peplomycin and Testicular-Neoplasms

A case of bilateral testicular germ cell tumors in a 23-year-old male is reported. He was admitted to the Department of Urology, Yamagata Prefecture Kahoku Hospital with the chief complaint of painless swelling in the left intrascrotal contents. Left high inguinal orchiectomy was carried out. At the same time, right hydrocele operation and right testicular biopsy were performed. Subsequent histological examination revealed anaplastic seminoma in the left testis and typical seminoma in the right. On July 21, 1988, he was referred to our clinic and right high inguinal orchiectomy was carried out. Postoperative chemotherapy was performed with CDDP, VP-16 and peplomycin, and postoperative course was uneventful with no distant metastasis or local recurrence. A total of 136 cases of bilateral testicular germ cell tumors in the Japanese literature are reviewed.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Dysgerminoma; Humans; Male; Orchiectomy; Peplomycin; Testicular Neoplasms

A 40-year-old man with stage I left testicular seminoma who had been followed for 18 months after orchiectomy, complained of pain in his left upper extremity and dysbasia. Magnetic resonance imaging (MRI) and bone scintigraphy suggested multiple bone lesions in the thoracic vertebrae and right ischium, and bone biopsy revealed metastasis of seminoma. There was no evidence of other metastatic lesions. After he was treated with 2 courses of first-line chemotherapy consisting of peplomycin, etoposide, and cisplatin, which were followed by 2 courses of high-dose chemotherapy with carboplatin, etoposide, and ifosfamide, the metastatic lesions were nearly in complete response on MRI and bone scintigraphy and the result of fluorodeoxyglucose-positron emission tomography was negative, but the hCG-beta level remained slightly elevated. In most advanced testicular tumors, bone metastasis usually coexists with other metastatic lesions and appears as a secondary lesion. Herein, we report this rare case of primary and solitary bone metastasis from testicular seminoma after orchiectomy.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Cisplatin; Etoposide; Fluorodeoxyglucose F18; Humans; Male; Orchiectomy; Peplomycin; Positron-Emission Tomography; Seminoma; Testicular Neoplasms

A 32-year-old man presented with a swelling of the left testis, for which he underwent high inguinal orchiectomy. Histopathological examination of the specimen revealed teratocarcinoma. Further evaluation revealed no metastasis (stage I), and he was followed-up by monthly examination without prophylactic chemotherapy (surveillance). Thirteen months after orchiectomy, AFP and hCG-beta were elevated at 133.8 ng/ml and 0.8 ng/ml respectively. Abdominal CT scan revealed para-aortic masses of recurrent tumor. Although the AFP and hCG-beta levels markedly declined after five courses of COMPE (CDDP, VCR, MTX, PEP, Etoposide) chemotherapy, the retroperitoneal masses had further enlarged and had undergone cystic change. Excision of the residual tumors was performed, and microscopic examination of specimens revealed mature teratoma without malignant components. The diagnosis of the growing teratoma syndrome was therefore made. The growing teratoma syndrome occurs in nonseminomatous testicular germ cell tumors following chemotherapy and is characterized by enlargement of metastatic lesions with normal tumor marker levels. Total surgical resection of the mass yields good results, and tumor is unresponsive to chemotherapy. Early recognition of this syndrome is important for successful treatment.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Etoposide; Humans; Male; Methotrexate; Orchiectomy; Peplomycin; Syndrome; Teratoma; Testicular Neoplasms; Vincristine

The advent of cisplatin rendered disseminated testicular germ cell tumor an often curable malignant disease. Patients with a heavy metastatic burden, however, remain poor risks; furthermore, many patients experience nausea or other adverse events. This paper reports a trial of a cisplatin-based (COMPE) combination chemotherapy regimen based on synchronization theory.. Twenty patients with disseminated germ cell testicular tumors were treated with COMPE; any residual tumor mass was surgically resected.. Seventeen patients (85%) achieved complete remission by chemotherapy. The actuarial overall and cause-specific 3-year survival rates were 89% and 94%, respectively. In the subset of 16 "good-risk" patients, all remain alive after a median follow-up of 43 months. Complications were quite tolerable, with nephrotoxicity in particular being extremely mild.. COMPE is an effective chemotherapy regimen in patients with disseminated germ cell testicular tumors. Complications arising from this therapy are mild.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Child, Preschool; Cisplatin; Etoposide; Germinoma; Humans; Male; Methotrexate; Middle Aged; Peplomycin; Survival Analysis; Testicular Neoplasms; Treatment Outcome; Vincristine

A 31-year-old man was admitted to our hospital with the chief complaint of painful right scrotal swelling. Based on the diagnosis of right testicular tumor with multiple lung metastasis and L2 vertebral body metastasis, right high orchiectomy and three courses of chemotherapy (peplomycin, etoposide, CDDP) were performed. Histological diagnosis was teratocarcinoma. With the complete remission for lung metastasis and no change for bone metastasis, L2 spondylectomy and additional four courses of the same chemotherapy were performed. The patient has been free of the disease for 11 months after the spondylectomy.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Disease-Free Survival; Etoposide; Humans; Lumbar Vertebrae; Lung Neoplasms; Male; Orchiectomy; Peplomycin; Spinal Neoplasms; Teratocarcinoma; Testicular Neoplasms

We report a case of pure yolk sac tumor of the left testis in a 22-year-old male. He consulted a physician with left back pain and induration of his left scrotal content in December, 1992. Intravenous pyelography (IVP) revealed left hydronephrosis. Computerized tomography (CT) revealed para-aortic lymph node swelling and lung metastases. Left high inguinal orchiectomy was performed. Histopathological diagnosis was pure yolk sac tumor. After two courses of "COMPE" chemotherapy consisting of cisplatin, vincristine, methotrexate, peplomycin and etoposide, two courses of "high dose "COMPE" chemotherapy and three courses of "high dose COME" chemotherapy without peplomycin, he achieved a partial response (the regression rate of the pulmonary metastases and the retroperitoneal lymph node metastasis were 100% and 96.0% on CT, respectively) and the residual masses in the retroperitoneum were removed. Necrosis and xanthogranulomatous fibrosis were found in the resected material. The patient showed no evidence of disease two years after chemotherapy.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Endodermal Sinus Tumor; Etoposide; Humans; Male; Methotrexate; Peplomycin; Remission Induction; Testicular Neoplasms; Vincristine

Since 1989, 4 patients with Stage III nonseminomatous germ cell tumor of the testis underwent thoracotomy for persistent radiographic masses after systemic chemotherapy. They were treated with multi-drug regimen including cisplatin, vincristine, methotrexate, peplomycin, and etoposide until normalization of tumor markers was obtained. Residual masses of the 4 patients consisted of viable cancer cells in 1 patient, immature teratoma in 1, mature teratoma in 1 and necrosis in 1. Of the 4 patients 3 achieved complete remission and are doing well with no evidence of disease, while the other case with residual viable cancer cells died of renal failure. The key to successful treatment of advanced testicular cancer was considered to be a favorable response to chemotherapy and complete resection of any residual tumors.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Chemotherapy, Adjuvant; Cisplatin; Drug Administration Schedule; Etoposide; Germinoma; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Methotrexate; Peplomycin; Testicular Neoplasms; Thoracotomy; Vincristine

A 43-year-old male visited our hospital with complaints of right scrotal swelling and lower abdominal mass. Computed tomographic (CT) scan showed the right testicular tumor and regional enlarged lymph nodes. However, there were no metastasis in lung, brain, liver, and bone. First, we performed chemotherapy of modified PVB regimen (cisplatinum, vinblastine, peplomycin) prior to the right orchiectomy, because a tumor lump was palpable from the right testis to the lower abdominal mass. After three courses of modified PVB chemotherapy, beta-HCG, HCG and LDH values became within normal limits and all tumors were necrotic on the CT scan. Then, we performed the right orchiectomy and retroperitoneal lymphadenectomy simultaneously. After operation, two courses of VIP chemotherapy (etoposide, ifosfamide, cisplatinum) were performed since viable cells in one of the obturator lymph nodes were pathologically noticed. The patient has been free of recurrence of the tumor for 15 months after the treatment. In the particular case, in which the primary testicular tumor was not extirpated en bloc, the initial chemotherapy followed by orchiectomy was found to be feasible.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Etoposide; Humans; Ifosfamide; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Orchiectomy; Peplomycin; Retroperitoneal Space; Seminoma; Testicular Neoplasms; Vinblastine

We presented 15 patients with advanced testicular cancer treated with to 7 courses (mean: 3.2 courses) of COMPE chemotherapy. The low dose COMPE, given 14 patients, consisted of the chemotherapeutic agents as follows: cisplatin, 5 mg/m2 by intravenous push infusion and thereafter 25 mg/m2 by continuous 24-hour-infusion on day 3 and 30 mg/m2 by continuous 24-hour-infusion on day 4; vincristine, 0.6 mg/m2 by drip intravenous infusion (div) on days 1 and 2; methotrexate, 10 mg/m2 by div on day 1; peplomycin, 10 mg/m2/day, divided to three times by intramuscular injection on days 1 to 3; etoposide, 100 mg/m2, by div on days 3 to 5. The regular dose COMPE (given one patient) had CDDP dosage up to 50 mg/m2/day on days 3 and 4. the regimens were given every 3 or 4 weeks in admission. Patients were adequately hydrated but no diuretics were used. The patients were diagnosed as 5 seminomas with 4IIA and one IIB and as 10 non-seminomas with 2IIA, one IIB, one IIIB 1,4 IIIB2, and 2 IIIC stagings, respectively. Of the 15 patients, 12 patients are alive with no evidence of disease at 13-86 months (mean: 39.5 months) of follow-up duration. Six patients achieved complete remission. Of 8 patients achieved partial remission with chemotherapy alone, 6 patients achieved complete remission by following resection of residual masses or irradiation but another 2 patients (IIB2:1, IIIC:1) failed to achieve complete remission had relapse and died after 19 and 25 months, respectively. One patient (IIIC) showed no change had progression and died after 5 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Drug Administration Schedule; Etoposide; Humans; Male; Methotrexate; Neoplasm Staging; Peplomycin; Seminoma; Testicular Neoplasms; Vincristine

A case of metastatic infantile yolk sac tumor of testis is reported herein. The patient was 23 months old with a painless swelling of the right scrotal contents. Histological examination revealed yolk sac tumor. Six months later, the serum alpha-fetoprotein (AFP) was re-elevated and solitary lung metastasis had developed. After 4 courses of chemotherapy with cisplatin (CDDP), vincristine (VCR), methotrexate (MTX), peplomycin (PEP) and Etoposide (COMPE), serum AFP was normalized and lung metastasis disappeared. He has shown no evidence of disease for 5 years with normal physical growth. Aggressive chemotherapy including CDDP might be used for Stage III infantile testicular cancer.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Endodermal Sinus Tumor; Etoposide; Humans; Infant; Lung Neoplasms; Male; Methotrexate; Peplomycin; Remission Induction; Testicular Neoplasms; Vincristine

We report a case of pure choriocarcinoma of the left testis in a 27-year-old male. He consulted a physician with left back pain in August, 1990. Intravenous pyelography (IVP) revealed left hydronephrosis. Abnormal computerized tomography (CT) revealed para-aortic lymph node swelling. The chest X-ray revealed bilateral multiple coin lesions. The genital examination revealed a left testicular nodule 8 mm in diameter. Left high inguinal orchiectomy was performed. Histopathological diagnosis was pure choriocarcinoma. After 4 courses of the PVB (cisplatin, vinblastine, bleomycin) therapy, tumor regression rate of the pulmonary metastases was 41.9%. He was transferred to our hospital on December 3, 1990 and was admitted 3 days later. "COMPE" chemotherapy, consisting of cisplatin, vincristine, methotrexate, peplomycin, and etoposide, was administered. After seven courses of "COMPE" chemotherapy, he achieved a partial response (the regression rate of the pulmonary metastases and the retroperitoneal lymph node metastasis were 78.8% and 69.1%, respectively) and the residual masses in the lungs and the retroperitoneum were removed. Necrosis and xanthogranulomatous fibrosis were found in the resected material. The patient showed no evidence of disease one year after thoracotomy.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Choriocarcinoma; Cisplatin; Drug Administration Schedule; Etoposide; Humans; Hydronephrosis; Male; Methotrexate; Peplomycin; Remission Induction; Testicular Neoplasms; Vinblastine; Vincristine

A 32-year-old Japanese male consulted a clinic complaining of gynecomastia. Right painless scrotal swelling was also detected. Right high orchiectomy was performed, then the surgical specimen was histopathologically confirmed as choriocarcinoma and mature teratoma. The imaging revealed cerebral, pulmonary, retroperitoneal metastases. After 3 courses of combination chemotherapy with cisplatin, etoposide and peplomycin (PEP therapy), the brain metastasis completely disappeared and the serum titer of the tumor markers such as beta-HCG became normal. The regression rates of lung and retroperitoneal metastases were 68% and 27%, respectively. Therefore, retroperitoneal lymph node dissection was performed. After the 5th course of PEP therapy, lung metastases disappeared completely. Until the present, no evidence of disease has persisted. The PEP therapy, which is a salvage therapy for refractory testicular cancer, was performed as first-line chemotherapy in this case. It was an excellent modality against choriocarcinoma, along with the surgical treatment.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Brain Neoplasms; Chemotherapy, Adjuvant; Choriocarcinoma; Cisplatin; Etoposide; Humans; Lung Neoplasms; Lymph Node Excision; Male; Neoplasms, Multiple Primary; Orchiectomy; Peplomycin; Remission Induction; Retroperitoneal Neoplasms; Teratoma; Testicular Neoplasms

Topics: Bleomycin; Female; Humans; Lipid Peroxides; Lung Neoplasms; Male; Peplomycin; Peptide Fragments; Peptidyl-Dipeptidase A; Phospholipids; Procollagen; Pulmonary Fibrosis; Radiotherapy; Testicular Neoplasms

A 28-year-old man, evidencing a painless swelling of the right scrotal content, was admitted and, after a diagnosis of a right testicular tumor, a right high orchiectomy was performed. A histological examination of the right testicular tumor revealed a seminoma. Eleven months after this operation, the patient returned, complaining of a painful swelling of the left testis. An examination revealed that his alpha-fetoprotein (AFP) was elevated (3319 ng/ml). A left high orchiectomy was performed after he was diagnosed as a non-seminomatous tumor. Later, a histological examination revealed, however, an embryonal carcinoma. Two months after the second operation, a metastases of right supra-clavicular lymph nodes was uncovered and adjuvant chemotherapy was started. Although he died from the progression of this metastases, at autopsy, the retroperitoneal and para-aortic metastatic lymph nodes revealed a mature teratomatous and embryonal carcinoma.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Dysgerminoma; Etoposide; Humans; Male; Neoplasms, Multiple Primary; Peplomycin; Teratoma; Testicular Neoplasms; Vinblastine

Prostate cancer: Considering the stagnation in chemotherapy of prostate cancer in recent years, the following experiments were carried out to determine their clinical value. Surgical specimens from 6 patients, 2 permanent cell lines (EB 33 and PC 93) originated from human prostate cancer and a tumor line serially transplanted in nude mice (PC-NCC) were subjected to chemosensitivity tests such as human tumor cloning assay (HTCA) and/or in vivo tumor growth curve experiments using nude mice. The possible chemosensitive drugs screened by using surgical specimens and PC-NCC tumor were cisplatinum (CDDP), bleomycin (BLM), 5-FU, vincristine (VCR), adriamycin (ADM) and methotrexate (MTX). Most of these drugs were also judged as "effective" by HTCA using a permanent cell line. The minimal discrepancy among them may lead to the conclusion that an in vitro assay using a cell line can substitute for the assay using surgical specimens which can not be obtained frequently. Partly based on the data obtained a chemotherapy regimen, VPM-CisCF, consisting of VCR, peplomycin, MTX, CDDP, cytosine arabinoside (Ara-C) and 5-FU, was designed. The effectiveness of this regimen was demonstrated experimentally. Testis cancer: Two different lines of experiments were performed. A human testicular cancer serially transplanted in nude mice was repeatedly exposed to CDDP in vivo to obtain hyposensitivity to this drug. The synergistic effect of CDDP and VP-16 was demonstrated in the tumor thus obtained. One of its mechanisms has been suggested by partial accumulation of cancer cells in the G1-S and G2-M phase in which CDDP exerts its potential effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cell Line; Cisplatin; Cytarabine; Etoposide; Fluorouracil; Male; Methotrexate; Mice; Mice, Nude; Neoplasm Transplantation; Peplomycin; Prostatic Neoplasms; Testicular Neoplasms; Tumor Cells, Cultured; Tumor Stem Cell Assay; Vinblastine; Vincristine

Malignant lymphoma of the left testis was seen in a 53-year-old man. Pathologically, the tumor cell showed malignant lymphoma of the diffuse, small cell type, especially, of lympho-plasmacytoid in LSG classification. Clinically, no other lesions were found. At 26 months following orchiectomy with chemotherapy (CHOP regimen: cyclophosphamide, hydroxydaunomycine, vincristine and prednisone) as well as post-operative irradiation (60Co, 30 Gy.), the patient has been doing well without any clinical evidence of recurrence generalization of the tumor.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cobalt Radioisotopes; Combined Modality Therapy; Cyclophosphamide; Daunorubicin; Humans; Lymphoma; Male; Orchiectomy; Peplomycin; Plasma Cells; Testicular Neoplasms; Vinblastine

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Doxorubicin; Dysgerminoma; Humans; Male; Middle Aged; Peplomycin; Remission Induction; Teratoma; Testicular Neoplasms

A 38-year-old man was admitted to Nara Medical University Hospital on Feb.7,1983, because of swelling of the scrotal contents on the right side and elevated serum AFP, beta-HCG and LDH suggestive of testicular tumor. Right orchiectomy was carried out and a pathological diagnosis of embryonal cell carcinoma of the right testis (pT3N0M1) was made. The patient, upon evidence of multiple pulmonary metastases, was treated with a combination chemotherapy of cis-Diamminedichloroplatinum, vincristine and peplomycin. After three courses of combination chemotherapy, pulmonary metastases were decreased, but their foci persisted. The patient was then treated with Etoposide 62 mg/m2 daily for 5 days every three weeks, and after this course, complete remission of pulmonary metastases was obtained. The patient recieved 3 courses of Etoposide and retroperitoneal lymph node dissection, and has since shown no evidence of disease for 2 years and 4 months after surgery.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Drug Administration Schedule; Etoposide; Humans; Lung Neoplasms; Lymph Node Excision; Male; Peplomycin; Podophyllotoxin; Teratoma; Testicular Neoplasms; Vincristine

Two patients with advanced germ cell tumor who entered complete remission following intensive combination chemotherapy, radiation therapy and surgical intervention are reported. A 28-year-old businessman presented with abdominal pain and masses associated with an elevated HCG level for which he underwent exploratory laparotomy. Large retroperitoneal masses were found and microscopical examination of the masses were revealed seminoma. Three courses of combination chemotherapy consisting of CDDP, VLB and PEP were given to the patient followed by radiation therapy to the parailiac, paraaortic, mediastinal and supraclavicular lymph nodes with boost irradiation to the paraaortic lymph nodes where the large masses were located. The other patient was a 21-year-old student who developed sharp precordial chest pain which proved to be due to a large mediastinal mass accompanied by an elevated AFP level. He was treated with radiation therapy to the mediastinum, surgical resection and combination chemotherapy. However, he showed recurrence in the lungs associated with rising AFP levels, and was given a salvage chemotherapy consisting of 3 courses of CDDP, ADR, PEP and Etoposide. Both patients were successfully treated with combined modalities of treatment including intensive chemotherapy and have been off therapy without recurrence for over 12 and 4 months, respectively.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Cryptorchidism; Doxorubicin; Dysgerminoma; Etoposide; Humans; Male; Mediastinal Neoplasms; Peplomycin; Retroperitoneal Neoplasms; Testicular Neoplasms

Fifty-nine cases of testicular cancers were admitted to our hospital between 1960 and 1984. Thirty cases were seminoma (patients aged 12-64 years) and 29 cases were non-seminoma (6 patients were 1-7 years old and 23 were 17-44 years old). One of each of the seminoma and non-seminoma cases was not included in our analysis due to death before sufficient treatment. Of the remaining 29 cases of seminoma, 24 were in stage I, 4 in stage II, and 1 was in stage III. Of the remaining 22 adult cases of non-seminoma, 15 were in stage I, 2 in stage II, and 5 in stage III. Most of the cases with seminoma were treated with radiation after orchiectomy. Two of the cases of advanced seminoma and all of the cases of non-seminoma without mature teratoma were treated with retroperitoneal lymphadenectomy and/or chemotherapy after orchiectomy. Of the seminoma cases, only one patient (stage II cancer) died. On the other hand, only one of the non-seminoma patients in stages II and III remained alive. Since 1979, 5 patients with stage III or bulky stage II disease have been treated with the PVB protocol and 4 were evaluable. Only one patient achieved complete remission (CR) but he suffered a relapse within a short period (4 months). Three patients were partial responders and two of them achieved CR following resection of residual disease and additional VAB-6 induction. Currently, none of the patients who were treated with the initial PVB protocol alone remain in CR.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Child; Cisplatin; Hospitals, Municipal; Humans; Male; Middle Aged; Peplomycin; Prognosis; Testicular Neoplasms; Vinblastine

Topics: Adult; Bleomycin; Cisplatin; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Injections, Intramuscular; Lung; Male; Neoplasms, Germ Cell and Embryonal; Peplomycin; Pulmonary Fibrosis; Radiography; Testicular Neoplasms; Vinblastine

The blood lymphocyte population was monitored in 6 patients with advanced malignant tumors who were treated with large doses of a new cytotoxic drug termed pepleomycin. It was observed that the size of the cell population, its cellular composition, mitogen stimulations and natural killer activity did not change in any consistent ways during or after treatment. It is concluded that pepleomycin does not directly affect the lymphocytic population.

Topics: Adenocarcinoma; Adult; Aged; Antineoplastic Agents; Bleomycin; Female; Fibrosarcoma; Humans; Kidney Neoplasms; Killer Cells, Natural; Leiomyosarcoma; Leukocyte Count; Lymphocytes; Male; Middle Aged; Neoplasms; Peplomycin; Testicular Neoplasms; Thyroid Neoplasms