シンポジウム9「精巣腫瘍診療ガイドラインを検証する｣ : 座長の言葉<第61回日本泌尿器科学会中部総会>

Abstract

Testicular cancer is a rare disease that affects 1-2 in 100, 000 people in Japan ; however, it is a very significant disease in that it has a high prevalence amongst young adults aged in their 20s and 30s and it brings about metastasis from a relatively early stage. The 2009 edition of the Testicular Cancer Clinical Practice Guidelines sets out a detailed summary of 32 clinical questions (CQ) considered necessary in routine clinical practice across the fields of epidemiology, diagnosis, treatment, etc, in the form of recommendations and commentary. These CQs are considered extremely important in understanding the foundation of future testicular cancer treatment guidelines. In this symposium, five doctors gave lectures consisting of the following contents in which they validated the guidelines and gave concrete clinical practice examples through cases they had experienced themselves with regards to the treatment strategies for (1) stage I patients, (2) patients with advanced cancer and (3) patients with extragonadal germ cell tumors. (1) Stage I patients : In seminoma cases, the doctors focused on the relapse prevention effect provided by single-agent carboplatin adjuvant chemotherapy. In non-seminoma cases, treatment options were considered according to risk based on the presence or absence of vascular invasion, a prognostic factor. (2) Patients with advanced cancer : 30% of testicular cancers are metastatic and progress to advanced cancer. In refractory cases resistant to bleomycin, etoposide and cisplatin therapy, etoposide ifosfamide, and cisplatin therapy and vinblastine, ifosfamide and cisplatin therapy have been used, but without satisfactory results and the development of new salvage chemotherapy is an important issue. The therapeutic strategies against advanced testicular cancer were narrowed down to (2) -1) therapeutic effects from ultra-high-dose chemotherapy, (2) -2) salvage chemotherapy in cases where residual tumors are observed in induction chemotherapy and (2) -3) minimally invasive surgical treatment for residual tumors after chemotherapy. Concrete clinical cases from basic treatment strategies to the latest findings in refractory cancer patients were presented and considered in detail. (3) Patients with extragonadal germ cell tumors : Extragonadal germ cell tumors account for less than 5% of all germ cell tumors, but they can be cured with multimodality therapy. Therefore, it is important to reach an accurate diagnosis and provide the correct treatment. This disease is suspected in patients with elevated α-fetoprotein and human chorionic gonadotropin without the appearance of tumors in the testes, and tumors can be observed on the center line of the body such as the mediastinum or retroperitoneum. Traditionally, computed tomography-guided biopsy has been carried out in diagnosis. However, new techniques such as endoscopic ultrasound-guided biopsy have also been reported in recent years and the latest information, including treatments, was presented at this symposium.