Skip to main content
Erschienen in:

01.11.2016 | Hodentumoren | CME

Diagnostik, Therapie und Nachsorge beim Hodentumor

verfasst von: Prof. Dr. med. Susanne Krege

Erschienen in: Die Onkologie | Ausgabe 11/2016

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Der Hodentumor ist eine Erkrankung des jungen erwachsenen Mannes und gehört zu den am häufigsten heilbaren Tumoren. Selbst in fortgeschrittenen, metastasierten Stadien werden heute Heilungsraten bis zu 80 % erzielt. Dies wurde durch die konsequente, an Stadien orientierte Umsetzung von Studien erreicht.

Therapie und Nachsorge

Das Behandlungskonzept ist interdisziplinär. Es umfasst nach Sicherung der Diagnose durch Entfernung des befallenen Hodens je nach Stadium die aktive Beobachtung, Chemotherapie, Radiatio, operative Maßnahmen oder eine Kombination der Optionen. Die gute Heilbarkeit hat Konsequenzen für den Langzeitverlauf („long-term survivorship“). Wichtig in der Nachsorge sind die Kontrolle bezüglich des Auftretens von Rezidiven sowie die Beobachtung und Behandlung von Langzeittoxizitäten der verschiedenen Therapiemaßnahmen.

Resümee

Da der Hodentumor mit etwa 4500 Fällen pro Jahr selten ist, sollte die Behandlung zumindest der fortgeschrittenen Stadien an Zentren erfolgen. Zudem etablierte die Interdisziplinäre Deutsche Hodentumorgruppe ein Zweitmeinungsportal.
Fußnoten
1
Die AUC („area under the curve“) gibt die Konzentration des Medikaments an, die man für die Indikation im Körper erreichen möchte. Die Berechnung der Carboplatindosis erfolgt mit Hilfe der Calvert-Formel, die auch die AUC berücksichtigt: Dosis [mg] = AUC x (GFR + 25).
 
Literatur
1.
2.
Zurück zum Zitat Heidenreich A, Weissbach L, Höltl W et al (2001) Organ sparing surgery for malignant germ cell tumor oft he testis. J Urol 166:2161–2165CrossRefPubMed Heidenreich A, Weissbach L, Höltl W et al (2001) Organ sparing surgery for malignant germ cell tumor oft he testis. J Urol 166:2161–2165CrossRefPubMed
3.
Zurück zum Zitat Spiekermann M, Belge G, Winter N et al (2014) MicroRNA miR-371a-3p in serum of patients with germ cell-tumours: Evaluations for establishing a serum biomarker. Andrology 3:78–84CrossRefPubMed Spiekermann M, Belge G, Winter N et al (2014) MicroRNA miR-371a-3p in serum of patients with germ cell-tumours: Evaluations for establishing a serum biomarker. Andrology 3:78–84CrossRefPubMed
4.
Zurück zum Zitat International Germ cell Cancer Collaborative Group (IGCCCG) (1997) The International Germ Cell Consensus Classification: A prognostic factor based staging system for metastatic germ cell cancer. J Clin Oncol 15:594–603 International Germ cell Cancer Collaborative Group (IGCCCG) (1997) The International Germ Cell Consensus Classification: A prognostic factor based staging system for metastatic germ cell cancer. J Clin Oncol 15:594–603
5.
Zurück zum Zitat UICC (Hrsg) (2010) TNM classification of malignant tumours, 7. Aufl. Wiley, Hoboken. ISBN 9781444332414 UICC (Hrsg) (2010) TNM classification of malignant tumours, 7. Aufl. Wiley, Hoboken. ISBN 9781444332414
6.
Zurück zum Zitat Warde P, Gospodarowicz MK, Banerjee D et al (1997) Prognostic factors for relapse in stage I testicular seminoma treated with surveillance. J Urol 157:1705–1710CrossRefPubMed Warde P, Gospodarowicz MK, Banerjee D et al (1997) Prognostic factors for relapse in stage I testicular seminoma treated with surveillance. J Urol 157:1705–1710CrossRefPubMed
7.
Zurück zum Zitat Cohn-Cedermark G, Stahl O, Tandstad T (2015) Suveillance vs. adjuvant therapy of clinical stage I testicular tumors – a review and the SWENOTECA experience. Andrology 3:102–110CrossRefPubMed Cohn-Cedermark G, Stahl O, Tandstad T (2015) Suveillance vs. adjuvant therapy of clinical stage I testicular tumors – a review and the SWENOTECA experience. Andrology 3:102–110CrossRefPubMed
8.
Zurück zum Zitat Jones WG, Fossa SD, Mead GM et al (2005) Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: A report on Medical Research Council Trial TE 18, European Organization for the Research and Treatment of cancer Trial 30942. J Clin Oncol 23(6):1200–1208CrossRefPubMed Jones WG, Fossa SD, Mead GM et al (2005) Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: A report on Medical Research Council Trial TE 18, European Organization for the Research and Treatment of cancer Trial 30942. J Clin Oncol 23(6):1200–1208CrossRefPubMed
9.
Zurück zum Zitat Oliver RT, Mead GM, Rustin GJ et al (2011) Randomized trial of carboplatin versus radiotherapy for stage I seminoma: Mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study. J Clin Oncol 29:957–962CrossRefPubMed Oliver RT, Mead GM, Rustin GJ et al (2011) Randomized trial of carboplatin versus radiotherapy for stage I seminoma: Mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study. J Clin Oncol 29:957–962CrossRefPubMed
10.
Zurück zum Zitat Horwich A, Fossa SD, Huddart R et al (2014) Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer 110:256–263CrossRefPubMed Horwich A, Fossa SD, Huddart R et al (2014) Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer 110:256–263CrossRefPubMed
11.
Zurück zum Zitat Classen J, Schmidberger H, Meicner C et al (2003) Radiotherapy for stage IIA/B testicular seminoma: Final report of a prospective multicenter clinical trial. J Clin Oncol 21:1101–1106CrossRefPubMed Classen J, Schmidberger H, Meicner C et al (2003) Radiotherapy for stage IIA/B testicular seminoma: Final report of a prospective multicenter clinical trial. J Clin Oncol 21:1101–1106CrossRefPubMed
12.
Zurück zum Zitat Tandstad T, Smaaland R, Solberg A et al (2011) Management of seminomatous testicular cancer: A binational prospective population-based study from the Swedish Norwegian testicular cancer study group. J Clin Oncol 29:719–725CrossRefPubMed Tandstad T, Smaaland R, Solberg A et al (2011) Management of seminomatous testicular cancer: A binational prospective population-based study from the Swedish Norwegian testicular cancer study group. J Clin Oncol 29:719–725CrossRefPubMed
13.
Zurück zum Zitat Albers P, Siener R, Kliesch S et al (2003) Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: Results of the German Testicular Cancer Study Group trial. J Clin Oncol 21:1505–1512CrossRefPubMed Albers P, Siener R, Kliesch S et al (2003) Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: Results of the German Testicular Cancer Study Group trial. J Clin Oncol 21:1505–1512CrossRefPubMed
14.
Zurück zum Zitat Daugaard G, Gundgaard MG, Mortensen MS et al (2014) Surveillance for stage I nonseminoma testicular cancer: Outcomes and long-term follow-up in a population-based cohort. J Clin Oncol 32:3817–3823CrossRefPubMed Daugaard G, Gundgaard MG, Mortensen MS et al (2014) Surveillance for stage I nonseminoma testicular cancer: Outcomes and long-term follow-up in a population-based cohort. J Clin Oncol 32:3817–3823CrossRefPubMed
15.
Zurück zum Zitat Kollmannsberger C, Tandstad T, Bedard PL et al (2015) Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol 33:51–57CrossRefPubMed Kollmannsberger C, Tandstad T, Bedard PL et al (2015) Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol 33:51–57CrossRefPubMed
16.
Zurück zum Zitat Tandstad T, Stahl O, Hakansson U et al (2014) One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group. Ann Oncol 25:2167–2172CrossRefPubMed Tandstad T, Stahl O, Hakansson U et al (2014) One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group. Ann Oncol 25:2167–2172CrossRefPubMed
17.
Zurück zum Zitat Huddart RA, Norman A, Shahidi M et al (2003) Cardiovascular disease as a long-term complication of treatment for testicular cancer. J Clin Oncol 21:1513CrossRefPubMed Huddart RA, Norman A, Shahidi M et al (2003) Cardiovascular disease as a long-term complication of treatment for testicular cancer. J Clin Oncol 21:1513CrossRefPubMed
18.
Zurück zum Zitat Fung C, Fossa SD, Milano MT et al (2015) Cardiovascular disease mortality after chemotherapy or surgery for testicular nonseminoma: A population-based study. J Clin Oncol 33:3105–3114CrossRefPubMedPubMedCentral Fung C, Fossa SD, Milano MT et al (2015) Cardiovascular disease mortality after chemotherapy or surgery for testicular nonseminoma: A population-based study. J Clin Oncol 33:3105–3114CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Vidal AD, Thalmann GN, Karamitopoulou-Diamantis E et al (2015) Long-term outcome of patients with clinical stage I high-risk nonseminomatous germ-cell tumors 15 years after one adjuvant cycle of bleomycin, etoposide, and cisplatin. Ann Oncol 26:374–377CrossRefPubMed Vidal AD, Thalmann GN, Karamitopoulou-Diamantis E et al (2015) Long-term outcome of patients with clinical stage I high-risk nonseminomatous germ-cell tumors 15 years after one adjuvant cycle of bleomycin, etoposide, and cisplatin. Ann Oncol 26:374–377CrossRefPubMed
20.
Zurück zum Zitat Williams SD, Stablein DM, Einhorn LH et al (1987) Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer. N Engl J Med 317:1433–1438CrossRefPubMed Williams SD, Stablein DM, Einhorn LH et al (1987) Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer. N Engl J Med 317:1433–1438CrossRefPubMed
21.
Zurück zum Zitat BeyerJ, Bokemeyer C (2004) Chemotherapie von Keimzelltumoren. Urologe A 43:1507–1513CrossRef BeyerJ, Bokemeyer C (2004) Chemotherapie von Keimzelltumoren. Urologe A 43:1507–1513CrossRef
22.
Zurück zum Zitat de Wit R, Skoneczna I, Daugaard G et al (2012) Randomized phase III study comparing paclitaxel-bleomycin, etoposide, and cisplatin (BEP) to standard BEP in intermediate-prognosis germ-cell cancer: Intergroup stud〈 EORTC 30983. J Clin Oncol 30:792–799CrossRefPubMedPubMedCentral de Wit R, Skoneczna I, Daugaard G et al (2012) Randomized phase III study comparing paclitaxel-bleomycin, etoposide, and cisplatin (BEP) to standard BEP in intermediate-prognosis germ-cell cancer: Intergroup stud〈 EORTC 30983. J Clin Oncol 30:792–799CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Fizazi K, Pagliaro L, Laplanche A et al (2014) Personalised chemotherapy based on tumour marker decline in poor prognosis germ-cell tumours (GETUG 13): A phase 3, multicenter, randomized trial. Lancet Oncol 15:1442–1450CrossRefPubMed Fizazi K, Pagliaro L, Laplanche A et al (2014) Personalised chemotherapy based on tumour marker decline in poor prognosis germ-cell tumours (GETUG 13): A phase 3, multicenter, randomized trial. Lancet Oncol 15:1442–1450CrossRefPubMed
24.
Zurück zum Zitat Heidenreich A, Pfister D, Witthuhn R et al (2009) Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: Radical or modified template resection. Eur Urol 55:217–226CrossRefPubMed Heidenreich A, Pfister D, Witthuhn R et al (2009) Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: Radical or modified template resection. Eur Urol 55:217–226CrossRefPubMed
25.
Zurück zum Zitat Ravi P, Gray KP, O’Donnell EK et al (2014) A meta-analysis of patient outcomes with subcentimeter disease after chemotherapy for metastatic non-seminomatous germ cell tumor. Ann Oncol 25:331–338CrossRefPubMed Ravi P, Gray KP, O’Donnell EK et al (2014) A meta-analysis of patient outcomes with subcentimeter disease after chemotherapy for metastatic non-seminomatous germ cell tumor. Ann Oncol 25:331–338CrossRefPubMed
26.
Zurück zum Zitat de Santis M, Becherer A, Bokemeyer C et al (2004) 2‑18 fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: An update of the prospective multicentric SEMPET trial. J Clin Oncol 22:1034–1039CrossRefPubMed de Santis M, Becherer A, Bokemeyer C et al (2004) 2‑18 fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: An update of the prospective multicentric SEMPET trial. J Clin Oncol 22:1034–1039CrossRefPubMed
27.
Zurück zum Zitat Schirren J, Trainer S, Eberlein M et al (2012) The role of residual tumor resection in the management of nonseminomatous germ cell cancer of testicular origin. Thorac Cardiovasc Surg 60:405–412CrossRefPubMed Schirren J, Trainer S, Eberlein M et al (2012) The role of residual tumor resection in the management of nonseminomatous germ cell cancer of testicular origin. Thorac Cardiovasc Surg 60:405–412CrossRefPubMed
28.
Zurück zum Zitat Lorch A, Bascoul-Mollevi C, Kramar A et al (2011) Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: Evidence from a large international database. J Clin Oncol 29:2178–2184CrossRefPubMed Lorch A, Bascoul-Mollevi C, Kramar A et al (2011) Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: Evidence from a large international database. J Clin Oncol 29:2178–2184CrossRefPubMed
29.
Zurück zum Zitat The International Prognostic Factors Study Group (2010) Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy. J Clin Oncol 28:4906–4911CrossRef The International Prognostic Factors Study Group (2010) Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy. J Clin Oncol 28:4906–4911CrossRef
30.
Zurück zum Zitat Flechon A, Tavemier E, Boyle H et al (2010) Long-term oncological outcome after post-chemotherapy retroperitoneal lymph node dissection in men with metastatic nonseminomatous germ cell tumours. BJU Int 106:779–785CrossRefPubMed Flechon A, Tavemier E, Boyle H et al (2010) Long-term oncological outcome after post-chemotherapy retroperitoneal lymph node dissection in men with metastatic nonseminomatous germ cell tumours. BJU Int 106:779–785CrossRefPubMed
31.
Zurück zum Zitat Hartmann M, Krege S, Souchon R et al (2011) Follow-up of testicular germ cell cancer patients: interdisciplinary evidence-based recommendations. Urologe A 50:830–835CrossRefPubMed Hartmann M, Krege S, Souchon R et al (2011) Follow-up of testicular germ cell cancer patients: interdisciplinary evidence-based recommendations. Urologe A 50:830–835CrossRefPubMed
Metadaten
Titel
Diagnostik, Therapie und Nachsorge beim Hodentumor
verfasst von
Prof. Dr. med. Susanne Krege
Publikationsdatum
01.11.2016
Verlag
Springer Medizin
Erschienen in
Die Onkologie / Ausgabe 11/2016
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-016-0114-5

Weitere Artikel der Ausgabe 11/2016

Der Onkologe 11/2016 Zur Ausgabe