Chemotherapy
PVeBx4 at Indiana University in the 1970's.
What is the regimen that proved cisplatin's ability to cure advanced GCT?
What is:
1 - ascending white line
2 - small bowel mesentery
3 - descending white line
4 - IMA
5 - IMV
African Americans, Asians, non-Hispanic whites.
What is the lowest, intermediate, and highest incidence of GCT in the US?
(F/U: What are the RR's compared to whites?)
Abysmal (5-10%) vs 80-90%.
What is the cure rate (LT survival) for advanced GCT pre-cisplatin, and since cisplatin?
(1) Pulmonary fibrosis
(2) Hematologic and GU toxicity
(3) Neuromoscular toxicity
(4) Neuro/oto/nephrotoxicity
What are the side effects of (1) bleomycin, (2) ifosfamide, (3) vinblastine, (4) cisplatin?
RP lymph node locations (pic)
What is:
A - inter-aortocaval
B - para-aortic
Western Europe, UK, Asia.
Where is the highest, intermediate, and lowest rate of testis cancer by region?
(F/U: Name two other places of highest rate?)
4-6x vs 2-3x.
What is the relative risk of testis Ca if cryptorchidism is repaired after puberty vs before puberty?
(F/U: Is the contralat descended testis at increased risk?)
26-62% of advanced NSGCT respond to first-line chemo one way, and 5-15% respond another way.
What is a complete response, and what is (a partial remission with +markers OR progression).
(F/U: What are other levels of response?)
Radical orchiectomy groin anatomy (pic)
What is the:
1 - external oblique fascia
2 - ilioinguinal nerve
3 - external inguinal ring
(F/U: What does ilioinguinal nerve do?)
Para-aortic then interaortocaval vs interaortocaval then (para-aortic and paracaval).
What is the order of RP lymphatic spread ('landing zone') of L-sided, and R-sided tumours?
The erectile nerves above the IMA vs below the IMA.
What is the postganglionic sympathetic fibers vs the superior hypogastric plexus?
Necrosis:teratoma:viable tumour (%):
40:45:15 vs 60:30:10
What are the rates of post induction chemo N:T:V in a RP residual mass vs non-retroperitoneal?
(F/U: What is the minimal size of a residual mass?)
GCT gross (pic)
What is a seminoma?
Lymphoma.
What is the most common testicular tumour in men over 50.
(1) teratoma --> rhabdomyosarc/adenoCa/primitive neuroectodermal tumour, and
(2) i(12p)
(1) What is malignant transformation of teratoma, and (2) what genetic abnormality identifies the germ cell origin of the somatic-type tumours?
VeIPx4, VIPx4, TIPx4
What are second-line chemotherapy regimens.
(F/U: what are the components of each of those?)
NCCN seminoma (pic).
What is:
1 - Carboplatinum x1
2 - RT (20-25.5Gy)
3 - RT dogleg (30Gy)
4 - BEPx3 or EPx4
Malignant fibrous histiocytoma and leiomyosarcoma
vs.
Liposarcoma
Which para-testicular sarcoma subtypes have the worst prognosis vs the best prognosis?
Azoospermia rate at diagnosis, post-chemo, and 5 years post treatment.
What is 10%, almost all, and 20%.