology after chemotherapy for metastatic nonseminomatous germ cell tumor: multivariate analysis of individual patient data from six study groups. J Clin Oncol 1995; 13: 1177–87

    PubMed  CAS  Google Scholar 

  94. Steyerberg EW, Gerl A, Fossa SD, et al. Validity of predictions of residual retroperitoneal mass histology in nonseminomatous testicular cancer. J Clin Oncol 1998; 16: 269–74

    PubMed  CAS  Google Scholar 

  95. Toner GC, Panicek DM, Heelan RT, et al. Adjunctive surgery after chemotherapy for nonseminomatous germ cell tumors: recommendations for patient selection. J Clin Oncol 1990; 8: 1683–94

    PubMed  CAS  Google Scholar 

  96. Fox E, Weathers T, Williams S, et al. Outcome analysis for patients with persistent nonteratomatous germ cell tumor in postchemotherapy retroperitoneal lymph node dissections. J Clin Oncol 1993; 11: 1294–9

    PubMed  CAS  Google Scholar 

  97. Hendry WF, A’Hern RP, Hetherington JW, et al. Para-aortic lymphadenectomy after chemotherapy for metastatic nonseminomatous germ cell tumours: prognostic value and theapeutic benefit. Br J Urol 1993; 71: 208–3

    Article  PubMed  CAS  Google Scholar 

  98. Fossa SD, Ous S, Lien HH, et al. Post-chemotherapy lymph node histology in radiologically normal patients with metastatic nonseminomatous testicular cancer. J Urol 1989; 141: 557–9

    PubMed  CAS  Google Scholar 

  99. Mulders PFA, Oosterhoff GON, Boetse C, et al. The importance of prognostic factors in the individual treatment of patients with disseminated germ cell tumours. Br J Urol 1990; 66: 425–9

    Article  PubMed  CAS  Google Scholar 

  100. Gerl A, Clemm C, Schmeller N, et al. Outcome analysis after post-chemotherapy surgery in patients with non-seminomatous germ cell tumours. Ann Oncol 1995; 6: 483–8

    PubMed  CAS  Google Scholar 

  101. Steyerberg EW, Keizer HJ, Zwartendijk J, et al. Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis. Br J Cancer 1993; 68: 195–200

    Article  PubMed  CAS  Google Scholar 

  102. Tait D, Peckham MJ, Hendry WF, et al. Post-chemotherapy surgery in advanced non-seminomatous germ-cell testicular tumours: the significance of histology with particular reference to differentiated (mature) teratoma. Br J Cancer 1984; 50: 601–9

    Article  PubMed  CAS  Google Scholar 

  103. Donohue JP, Fox EP, Williams SD, et al. Persistent cancer in postchemotherapy retroperitoneal lymph-node dissection: outcome analysis. World J Urol 1994; 12: 190–5

    PubMed  CAS  Google Scholar 

  104. Fizazi K, Ragan D, Bokemeyer C, et al. Viable malignant cells after primary chemotherapy for metastatic non-seminomatous germ-cell tumors (NSGCT): results from an international study [abstract no. 1183]. Proc Am Soc Clin Oncol 1999; 18: 308a

    Google Scholar 

  105. Gerl A, Clemm C, Schmeller N, et al. Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic non-seminomatous germ cell tumours. Br J Cancer 1994; 70: 960–5

    Article  PubMed  CAS  Google Scholar 

  106. Brenner PC, Harry W, Morse MJ, et al. Simultaneous retroperitoneal, thoracic, and cervical resection of postchemotherapy residual masses in patients with metastatic nonseminomatous germ cell tumors of the testis. J Clin Oncol 1996; 14: 1765–9

    PubMed  CAS  Google Scholar 

  107. Tiffany P, Morse MJ, Bosl G, et al. Sequential excision of residual thoracic and retroperitoneal masses after chemotherapy for stage III germ cell tumours. Cancer 1986; 57: 978–83

    Article  PubMed  CAS  Google Scholar 

  108. Qvist HL, Fossa SD, Ous S, et al. Post-chemotherapy tumour residuals in patients with advanced nonseminomatous testicular cancer: is it necessary to resect all residual masses? J Urol 1991; 145: 300–3

    PubMed  CAS  Google Scholar 

  109. Mandelbaum I, Yaw PB, Einhorn LH, et al. The importance of one-stage median sternotomy and retroperitoneal node dissection in disseminated testicular cancer. Ann Thorac Surg 1983; 36: 524–8

    Article  PubMed  CAS  Google Scholar 

  110. Hartmann JT, Candelaria M, Kuczyk MA, et al. Comparison of histological results from the resection of residual masses at different sites after chemotherapy for metastatic non-seminomatous germ cell tumours. Eur J Cancer 1997; 33: 843–7

    Article  PubMed  CAS  Google Scholar 

  111. Coogan CL, Hejase MJ, Wahle GR, et al. Nerve sparing postchemotherapy retroperitoneal lymph node dissection for advanced testicular cancer. J Urol 1996; 156: 1656–8

    Article  PubMed  CAS  Google Scholar 

  112. Stephens WS, Gonin R, Hutchins GD, et al. Positron emission tomography evaluation of residual radiographie abnormalities in postchemotherapy germ cell tumour patients. J Clin Oncol 1996; 14: 1637–41

    PubMed  CAS  Google Scholar 

  113. Ellison M, Mostofi F, Flanigan R. Treatment of the residual retroperitoneal mass after chemotherapy for advanced seminoma. J Urol 1988; 140: 618–20

    PubMed  CAS  Google Scholar 

  114. Herr HW, Sheinfeld J, Puc HS, et al. Surgery for a post-chemotherapy residual mass in seminoma. J Urol 1997; 157: 860–2

    Article  PubMed  CAS  Google Scholar 

  115. Puc HS, Heelan R, Mazumdan M, et al. Management of residual mass in advanced seminoma: results and recommendations from the Memorial Sloan Kettering Cancer Center. J Clin Oncol 1996; 14: 454–60

    PubMed  CAS  Google Scholar 

  116. Duchesne GM, Stenning SP, Aass N, et al. Radiotherapy after chemotherapy for metastatic seminoma — a diminishing role. MRC Testicular Tumour Working Party. Eur J Cancer 1997; 33: 829–35

    CAS  Google Scholar 

  117. Nichols CR, Roth BJ, Loehrer PJ, et al. Salvage chemotherapy for recurrent germ cell cancer. Semin Oncol 1994; 25 (5 Suppl. 12): 102–8

    Google Scholar 

  118. Harstrick A, Schmoll HJ, Wilke H, et al. Cisplatin, etoposide and ifosfamide salvage therapy for refractory or relapsed germ cell carcinoma. J Clin Oncol 1991; 9: 1549–55

    PubMed  CAS  Google Scholar 

  119. Motzer RJ, Bajorin DF, Bosl GJ, et al. Paclitaxel (T) containing first-line salvage therapy selected by risk for patients (pts) with germ cell tumors (GCT) [abstract no. 1146]. Proc Am Soc Clin Oncol 1997; 16: 322a

    Google Scholar 

  120. Motzer RJ, Cooper K, Geller NL, et al. The role of ifosfamide plus cisplatin-based chemotherapy as salvage therapy for patients with refractory germ cell tumors. Cancer 1990; 66: 2476–81

    Article  PubMed  CAS  Google Scholar 

  121. Bosl GJ, Yagoda A, Golbey RB, et al. Role of etoposide-based chemotherapy in the treatment of patients with refractory or relapsing germ cell tumors. Am J Med 1985; 78: 423–8

    Article  PubMed  CAS  Google Scholar 

  122. Hainsworth JD, Williams SD, Einhorn LH, et al. Successful treatment of resistant germinal neoplasms with VP-16 and cisplatin: results of a Southeastern Cancer Study Group trial. J Clin Oncol 1985; 3: 666–71

    PubMed  CAS  Google Scholar 

  123. Pizzocaro G, Pasi M, Salvioni R, et al. Cisplatin and etoposide salvage therapy and resection of the residual tumor in pretreated germ cell testicular cancer. Cancer 1985; 56: 2399–403

    Article  PubMed  CAS  Google Scholar 

  124. Loehrer PJ, Lauer R, Roth BJ, et al. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med 1988; 109: 540–6

    PubMed  Google Scholar 

  125. Josefsen D, Ous S, Hoie J, et al. Salvage treatment in male patients with germ cell tumours. Br J Cancer 1993; 67: 568–72

    Article  PubMed  CAS  Google Scholar 

  126. Ledermann JA, Holden L, Newlands ES, et al. The long-term outcome of patients who relapse after chemotherapy for nonseminomatous germ cell tumours. Br J Urol 1994; 74: 225–30

    Article  PubMed  CAS  Google Scholar 

  127. Gerl A, Clemm C, Schmeller N, et al. Prognosis after salvage treatment for unselected male patients with germ cell tumours. Br J Cancer 1995; 72: 1026–32

    Article  PubMed  CAS  Google Scholar 

  128. Farhat F, Culine S, Theodore C, et al. Cisplatin and ifosfamide with either vinblastine or etoposide as salvage therapy for refractory or relapsing germ cell tumor patients: the Institut Gustave Roussy experience. Cancer 1996; 77: 1193–7

    Article  PubMed  CAS  Google Scholar 

  129. McCaffrey JA, Mazumdar M, Bajorin DF, et al. Ifosfamide- and cisplatin-containing chemotherapy as first-line salvage therapy in germ cell tumors: response and survival. J Clin Oncol 1997; 15: 2559–63

    PubMed  CAS  Google Scholar 

  130. Loehrer PJ, Gonin R, Nichols CR, et al. Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor. J Clin Oncol 1998; 16: 2500–4

    PubMed  CAS  Google Scholar 

  131. Nichols CR, Tricot G, Williams S, et al. Dose-intensive chemotherapy in refractory germ cell cancer: a phase I/II trial of high-dose carboplatin and etoposide with autologous bone marrow transplantation. J Clin Oncol 1989; 7: 932–9

    PubMed  CAS  Google Scholar 

  132. Broun ER, Nichols CR, Kneebone P, et al. Long-term outcome of patients with relapsed and refractory germ cell tumors treated with high-dose chemotherapy and autologous bone marrow rescue. Ann Intern Med 1992; 117: 124–8

    PubMed  CAS  Google Scholar 

  133. Linkesch W, Krainer M, Wagner A. Phase I/II trial of ultrahigh carboplatin, etoposide, cyclophosphamide with ABMT in refractory or relapsed non-seminomatous germ cell tumors (NSGCT) [abstract no. 600]. Proc Am Soc Clin Oncol 1992; 11: 1960

    Google Scholar 

  134. Broun ER, Nichols CR, Mandanas R, et al. Dose escalation study of high-dose carboplatin and etoposide with autologous bone marrow support in patients with recurrent and refractory germ cell tumors. Bone Marrow Transplant 1995; 16: 353–8

    PubMed  CAS  Google Scholar 

  135. Motzer RJ, Gulati SC, Crown JP, et al. High-dose chemotherapy and autologous bone marrow rescue for patients with refractory germ cell tumors. Cancer 1992; 69: 550–6

    Article  PubMed  CAS  Google Scholar 

  136. Motzer RJ, Mazumdar M, Subhash CG, et al. Phase II trial of high-dose carboplatin and etoposide with autologous bone marrow transplantation in first-line therapy for patients with poor-risk germ cell tumors. J Natl Cancer Inst 1993; 85: 1828–35

    Article  PubMed  CAS  Google Scholar 

  137. Rosti G, Albertazzi L, Salioni R, et al. High-dose chemotherapy supported with autologous bone marrow transplantation (ABMT) in germ cell tumors: a phase two study. Ann Oncol 1992; 3: 809–12

    PubMed  CAS  Google Scholar 

  138. Margolin K, Doroshow JH, Ahn C, et al. Treatment of germ cell cancer with two cycles of high-dose ifosfamide, carboplatin, and etoposide with autologous stem-cell support. J Clin Oncol 1996; 14: 2631–37

    PubMed  CAS  Google Scholar 

  139. Motzer RJ, Mazumdar M, Bosl GJ, et al. High-dose carboplatin, etoposide, and cyclophosphamide for patients with refractory germ cell tumors: treatment results and prognostic factors for survival and toxicity. J Clin Oncol 1996; 14: 1098–105

    PubMed  CAS  Google Scholar 

  140. Siegert W, Beyer J, Strohscheer I, German Testicular Cancer Cooperative Study Group, et al. High-dose treatment with carboplatin, etoposide, and ifosfamide followed by autologous stem-cell transplantation in relapsed or refractory germ cell cancer: a phase I/II study. J Clin Oncol 1994; 12: 1223–31

    PubMed  CAS  Google Scholar 

  141. Beyer J, Kingreen D, Krause M, et al. Long-term survival of patients with recurrent or refractory germ cell tumors after high dose chemotherapy. Cancer 1997; 79: 161–8

    Article  PubMed  CAS  Google Scholar 

  142. Lampe H, Dearnaley DP, Price A, et al. High-dose carboplatin and etoposide for salvage chemotherapy of germ cell tumours: Eur J Cancer 1995; 31A: 717–23

    Article  PubMed  CAS  Google Scholar 

  143. Droz JP, Kramar A, Pico JL. Prediction of long-term response after high-dose chemotherapy with autologous bone marrow transplantation in the salvage treatment of non-seminomatous germ cell tumours. Eur J Cancer 1993; 29 A: 818–21

    Article  PubMed  CAS  Google Scholar 

  144. Beyer J, Kramar A, Mandanas R, et al. High-dose chemotherapy as salvage treatment in germ cell tumors: a multivariate analysis of prognostic variables. J Clin Oncol 1996; 14: 2638–45

    PubMed  CAS  Google Scholar 

  145. Murphy B, Breeden E, Donohue J, et al. Surgical salvage of chemorefractory germ cell tumors. J Clin Oncol 1993; 11: 324–9

    PubMed  CAS  Google Scholar 

  146. Wood D, Herr H, Motzer R, et al. Surgical resection of solitary metastases after chemotherapy in patients with nonseminomatous germ cell tumors and elevated serum tumor markers. Cancer 1992; 70: 2354–7

    Article  PubMed  Google Scholar 

  147. Baniel J, Foster RS, Gonin R, et al. Late relapse of testicular cancer. J Clin Oncol 1995; 13: 1170–6

    PubMed  CAS  Google Scholar 

  148. McGuire WP, Rowinsky EK, Rosenshein NB, et al. Taxol: a unique antineoplastic agent with significant activity in advanced ovarian epithelial neoplasms. Ann Intern Med 1989; 111: 273–9

    PubMed  CAS  Google Scholar 

  149. Rowinsky EK, Gilbert MR, McGuire WP, et al. Sequences of taxol and cisplatin: a phase I and pharmacologie study. J Clin Oncol 1991; 9: 1692–703

    PubMed  CAS  Google Scholar 

  150. Dunn TA, Grunwald V, Bokemeyer C, et al. Pre-clinical activity of taxol in non-seminomatous germ cell tumor cell lines and nude mouse xenografts. Invest New Drugs 1997; 15: 91–8

    Article  PubMed  CAS  Google Scholar 

  151. Bokemeyer C, Schmoll HJ, Natt F, et al. Preliminary results of a phase I/II trial of paclitaxel in patients with relapsed or cisplatin-refractory testicular cancer. J Cancer Res Clin Oncol 1994; 120: 754–57

    Article  PubMed  CAS  Google Scholar 

  152. Motzer RJ, Bajorin DF, Schwartz LH, et al. Phase II trial of paclitaxel shows antitumor activity in patients with previously treated germ cell tumors. J Clin Oncol 1994; 12: 2277–83

    PubMed  CAS  Google Scholar 

  153. Bokemeyer C, Beyer J, Rüther U, et al. Phase II study of paclitaxel in patients with relapsed or cisplatin-refractory testicular cancer. Ann Oncol 1996; 7: 31–4

    Article  PubMed  CAS  Google Scholar 

  154. Sandier AB, Christou A, Fox S, et al. A phase II trial of paclitaxel in refractory germ cell neoplasms. Cancer 1998; 82: 1381–6

    Article  Google Scholar 

  155. Partyka S, Hutchinson L, Amato R. Preliminary results of taxol/cisplatin chemotherapy in patients with refractory or relapsed nonseminomatous germ cell tumor [abstract no. 1161]. Proc Am Assoc Cancer Res 1996; 37: 169

    Google Scholar 

  156. Beyer J, Bokemeyer C, Rick O, et al. Salvage treatment in germ-cell tumors using taxol, ifosfamide, cisplatin (TIP) followed by high-dose carboplatin, etoposide and thiotepa (HDCET): first results [abstract no. 1242]. Proc Am Soc Clin Oncol 1998; 17: 322a

    Google Scholar 

  157. Bokemeyer C, Hartmann JT, Kuczyk MA, et al. The role of paclitaxel in chemosensitive urological malignancies: current strategies in bladder cancer and testicular germ-cell tumors. World JUrol 1998; 16: 155–62

    Article  CAS  Google Scholar 

  158. Bokemeyer C, Gerl A, Schöffski, et al. Gemcitabine in patients with relapsed or cisplatin-refractory testicular cancer. J Clin Oncol 1999; 17: 512–6

    PubMed  CAS  Google Scholar 

  159. Italian Group for Antiemetic Research. Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med 1995; 332: 1–5

    Article  Google Scholar 

  160. Vogelzang NJ, Torkelson JL, Kennedy BJ. Hypomagnesemia, renal dysfunction, and Raynaud’s phenomenon in patients treated with cisplatin, vinblastine, and bleomycin. Cancer 1985; 56: 2765–70

    Article  PubMed  CAS  Google Scholar 

  161. Bosl GJ, Leitner SP, Atlas SA, et al. Increased plasma renin and aldosterone in patients treated with cisplatin-based chemotherapy for metastatic germ-cell tumors. J Clin Oncol 1986; 4: 1684–9

    PubMed  CAS  Google Scholar 

  162. Bokemeyer C, Hartmann JT, Fels L, et al. Amifostine protects against early cisplatin-induced renal damage and enhances CD 34+-cell numbers for PBSC-collection [abstract no. 166]. Proc Am Soc Clin Oncol 1997; 16: 47a

    Google Scholar 

  163. Bokemeyer C, Fels LM, Dunn T, et al. Silibinin protects against cisplatin-induced nephrotoxicity without compromising cisplatin or ifosfamide anti-tumor activity. Br J Cancer 1996; 74: 2036–41

    Article  PubMed  CAS  Google Scholar 

  164. Hartmann JT, Kollmannsberger C, Kanz L, et al. Platinum organ toxicity and possible prevention in patients with testicular cancer. In J Cancer. In press

  165. Bokemeyer C, Kuczyk MA, Kohne H, et al. Haematopoietic growth factors and treatment of testicular cancer: biological interactions, routine use and dose-intensive chemotherapy. Ann Hematol 1996; 72: 1–9

    Article  PubMed  CAS  Google Scholar 

  166. Fossa SD, Kaye SB, Mead GM, et al. Filgrastim during combination chemotherapy of patients with poor-prognosis metastatic germ cell malignancy. J Clin Oncol 1998; 16: 716–24

    PubMed  CAS  Google Scholar 

  167. Bokemeyer C, Berger CC, Kuczyk MA, et al. Evaluation of long-term toxicity after chemotherapy for testicular cancer. J Clin Oncol 1996; 14: 2923–32

    PubMed  CAS  Google Scholar 

  168. Boyer M, Raghavan D, Harris PJ, et al. Lack of late toxicity in patients treated with cisplatin-containing combination chemotherapy for metastatic testicular cancer. J Clin Oncol 1990; 8: 21–6

    PubMed  CAS  Google Scholar 

  169. Osanto S, Bukman A, Van Hoek F, et al. Long-term effects of chemotherapy in patients with testicular cancer. J Clin Oncol 1992; 10: 574–9

    PubMed  CAS  Google Scholar 

  170. Roth BJ, Einhorn LH, Greist A. Long-term complications of cisplatin-based chemotherapy for testis cancer. Semin Oncol 1988; 15: 345–50

    PubMed  CAS  Google Scholar 

  171. Bokemeyer C, Schmoll HJ. Treatment of testicular cancer and the development of secondary malignancies. J Clin Oncol 1995; 13: 283–92

    PubMed  CAS  Google Scholar 

  172. Berger CC, Bokemeyer C, Schneider M, et al. Secondary Raynaud’s phenomenon and other late vascular complications following chemotherapy for testicular cancer. Eur J Cancer 1995; 31: 2229–38

    Article  Google Scholar 

  173. Boyer M, Raghavan D. Toxicity of treatment of germ cell tumors. Semin Oncol 1992; 2: 128–42

    Google Scholar 

  174. Vogelzang NJ, Bosl GJ, Johnson K. Raynaud’s phenomenon: a common toxicity after combination chemotherapy for testicular cancer. Ann Intern Med 1981; 95: 288–92

    PubMed  CAS  Google Scholar 

  175. Berger CC, Bokemeyer C, Schuppert F, et al. Endocrinological late effects after chemotherapy for testicular cancer. Br J Cancer 1996; 73: 1108–14

    Article  PubMed  CAS  Google Scholar 

  176. Bokemeyer C, Berger CC, Hartmann JT, et al. Analysis of risk factors for cisplatin-induced ototoxicity in patients with testicular cancer. Br J Cancer 1998; 77: 1355–62

    Article  PubMed  CAS  Google Scholar 

  177. Gietema JA, Sleijfer DTh, Willemse PHB, et al. Long-term follow-up of cardiovascular risk factors in patients given chemotherapy for disseminated nonseminomatous testicular cancer. Ann Intern Med 1992; 116: 709–15

    PubMed  CAS  Google Scholar 

  178. Lampe H, Horwich A, Norman A, et al. Fertility after chemotherapy for testicular germ cell cancers. J Clin Oncol 1997; 15: 239–45

    PubMed  CAS  Google Scholar 

  179. Leitner SP, Bosl GJ, Bajorunas D. Gonadal dysfunction in patients treated for metastatic germ-cell tumors. J Clin Oncol 1986; 4: 1500–5

    PubMed  CAS  Google Scholar 

  180. Hartmann JT, Schmoll H-J, Albrecht C, et al. Long-term effects on sexual functioning and fertility after treatment of testicular cancer. Br J Cancer 1999; 80: 801–7

    Article  PubMed  CAS  Google Scholar 

  181. Travis LB, Curtis RE, Storm H, et al. Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst 1997; 89: 1429–39

    Article  PubMed  CAS  Google Scholar 

  182. Bajorin DF, Motzer RJ, Rodriquez E, et al. Acute nonlymphocytic leukemia in germ cell tumor patients treated with etoposide-containing chemotherapy. J Natl Cancer Inst 1993; 85: 60–2

    Article  PubMed  CAS  Google Scholar 

  183. Nichols CR, Breeden ES, Loehrer PJ. Secondary leukemia associated with a conventional dose of etoposide: review of serial germ cell tumor protocols. J Natl Cancer Inst 1993; 85: 36–40

    Article  PubMed  CAS  Google Scholar 

  184. Pedersen-Bjergaard J, Daugaard G, Hansen ST, et al. Increased risk of myelodysplasia and leukemia after etoposide, cisplatin, and bleomycin for germ-cell tumors. Lancet 1991; 338(8763): 359–63

    Article  PubMed  CAS  Google Scholar 

  185. Kollmannsberger C, Beyer J, Droz J-P, et al. Secondary leukemia following high cumulative doses of etoposide in patients treated for advanced germ cell tumors. J Clin Oncol 1998; 16: 3386–91

    PubMed  CAS  Google Scholar 

  186. Hartmann JT, Nichols CR, Droz JP, et al. Extragonadal germ cell tumors (EGGCT) and hematological disorders: incidence and outcome from an international database [abstract no. 268]. Ann Oncol 1998; 9 (4 Suppl.): 56

    Article  Google Scholar 

  187. Bokemeyer C, Schmoll HJ. Secondary neoplasms following treatment of malignant germ cell tumors. J Clin Oncol 1993; 11: 1703–9

    PubMed  CAS  Google Scholar 

  188. Kollmannsberger C, Hartmann JT, Kanz L, et al. Risk of secondary myeloid leukemia and myelodysplastic syndrome following standard-dose chemotherapy or high-dose chemotherapy with stem cell support in patients with potentially curable malignancies. J Cancer Res Clin Oncol 1998; 124: 207–14

    Article  PubMed  CAS  Google Scholar 

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  1. UKL - University Medical Center II, Department of Hematology/Oncology/Immunology, Eberhard-Karls-University, Otfried-Mueller-Strasse 10, 72076, Tübingen, Germany

    Jörg T. Hartmann, Lothar Kanz &  Carsten Bokemeyer

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Hartmann, J.T., Kanz, L. & Bokemeyer, C. Diagnosis and Treatment of Patients with Testicular Germ Cell Cancer. Drugs 58, 257–281 (1999). https://doi.org/10.2165/00003495-199958020-00004

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