Long-term results of treatment of testicular tumors in children and adolescents. A retrospective analysis of a group of patients (1998–2021)
Authors:
Viera Bajčiová 1; Pavel Zerhau 2; Matěj Husár 2; Marta Ježová 3; Denisa Krejčí 4
Authors‘ workplace:
Klinika dětské onkologie FN Brno
1; Klinika dětské chirurgie, ortopedie a traumatologie FN Brno
2; Anatomický ústav FN Brno
3; Institut biostatistiky a analýz LF MU Brno
4
Published in:
Ces Urol 2022; 26(2): 99-110
Category:
Original article
Overview
Aim: Retrospective analysis of 96 patients with primary testicular cancer treated at a pediatric oncology department in the period 1998–2021. Evaluation of epidemiology, age-specific distribution of types of germinal testicular tumors, type of operation, type of chemotherapy and treatment results. Evaluation of late effects of treatment in long-term survivors.
Methods and characteristics: during the study period, 96 patients with primary testicular tumor – 89 germinal tumor type (TGCT), 6 stromal tumor type were treated. 1 patient was diagnosed with primary non-Hodgkin’s testicular lymphoma. In 1 case, the tumor was bilateral. In 58 cases, TGCT was a malignant type of tumor, and a mature prepubertal teratoma was diagnosed in 31 cases. The TGCT subtype was significantly associated with the patient’s age. Malignant tumors predominated in adolescents; in prepubertal age, most tumors were benign. Higher clinical stages (III and IV) were more common in adolescents. All patients underwent surgery – radical orchiectomy in 81 patients, testis sparing surgery (TSS) in 15 patients. Residual tumor mass surgery in metastatic patients after the end of chemotherapy took place in 9 patients, only 2 patients showed signs of vital tumor. No retroperitoneal lymph node dissection was indicated in any patient. Watch and wait strategies without adjuvant treatment were indicated in all prepubertal patients, in 14 adolescent patients and in all patients with stromal tumor type. Chemotherapy was indicated according to the type of tumor, clinical stage, age of the patient, the dynamics of the tumor markers and the classification into the risk group.
Results: All 89 patients with TGCT achieved remission. 2 patients with vital residual tumor after the end of first-line treatment achieved clinical remission after the second-line treatment. 1 patient developed metachronous malignant TGCT in the contralateral testis 7,4 years after the primary diagnosis. 1 patient developed late metastatic progression of mixed TGCT after 3,1 years and exited. 5-year overall survival (OS) is 98,7%, 5-year event free survival (EFS) is 98,7%. The median follow-up after treatment is 11,5 years. Nephrotoxicity and ototoxicity gr I and II and fertility disorders were confirmed in 11 patients. Pulmonary toxicity is present in 2 patients, 2 patients have psychological problems.
Conclusion: Testicular tumors are rare in prepubertal children, their incidence increases with age. They are the most common cancer in adolescents. The germ cell tumors are the most frequent type. The distribution of histological types of TGCT is age-specific. The patient’s prognosis depends on early diagnosis, the extent of the disease and the dynamics of the decline in tumor markers. The gold standard of treatment is radical orchiectomy, TSS is possible in a well-defined group of prepubertal boys. Chemotherapy significantly improved the prognosis of TGCT and included testicular tumors among the curative types of tumors. The risks of toxicity and late effects of treatment lead to efforts to reduce the dose and duration of chemotherapy while maintaining the results. Improving health education in adolescents is also an important factor.
Keywords:
Adolescents – analysis – children – testicular tumors
Sources
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Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2022 Issue 2
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