The Use of Modified Templates in Early and Advanced Stage Nonseminomatous Germ Cell Tumor

Masterson, Timothy A.; Cary, K. Clinton

doi:10.1155/2018/6783147

“…The anatomical borders for this type of resection are the renal hilar vessels, the ureters, and the common iliac arteries. 4,5,12 The template-guided approach has been widely adopted in an effort to reduce the morbidity associated with this procedure, while also preserving the antegrade ejaculation and erectile function. 13,14 Templates were developed under the rationale that retroperitoneal lymph drainage follow a characteristic lymph node spread, based on the laterality of the testicular primary, given the absence of crossover between the landing zones among patients with solitary metastases to either the left or right testicle.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Blood-Based Molecular Profiling in Pancreatic Adenocarcinoma

Chung

¹

,

Galvin

²

,

Achenbach

³

et al. 2021

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Based on overall survival (OS) dataThe FIRST and ONLY immunotherapy approved in the first-line maintenance setting BAVENCIO ® (avelumab) is indicated for the maintenance treatment of patients with locally advanced or metastatic urothelial carcinoma (UC) that has not progressed with fi rst-line platinum-containing chemotherapy. First-line maintenance treatment of urothelial carcinomaBAVENCIO can cause severe and fatal immune-mediated adverse reactions in any organ system or tissue and at any time after starting treatment with a PD-1/PD-L1 blocking antibody, including after discontinuation of treatment.Early identifi cation and management of immune-mediated adverse reactions are essential to ensure safe use of PD-1/PD-L1 blocking antibodies. Monitor patients closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate.No dose reduction for BAVENCIO is recommended. For immunemediated adverse reactions, withhold or permanently discontinue BAVENCIO depending on severity. In general, withhold BAVENCIO for severe (Grade 3) immune-mediated adverse reactions. Permanently discontinue BAVENCIO for life-threatening (Grade 4) immune-mediated adverse reactions, recurrent severe (Grade 3) immune-mediated reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone or equivalent per day within 12 weeks of initiating corticosteroids. In general, if BAVENCIO requires interruption or discontinuation, administer systemic corticosteroid therapy (1 to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immunemediated adverse reactions are not controlled with corticosteroid therapy. Toxicity management guidelines for adverse reactions that do not necessarily require systemic corticosteroids (eg, endocrinopathies and dermatologic reactions) are discussed in subsequent sections.BAVENCIO can cause immune-mediated pneumonitis. Withhold BAVENCIO for Grade 2, and permanently discontinue for Grade 3 or Grade 4 pneumonitis. Immune-mediated pneumonitis occurred in 1.2% (21/1738) of patients, including fatal (0.1%), Grade 4 (0.1%), Grade 3 (0.3%), and Grade 2 (0.6%) adverse reactions. Systemic corticosteroids were required in all (21/21) patients with pneumonitis.BAVENCIO can cause immune-mediated colitis. The primary component of immune-mediated colitis consisted of diarrhea. Cytomegalovirus infection/reactivation has been reported in patients with corticosteroid-refractory immu...

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“…The anatomical borders for this type of resection are the renal hilar vessels, the ureters, and the common iliac arteries. 4,5,12 The template-guided approach has been widely adopted in an effort to reduce the morbidity associated with this procedure, while also preserving the antegrade ejaculation and erectile function. 13,14 Templates were developed under the rationale that retroperitoneal lymph drainage follow a characteristic lymph node spread, based on the laterality of the testicular primary, given the absence of crossover between the landing zones among patients with solitary metastases to either the left or right testicle.…”

Section: Discussionmentioning

confidence: 99%

Management of Residual Disease After First-line Chemotherapy in a Patient With a Nonseminomatous Germ Cell Tumor

Barragán-Carrillo

¹

,

Mateos-Corella

²

,

Ortíz-Hidalgo

³

et al. 2021

Oncology

0

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Based on overall survival (OS) dataThe FIRST and ONLY immunotherapy approved in the first-line maintenance setting BAVENCIO ® (avelumab) is indicated for the maintenance treatment of patients with locally advanced or metastatic urothelial carcinoma (UC) that has not progressed with fi rst-line platinum-containing chemotherapy. First-line maintenance treatment of urothelial carcinomaBAVENCIO can cause severe and fatal immune-mediated adverse reactions in any organ system or tissue and at any time after starting treatment with a PD-1/PD-L1 blocking antibody, including after discontinuation of treatment.Early identifi cation and management of immune-mediated adverse reactions are essential to ensure safe use of PD-1/PD-L1 blocking antibodies. Monitor patients closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate liver enzymes, creatinine, and thyroid function at baseline and periodically during treatment. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate.No dose reduction for BAVENCIO is recommended. For immunemediated adverse reactions, withhold or permanently discontinue BAVENCIO depending on severity. In general, withhold BAVENCIO for severe (Grade 3) immune-mediated adverse reactions. Permanently discontinue BAVENCIO for life-threatening (Grade 4) immune-mediated adverse reactions, recurrent severe (Grade 3) immune-mediated reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone or equivalent per day within 12 weeks of initiating corticosteroids. In general, if BAVENCIO requires interruption or discontinuation, administer systemic corticosteroid therapy (1 to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immunemediated adverse reactions are not controlled with corticosteroid therapy. Toxicity management guidelines for adverse reactions that do not necessarily require systemic corticosteroids (eg, endocrinopathies and dermatologic reactions) are discussed in subsequent sections.BAVENCIO can cause immune-mediated pneumonitis. Withhold BAVENCIO for Grade 2, and permanently discontinue for Grade 3 or Grade 4 pneumonitis. Immune-mediated pneumonitis occurred in 1.2% (21/1738) of patients, including fatal (0.1%), Grade 4 (0.1%), Grade 3 (0.3%), and Grade 2 (0.6%) adverse reactions. Systemic corticosteroids were required in all (21/21) patients with pneumonitis.BAVENCIO can cause immune-mediated colitis. The primary component of immune-mediated colitis consisted of diarrhea. Cytomegalovirus infection/reactivation has been reported in patients with corticosteroid-refractory immu...

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“…While always PET negative residual teratoma in lymph nodes >1 cm must be surgically resected in all cases, the clear survival benefit for patients undergoing PC-RPLND underlines the necessity of this procedure regardless of PET-CT findings. Ten to twenty percent of patients with lymph nodes larger than 1 cm harbor viable non-seminomatous cancer ( 53 , 54 ). The survival benefit for PC-RPLND in this scenario has been repeatedly shown ( 53 , 55 ).…”

Section: The Role Of Fdg-pet/ct Scanningmentioning

confidence: 99%

“…Ten to twenty percent of patients with lymph nodes larger than 1 cm harbor viable non-seminomatous cancer ( 53 , 54 ). The survival benefit for PC-RPLND in this scenario has been repeatedly shown ( 53 , 55 ). For instance, we believe that routine implementation of PC-RPLND in non-seminoma patients at our institution in 2008 contributed to the significantly improved outcomes for overall survival in series of 426 patients treated before and after 2008 (HR = 0.44, 95% CI 0.30–0.65; P = 0.0003) ( 56 ).…”

Section: The Role Of Fdg-pet/ct Scanningmentioning

confidence: 99%

Intricacies of Radiographic Assessment in Testicular Germ Cell Tumors

Makovnik

¹

,

Rejleková

²

,

Uhrin³

et al. 2021

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Testicular germ cell tumors (GCTs) are malignancies with a unique biology, pathology, clinical appearance, and excellent outcomes. A correct radiographic assessment of GCTs is extremely important for the clinical management in several typical scenarios. Advancements in the field of diagnostic medicine bring an increasing number of sophisticated imaging methods to increase the performance of imaging studies. The conventional computed tomography (CT) remains the mainstay of diagnostic imaging in the management of GCTs. While certain improvements in the sensitivity and specificity are suggested with magnetic resonance (MR) imaging with lymphotrophic nanoparticles in evaluating retroperitoneal lymph nodes during the staging procedure, further exploration in larger prospective studies is needed. A common diagnostic dilemma is assessing the post-chemotherapy residual disease in GCTs. Several studies have consistently shown advantages in the utility of positron emission tomography (PET) scanning in post-chemotherapy residual retroperitoneal lymph nodes in patients with seminoma, but not with non-seminoma. Recommendations suggest that seminoma patients with a residual disease in the retroperitoneum larger than 3 cm should be subjected for PET scanning with 18-fluorodeoxyglucose. Relatively high sensitivity, specificity and a negative predictive value (80–95%) may guide clinical decision to spare these patients of high morbidity of an unnecessary surgery. However, a positive predictive value of around 50% renders PET scanning difficult to interpret in the case of positive finding. These patients often require extremely difficult surgical procedures with the high risk of post-operative morbidity. Therefore, seminoma patients with PET positive residual masses larger than 3 cm still remain a serious challenge in the decision making of nuclear medicine specialist, oncologists, and urologic surgeons. In this article, we aim to summarize data on controversial dilemmas in staging procedures, active surveillance, and post-chemotherapy assessment of GCTs based on the available published literature.

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The Use of Modified Templates in Early and Advanced Stage Nonseminomatous Germ Cell Tumor

Cited by 19 publications

References 26 publications

Characterization of Blood-Based Molecular Profiling in Pancreatic Adenocarcinoma

Characterization of Blood-Based Molecular Profiling in Pancreatic Adenocarcinoma

Management of Residual Disease After First-line Chemotherapy in a Patient With a Nonseminomatous Germ Cell Tumor

Intricacies of Radiographic Assessment in Testicular Germ Cell Tumors

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