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Joel Sheinfeld - One of the best experts on this subject based on the ideXlab platform.
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incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy Retroperitoneal lymph node dissection
Journal of Clinical Oncology, 2007Co-Authors: Brett S Carver, George J Bosl, Robert J Motzer, Jason Stasi, Bobby Shayegan, Scott E Eggener, Joel SheinfeldAbstract:Introduction Modified template Retroperitoneal lymph node dissections (RPLND) have become increasing applied in the postchemotherapy (PC) setting. We evaluated our experience with PC-RPLND to determine the incidence of Disease extending outside the boundaries of a modified PC-RPLND. Patients and Methods From 1989 through 2003, a total of 532 men underwent PC-RPLND for metastatic nonseminomatous germ cell tumor (NSGCT). Of these, 269 (51%) had either viable germ cell tumor (GCT) or teratoma present in the RPLND specimen. After Institutional Review Board approval, clinical and pathologic data were obtained from our prospective surgical database. The incidence of Retroperitoneal Disease outside the boundaries of five modified templates was reported for the presence of viable GCT or teratoma. Results Of the 269 patients with viable GCT or teratoma, 20 to 86 (7% to 32%) patients had evidence of extratemplate Retroperitoneal Disease, depending on the boundaries of the modified template. There was no difference ...
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Management of patients with low-stage nonseminomatous germ cell testicular cancer
Current Treatment Options in Oncology, 2005Co-Authors: Andrew J Stephenson, Joel SheinfeldAbstract:Management options for patients with clinical stage (CS) I nonseminomatous germ cell testicular cancer (NSGCT) include surveillance, Retroperitoneal lymph node dissection (RPLND), or two cycles of bleomycin-etoposide-cisplatin (BEPx2) chemotherapy. The optimal management of these patients is controversial, as cure rates of 97% or greater are reported with each of these treatment modalities. Patients without evidence of lymphovascular invasion, a predominant component of embryonal carcinoma, or advanced pathologic (p) T stage (pT2 or greater) are at low risk for occult metastases and are optimal candidates for surveillance. Compliance with diagnostic testing and imaging is essential for a successful surveillance strategy to detect and treat metastases at an early stage. For patients who are not candidates for surveillance, RPLND offers several advantages over chemotherapy. RPLND alone is curative in 50% to 80% of CS I patients with pathologic stage (PS) II, and an estimated 75% of CS I patients avoid chemotherapy (as adjuvant therapy or for treatment of relapse). Virtually all patients are cured following two cycles of adjuvant chemotherapy for PS II Disease, which is reserved for patients with high-volume (PN2-3) Retroperitoneal Disease. The poor outcome of patients with late Retroperitoneal recurrence from unresected, chemorefractory germ cell testicular cancer indicates that RPLND is a vital component to the long-term cure of patients with NSGCT. Approximately 20% to 30% of patients with PS II Disease have Retroperitoneal teratoma (which is chemoresistant), and an estimated 5% of PS II patients have chemoresistant viable cancer following BEPx2 as primary therapy. When RPLND is omitted, these patients are at risk for late recurrence with potentially lethal consequences. Patients who relapse after RPLND are “chemotherapy-naïve” and cured in virtually all cases with good-risk chemotherapy regimens. When nerve-sparing techniques are employed to preserve ejaculation, RPLND is also associated with a more favorable long-term toxicity profile compared with chemotherapy. In the absence of conclusive evidence from a randomized trial, we believe RPLND is the treatment of choice for patients with CS I NSGCT who are not candidates for surveillance, as it offers the greatest likelihood of longterm cure with considerably less morbidity than primary chemotherapy.
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Retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer impact of patient selection factors on outcome
Journal of Clinical Oncology, 2005Co-Authors: Andrew J Stephenson, George J Bosl, Robert J Motzer, Michael W Kattan, Jason Stasi, Dean F Bajorin, Joel SheinfeldAbstract:Purpose To investigate the impact of patient selection criteria on the outcome of patients with nonseminomatous germ cell testicular cancer (NSGCT) treated by primary Retroperitoneal lymph node dissection (RPLND). Since 1999, our criteria have excluded patients with persistent postorchiectomy elevation of serum tumor markers (STM) or clinical stage (CS) IIB Disease from RPLND. Patients and Methods Between 1989 and 2002, 453 patients underwent primary RPLND at our institution for CS I to IIB NSGCT. Patient information was obtained from a prospective database. Retroperitoneal pathology and relapse rates were compared for patients treated before and after application of the current selection criteria in 1999. Results By excluding patients with elevated STM or CS IIB Disease after 1999, the proportion of pathologic stage II patients with low-volume (pN1) Retroperitoneal Disease increased significantly (40% before 1999 v 64% after 1999; P = .01), without significantly affecting the rate of Retroperitoneal tera...
George J Bosl - One of the best experts on this subject based on the ideXlab platform.
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incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy Retroperitoneal lymph node dissection
Journal of Clinical Oncology, 2007Co-Authors: Brett S Carver, George J Bosl, Robert J Motzer, Jason Stasi, Bobby Shayegan, Scott E Eggener, Joel SheinfeldAbstract:Introduction Modified template Retroperitoneal lymph node dissections (RPLND) have become increasing applied in the postchemotherapy (PC) setting. We evaluated our experience with PC-RPLND to determine the incidence of Disease extending outside the boundaries of a modified PC-RPLND. Patients and Methods From 1989 through 2003, a total of 532 men underwent PC-RPLND for metastatic nonseminomatous germ cell tumor (NSGCT). Of these, 269 (51%) had either viable germ cell tumor (GCT) or teratoma present in the RPLND specimen. After Institutional Review Board approval, clinical and pathologic data were obtained from our prospective surgical database. The incidence of Retroperitoneal Disease outside the boundaries of five modified templates was reported for the presence of viable GCT or teratoma. Results Of the 269 patients with viable GCT or teratoma, 20 to 86 (7% to 32%) patients had evidence of extratemplate Retroperitoneal Disease, depending on the boundaries of the modified template. There was no difference ...
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Retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer impact of patient selection factors on outcome
Journal of Clinical Oncology, 2005Co-Authors: Andrew J Stephenson, George J Bosl, Robert J Motzer, Michael W Kattan, Jason Stasi, Dean F Bajorin, Joel SheinfeldAbstract:Purpose To investigate the impact of patient selection criteria on the outcome of patients with nonseminomatous germ cell testicular cancer (NSGCT) treated by primary Retroperitoneal lymph node dissection (RPLND). Since 1999, our criteria have excluded patients with persistent postorchiectomy elevation of serum tumor markers (STM) or clinical stage (CS) IIB Disease from RPLND. Patients and Methods Between 1989 and 2002, 453 patients underwent primary RPLND at our institution for CS I to IIB NSGCT. Patient information was obtained from a prospective database. Retroperitoneal pathology and relapse rates were compared for patients treated before and after application of the current selection criteria in 1999. Results By excluding patients with elevated STM or CS IIB Disease after 1999, the proportion of pathologic stage II patients with low-volume (pN1) Retroperitoneal Disease increased significantly (40% before 1999 v 64% after 1999; P = .01), without significantly affecting the rate of Retroperitoneal tera...
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the management of patients with nonseminomatous germ cell tumors of the testis with serologic Disease only after orchiectomy
The Journal of Urology, 1994Co-Authors: Bradley E Davis, Harry W Herr, William R Fair, George J BoslAbstract:AbstractManagement of patients with nonseminomatous germ cell tumors of the testis who have persistently elevated serum tumor marker levels (α-fetoprotein and/or human chorionic gonadotropin) following orchiectomy and no clinical evidence of Disease is controversial. We reviewed our experience with 15 such patients at our cancer center between March 1977 and November 1991. Group 1 (11 patients) underwent initial Retroperitoneal lymph node dissection and group 2 (4 patients) received primary chemotherapy. All group 1 patients required subsequent chemotherapy for Retroperitoneal Disease or persistent marker elevation, whereas only 1 of the 4 who received primary chemotherapy required later surgery. We conclude that tumor marker elevation in this setting is usually indicative of systemic tumor, which is best treated primarily by initial chemotherapy.
Andrew J Stephenson - One of the best experts on this subject based on the ideXlab platform.
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Management of patients with low-stage nonseminomatous germ cell testicular cancer
Current Treatment Options in Oncology, 2005Co-Authors: Andrew J Stephenson, Joel SheinfeldAbstract:Management options for patients with clinical stage (CS) I nonseminomatous germ cell testicular cancer (NSGCT) include surveillance, Retroperitoneal lymph node dissection (RPLND), or two cycles of bleomycin-etoposide-cisplatin (BEPx2) chemotherapy. The optimal management of these patients is controversial, as cure rates of 97% or greater are reported with each of these treatment modalities. Patients without evidence of lymphovascular invasion, a predominant component of embryonal carcinoma, or advanced pathologic (p) T stage (pT2 or greater) are at low risk for occult metastases and are optimal candidates for surveillance. Compliance with diagnostic testing and imaging is essential for a successful surveillance strategy to detect and treat metastases at an early stage. For patients who are not candidates for surveillance, RPLND offers several advantages over chemotherapy. RPLND alone is curative in 50% to 80% of CS I patients with pathologic stage (PS) II, and an estimated 75% of CS I patients avoid chemotherapy (as adjuvant therapy or for treatment of relapse). Virtually all patients are cured following two cycles of adjuvant chemotherapy for PS II Disease, which is reserved for patients with high-volume (PN2-3) Retroperitoneal Disease. The poor outcome of patients with late Retroperitoneal recurrence from unresected, chemorefractory germ cell testicular cancer indicates that RPLND is a vital component to the long-term cure of patients with NSGCT. Approximately 20% to 30% of patients with PS II Disease have Retroperitoneal teratoma (which is chemoresistant), and an estimated 5% of PS II patients have chemoresistant viable cancer following BEPx2 as primary therapy. When RPLND is omitted, these patients are at risk for late recurrence with potentially lethal consequences. Patients who relapse after RPLND are “chemotherapy-naïve” and cured in virtually all cases with good-risk chemotherapy regimens. When nerve-sparing techniques are employed to preserve ejaculation, RPLND is also associated with a more favorable long-term toxicity profile compared with chemotherapy. In the absence of conclusive evidence from a randomized trial, we believe RPLND is the treatment of choice for patients with CS I NSGCT who are not candidates for surveillance, as it offers the greatest likelihood of longterm cure with considerably less morbidity than primary chemotherapy.
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Retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer impact of patient selection factors on outcome
Journal of Clinical Oncology, 2005Co-Authors: Andrew J Stephenson, George J Bosl, Robert J Motzer, Michael W Kattan, Jason Stasi, Dean F Bajorin, Joel SheinfeldAbstract:Purpose To investigate the impact of patient selection criteria on the outcome of patients with nonseminomatous germ cell testicular cancer (NSGCT) treated by primary Retroperitoneal lymph node dissection (RPLND). Since 1999, our criteria have excluded patients with persistent postorchiectomy elevation of serum tumor markers (STM) or clinical stage (CS) IIB Disease from RPLND. Patients and Methods Between 1989 and 2002, 453 patients underwent primary RPLND at our institution for CS I to IIB NSGCT. Patient information was obtained from a prospective database. Retroperitoneal pathology and relapse rates were compared for patients treated before and after application of the current selection criteria in 1999. Results By excluding patients with elevated STM or CS IIB Disease after 1999, the proportion of pathologic stage II patients with low-volume (pN1) Retroperitoneal Disease increased significantly (40% before 1999 v 64% after 1999; P = .01), without significantly affecting the rate of Retroperitoneal tera...
Stéphane Culine - One of the best experts on this subject based on the ideXlab platform.
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Treatment with Sunitinib Enabled Complete Resection of Massive Lymphadenopathy not Previously Amenable to Excision in a Patient with Renal Cell Carcinoma.
European Urology, 2009Co-Authors: Jean-jacques Patard, Rodolphe Thuret, Avakian Raffi, Brigitte Laguerre, Karim Bensalah, Stéphane CulineAbstract:We present a case of previously unresectable lymphadenopathy in a patient with renal cell carcinoma treated with sunitinib. Complete resection of a 15-cm left renal cell carcinoma was initially impossible due to massive Retroperitoneal Disease and encasement of the great vessels and mesenteric vessels. Residual Retroperitoneal Disease from a radical nephrectomy was treated with the oral, multitargeted receptor tyrosine kinase inhibitor, sunitinib. Tumour shrinkage following five cycles of treatment allowed uncomplicated complete resection of the lymphadenopathy. Follow-up after 6 mo showed no evidence of Disease recurrence.
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primary chemotherapy in patients with nonseminomatous germ cell tumors of the testis and biological Disease only after orchiectomy
The Journal of Urology, 1996Co-Authors: Stéphane Culine, Christine Theodore, M J Terrierlacombe, J P DrozAbstract:AbstractPurpose: We assessed the efficacy of primary chemotherapy in patients with nonseminomatous germ cell tumors of the testis and elevated serum tumor markers as the only evidence of Disease after orchiectomy.Materials and Methods: We analyzed the outcome of 20 patients with biological Disease only who received cisplatin-based (16) or carboplatin-based (4) chemotherapy as primary treatment following orchiectomy.Results: Serum tumor markers returned to normal levels in all 20 patients. One patient required subsequent surgery for recurrent Retroperitoneal mature teratoma. Two patients experienced a relapse with active Disease, 1 of whom died of progressive germ cell tumor. Of the patients 19 remained free of Disease 18 to 116 months after the end of treatment.Conclusions: Since results with primary Retroperitoneal lymph node dissection suggest that elevated serum tumor markers usually reflect systemic metastases rather than Retroperitoneal Disease, primary chemotherapy seems to be the most appropriate s...
Steven Joniau - One of the best experts on this subject based on the ideXlab platform.
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reply from authors re francesco greco metastatic renal cell carcinoma an invincible enemy eur urol 2013 63 653 4 metastatic renal cell carcinoma from invincible enemy to predictable enemy
European Urology, 2013Co-Authors: Lorenzo Tosco, Hendrik Van Poppel, Bruno Frea, Steven JoniauAbstract:Metastatic renal cell carcinoma (mRCC) still represents a challenging Disease, but encouraging results of novel targeted therapies and active research in the field are changing perspectives. Based on this background, Greco [1] questions whether mRCC continues to be an ‘‘invincible enemy’’ or if there are developments in this field. In an attempt to answer this question, it is useful to analyse some examples that were previously considered to be invincible enemies in urology. Testicular cancer is a paradigmatic Disease in which a drastic reduction in mortality was achieved after introducing effective platinum-based chemotherapy [2]. Surgery still has an important role in removing the primary cancer and in removing residual Retroperitoneal Disease following chemotherapy. Unfortunately, at present, no treatments with comparable efficacy are available for mRCC, but targeted agents have shown encouraging results in Disease stabilisation and, in some cases, complete responses have been described [3]. The role of cytoreductive nephrectomy and removal of (residual) metastatic Disease is more controversial in this context. Another important example of a drastic therapeutic evolution in uro-oncology is the treatment of node-positive prostate cancer. Initially, this Disease stage was thought to represent systemic Disease for which surgical treatment was considered inappropriate. Nevertheless, more recently, radical prostatectomy with extended lymphadenectomy was introduced as an accepted and important first step in the treatment of node-positive prostate cancer [4], leaving the possibility of adding androgen-deprivation therapy with or without radiotherapy as effective adjuvant treatments. Such multimodal therapy, combining surgery, radiotherapy, and systemic treatment, appeared to drastically improve cancer-specific survival [5]. It is obviously impossible to compare mRCC with testicular or node-positive prostate cancer in terms of tumour biology and natural history, but the message we should take home from these experiences is that multimodal therapy is a valid contemporary strategy in the