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- Title
Exploring therapeutic pathways for recurrent testicular seminoma in young patients: a case report on salvage treatments.
- Authors
Chirea, Irina-Alexandra; Gheorghe, Adelina-Silvana; Dumitrescu, Elena-Adriana; Siminiceanu, Crina-Maria; Bălașa, Mihai; Kajanto, Lidia-Anca; Mihăilă, Raluca-Ioana; Zob, Daniela; Stănculeanu, Dana-Lucia
- Abstract
Introduction. Testicular cancer is a relatively rare but highly curable malignancy, with seminoma being one of its most common histological subtypes. This complex case presentation highlights the evolution of a 34-year-old patient who was diagnosed with testicular seminoma. Case presentation. The patient underwent a radical inguinal orchiectomy in August 2021, the standard surgical approach for testicular cancer. Following surgery, the computed tomography (CT) scan revealed the existence of lymph node metastasis – stage IIC, pT3cN3M0 S1, and he began the treatment with first-line chemotherapy (four cycles of EP). Post-chemotherapy, PET-CT confirmed the residual disease, and retroperitoneal lymph node dissection was performed. Afterwards, the CT scan showed the rapid progression of the disease (lymphatic metastasis), with the increase of lactate dehydrogenase. Thereby, the second line of chemotherapy was started (four cycles of TIP). After six months, lymphatic, pleural, pulmonary, hepatic, peritoneal and bone metastasis were noted, and he was proposed for another platinum-based therapy followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT). The salvage chemotherapy was initiated with CBOP/BEP protocol, with weekly administration, and a partial initial response was noted. Bone marrow biopsy was performed but, unfortunately, the histopathological exam proved the extension of the disease to the bone marrow, therefore the ASCT was no longer feasible. The patient experienced a rapid progression in the following months, complex palliative care for pain control, and he eventually died. Conclusions. While salvage therapies remain an essential component in the treatment arsenal for testicular seminoma, their limitations point to a pressing need for innovation and individualized treatment strategies to improve the prognosis for this challenging patient population. Unfortunately, in patients with relapse after salvage chemotherapy or with cisplatin-refractory disease, the cure is infrequently achieved.
- Subjects
SEMINOMA; TESTICULAR cancer; STEM cell transplantation; LYMPHADENECTOMY; PATIENT experience; PAIN management; DISEASE relapse
- Publication
Oncolog-Hematolog, 2023, Issue 64, p31
- ISSN
2066-8716
- Publication type
Article