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Aggressive multimodal therapy may prolong disease-free survival in recurrent primary retroperitoneal embryonal carcinoma.

Straka M, Manasek V, Stursa M, Andelova R - Int J Surg Case Rep (2015)

Bottom Line: The patient is currently disease-free at 34 months.Aggressively treated metastatic recurrent disease does not preclude prolonged survival.Despite a generally poor prognosis, repeated complex oncosurgical therapy for retroperitoneal extragonadal tumours may be worthwhile.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Comprehensive Cancer Centre and AGEL Research and Training Institute, Novy Jicin Hospital, Purkynova 2138-16, 741 01 Novy Jicin Czech Republic. Electronic address: tulakmato@gmail.com.

No MeSH data available.


Related in: MedlinePlus

Mature teratoma, HE stain (100×).
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fig0020: Mature teratoma, HE stain (100×).

Mentions: The patient was given a course of 1st-line BEP chemotherapy (bleomycin 30 IU day 1, 8, and 15, etoposid 100 mg/qm day 1–5, cisplatin 20 mg/qm day 1–5) (4 cycles q3w) (November 2007–February 2008). After the first cycle, febrile neutropenia and septic shock occurred, but this was managed successfully. Subsequent chemotherapy was delivered with granulocyte-colony stimulating factor (G-CSF) prophylaxis–pegfilgrastim (Neulasta, Amgen Europe B.V.(NLD)) and was uneventful. In April 2008, complete extirpation of tumour residuum and retroperitoneal lymphadenectomy (RPLND) was performed and structures of mature teratoma were revealed on final histopathological examination (Fig. 4). The patient experienced complete clinical remission for almost 3.5 years. Disease progression occurred in May 2011 involving the patient’s left adrenal as a solitary lesion. Increased level of ßHCG (5.7 IU/l) was recorded and based on the MDT decision, the patient underwent surgery. Left adrenalectomy, partial pancreatectomy and splenectomy were performed in order to resect the adrenal lesion in close relation to the pancreatic tail pseudocyst (a complication after the first surgical intervention). Metastatic embryonal carcinoma with high mitotic activity (more than 10 mitoses per 10 high-power fields) was confirmed on histopathology. After the surgery, the patient received a full 4 cycles of 2nd-line VeIP chemotherapy q3w (vinblastin 0.11 mg/kg day 1–2, ifosfamide 1.2 g/qm day 1–5, cisplatin 20 mg/qm day 1–5) plus G-CSF prophylaxis according to current EORTC (European Organisation for Research and Treatment of Cancer) recommendation (August–October 2011). Second disease progression was diagnosed early after systemic therapy completion in February 2012 (Fig. 5). The PET/CT (positron emission tomography–computed tomography) showed a lesion suspected to be a locoregional recurrence at the site of the left adrenalectomy, and metastatic mass in the gastric fundus (Fig. 6). The patient underwent “desperation surgery” in April 2012. Previous interventions made disecretion of postoperative and tumour changes impossible and multivisceral resection had to be performed (en bloc gastrectomy with distal pancreatectomy, left nephrectomy and splenic flexure resection). On histopathological analysis, metastatic embryonal carcinoma in both the gastric and colonic wall was found. No locoregional recurrence was confirmed, but the metastases had close relation to severe postoperative changes. Two cycles of 3rd-lineTIP (paclitaxel 250 mg/qm day 1, ifosfamid 1500 mg/qm day 2–5, cisplatin 25 mg/qm day 2–5) salvage chemotherapy were delivered (May–June 2012). The patient has had regular follow-up, is currently 34 months disease-free, and being carefully monitored in order to detect relapse, development of secondary malignancies and to assess cardiovascular events, whose frequency is higher after combination chemotherapy for germ cell tumours.


Aggressive multimodal therapy may prolong disease-free survival in recurrent primary retroperitoneal embryonal carcinoma.

Straka M, Manasek V, Stursa M, Andelova R - Int J Surg Case Rep (2015)

Mature teratoma, HE stain (100×).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430178&req=5

fig0020: Mature teratoma, HE stain (100×).
Mentions: The patient was given a course of 1st-line BEP chemotherapy (bleomycin 30 IU day 1, 8, and 15, etoposid 100 mg/qm day 1–5, cisplatin 20 mg/qm day 1–5) (4 cycles q3w) (November 2007–February 2008). After the first cycle, febrile neutropenia and septic shock occurred, but this was managed successfully. Subsequent chemotherapy was delivered with granulocyte-colony stimulating factor (G-CSF) prophylaxis–pegfilgrastim (Neulasta, Amgen Europe B.V.(NLD)) and was uneventful. In April 2008, complete extirpation of tumour residuum and retroperitoneal lymphadenectomy (RPLND) was performed and structures of mature teratoma were revealed on final histopathological examination (Fig. 4). The patient experienced complete clinical remission for almost 3.5 years. Disease progression occurred in May 2011 involving the patient’s left adrenal as a solitary lesion. Increased level of ßHCG (5.7 IU/l) was recorded and based on the MDT decision, the patient underwent surgery. Left adrenalectomy, partial pancreatectomy and splenectomy were performed in order to resect the adrenal lesion in close relation to the pancreatic tail pseudocyst (a complication after the first surgical intervention). Metastatic embryonal carcinoma with high mitotic activity (more than 10 mitoses per 10 high-power fields) was confirmed on histopathology. After the surgery, the patient received a full 4 cycles of 2nd-line VeIP chemotherapy q3w (vinblastin 0.11 mg/kg day 1–2, ifosfamide 1.2 g/qm day 1–5, cisplatin 20 mg/qm day 1–5) plus G-CSF prophylaxis according to current EORTC (European Organisation for Research and Treatment of Cancer) recommendation (August–October 2011). Second disease progression was diagnosed early after systemic therapy completion in February 2012 (Fig. 5). The PET/CT (positron emission tomography–computed tomography) showed a lesion suspected to be a locoregional recurrence at the site of the left adrenalectomy, and metastatic mass in the gastric fundus (Fig. 6). The patient underwent “desperation surgery” in April 2012. Previous interventions made disecretion of postoperative and tumour changes impossible and multivisceral resection had to be performed (en bloc gastrectomy with distal pancreatectomy, left nephrectomy and splenic flexure resection). On histopathological analysis, metastatic embryonal carcinoma in both the gastric and colonic wall was found. No locoregional recurrence was confirmed, but the metastases had close relation to severe postoperative changes. Two cycles of 3rd-lineTIP (paclitaxel 250 mg/qm day 1, ifosfamid 1500 mg/qm day 2–5, cisplatin 25 mg/qm day 2–5) salvage chemotherapy were delivered (May–June 2012). The patient has had regular follow-up, is currently 34 months disease-free, and being carefully monitored in order to detect relapse, development of secondary malignancies and to assess cardiovascular events, whose frequency is higher after combination chemotherapy for germ cell tumours.

Bottom Line: The patient is currently disease-free at 34 months.Aggressively treated metastatic recurrent disease does not preclude prolonged survival.Despite a generally poor prognosis, repeated complex oncosurgical therapy for retroperitoneal extragonadal tumours may be worthwhile.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Comprehensive Cancer Centre and AGEL Research and Training Institute, Novy Jicin Hospital, Purkynova 2138-16, 741 01 Novy Jicin Czech Republic. Electronic address: tulakmato@gmail.com.

No MeSH data available.


Related in: MedlinePlus