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¸‘ƒŽîᇁ@`f—ĂƒKƒCƒhƒ‰ƒCƒ“

ƒKƒCƒhƒ‰ƒCƒ“•ś’†‚Ě•śŒŁ”ԍ†‚Š‚çCŠY“–‚ˇ‚éŽQl•śŒŁˆę——‚đŽQĆ‚ˇ‚é‚ą‚Ć‚Ş‚Ĺ‚Ť‚Ü‚ˇ

–ÚŽŸF


CQ 1

œ¸‘ƒŽîᇂɂ͂ǂ̂悤‚ČŠëŒŻˆöŽq‚Ş‚ ‚é‚ŠH


„§
¸‘ƒŽîᇂ̉Ƒ°—đC’â—Ż¸‘ƒC”˝‘Α¤‚̐¸‘ƒŽîᇂ̊ů‰‚́C¸‘ƒŽîᇂ̊댯ˆöŽq‚Ĺ‚ ‚éB•s”DÇE¸‰tŒŸ¸ˆŮí‚ŕƒŠƒXƒN‚É‚Č‚éB‘ŽYE’á‘̏dŽ™E–˘nŽ™C‹“űEƒ`[ƒY‚̐ێćC‚g’ˇ‚Č‚Ç‚ŕŠëŒŻˆöŽq‚̉”\Ť‚Ş‚ ‚éB
y‰đ ŕz

¸‘ƒŽîᇂ͑˝‚­‚̐ź—m”‘‚É‚¨‚˘‚āC20 ˘‹I”ź‚΂Š‚ç”­ś—Ś‚Ş‘‰Á‚ľ‚Ä‚˘‚é‚ŞC¸‘ƒŽîᇂ̉uŠw‚Í–žŠm‚É‚Í‚Č‚Á‚Ä‚˘‚Č‚˘B¸‘ƒŽîᇂ̔­ś‚ɂ́Cˆâ“`“IˆöŽq‚Ɗ‹ŤˆöŽq‚ŞŠÖ‚í‚Á‚Ä‚¨‚čClŽí‚É‚¨‚Ż‚é”­ś—Ś‚̍ˇˆŮC‰Ć‘°Ť”­śCƒGƒXƒgƒƒQƒ“‚ȂǁC‘Ů“ŕƒzƒ‹ƒ‚ƒ“ŠÂ‹Ť‚â•ęe‚Ě‹i‰Œ‚Č‚Ç‘ŮŽ™Šú‚É‚¨‚Ż‚é‰e‹żC–˘nŽ™‚â’á‘̏dŽ™E’â—Ż¸‘ƒ‚âŠÂ‹Ťƒzƒ‹ƒ‚ƒ“”픘‚ȂǁCoś‚Š‚çŽvtŠú‚É‚¨‚Ż‚é‰e‹ż‚Č‚Ç‘˝‚­‚ĚˆöŽq‚ŞŠÖ‚í‚Á‚Ä‚˘‚é1-3jB

¸‘ƒŽîᇂ̉Ƒ°Ť”­ś‚ł́C•ƒe‚ސ¸‘ƒŽîᇂł ‚ę‚Î4 ”{‚ĚƒŠƒXƒNCŒZ’í‚Ş¸‘ƒŽîᇂł ‚ę‚Î8 ”{‚ĚƒŠƒXƒN‚Ş‚ ‚čCŒZ’í‚ł͊‹ŤˆöŽq‚ŕ‹¤—L‚ˇ‚é‚˝‚ß—lX‚ČˆöŽq‚މÁ‚í‚é‚ƁC10 ”{ˆČă‚ĚƒŠƒXƒN‚Ş‚ ‚é‚Ć‚ł‚ę‚Ä‚˘‚é1jBˆę•űC‰Ć‘°Ť”­ś—á‚É‚¨‚Ż‚éˆâ“`Žq‰đÍ‚ĚŒ‹‰Ę‚Š‚ç‚́C¸‘ƒŽîᇂ̔­ś‚É‚Í’Pˆę‚Ěˆâ“`Žq‚ž‚Ż‚Ĺ‚Í‚Č‚­C•Ą”‚Ěˆâ“`Žq‚ŞŠÖ‚í‚é‚ą‚Ć‚ŞŽŚ´‚ł‚ę‚Ä‚˘‚é4jB‚Ü‚˝C—ź‘¤”­ś—á‚ĚŒ¤‹†‚Š‚çC”˝‘Α¤‚̐¸‘ƒŽîᇂ̃ŠƒXƒN‚Í25 ”{‚É‚Č‚é‚Ć‚Ě•ń‚ŕ‚ ‚é2jB¸×ŠÇ“ŕˆŤŤăó×–EŽîi¸×ŠÇă”ç“ŕŠŕFCISj‚Í5 ”NˆČ“ŕ‚É50“‚ސ¸‘ƒŽîᇂɂȂé‚Ć‚Ě•ń‚Ş‚ ‚čCŽvtŠú‚ÉCIS ‚đ—L‚ˇ‚éę‡C‚Ů‚Ú‘S—á‚Ő¸‘ƒŽîᇂ𔭏ǂˇ‚é‚Ć‚Ěl‚Ś‚ŕ‚ ‚é3jB

’â—Ż¸‘ƒ‚ÉŠÖ‚ľ‚Ä‚Í‘˝‚­‚Ě•ń‚Ş‚ ‚čCŠm—§‚ľ‚˝ŠëŒŻˆöŽq‚Ć‚ł‚ę‚Ä‚˘‚é1-3, 5jB21 ‚ĚŒ¤‹†‚đ‚Ü‚Ć‚ß‚é‚ƁC4.8 ”{‚ĚƒŠƒXƒN‚É‚Č‚é‚Ć‚Ě•ń2jC2-4 ”{‚ĚƒŠƒXƒNE5-10 ”{‚ĚƒŠƒXƒN‚É‚Č‚é‚Ć‚Ě•ń3jCŽčp‚ĚŽžŠú‚Ş’x‚­‚Č‚é‚ĆƒŠƒXƒN‚ލ‚‚­‚Č‚é‚Ć‚Ě•ń1j‚Č‚Ç‚Ş‚ ‚éBƒXƒEƒF[ƒfƒ“‚Ě‘˝”—á‚ł̉đÍ‚ł́C¸‘ƒŒĹ’čp‚đ13 Î–˘–ž‚ĹŽ{s‚ľ‚˝ę‡‚̓ŠƒXƒN‚Ş2.23 ”{‚É‚Č‚é‚̂ɑ΂ľC13 ÎˆČă‚ĹŽ{s‚ľ‚˝ę‡‚Í5.40 ”{‚É‚Č‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é6jB‚ł‚ç‚ɁC’â—Ż¸‘ƒ‚Ş‚ ‚é‚ĆƒŠƒXƒN‚Ş3.71 ”{C”A“š‰ş—ô‚Ş‚ ‚é‚ĆƒŠƒXƒN‚Ş2.13 ”{‚É‚Č‚é‚Ć‚Ě•ń‚ŕ‚ ‚é7jB

‚Ü‚˝C•s”DÇ‚␸‰tŒŸ¸ŠŒŠ‚ĚˆŮí‚Ɛ¸‘ƒŽîᇂ̊֘A‚ŕ•ń‚ł‚ę‚Ä‚˘‚é8, 9jB•s”DÇ‚Ɛf’f‚ł‚ę‚˝ę‡‚̓ŠƒXƒN‚Ş2.4 ”{‚Ć‚Ě•ń9jC¸‰tŒŸ¸‚ÉˆŮí‚Ě‚ ‚é•s”DÇ‚Ě’jŤ‚Í20 ”{‚ĚƒŠƒXƒN‚Ş‚ ‚é‚Ć‚Ě•ń‚ŕ‚ ‚é8jB‚Ü‚˝C”D›sŤ’ቺisubfertilityj‚͐¸‘ƒŽîᇂ̃ŠƒXƒN‚Ş1.68 ”{‚Ć‚Ě•ń‚ŕ‚ ‚é10jB

oś‘O‚ ‚邢‚ÍŽüŽYŠú‚ĚˆöŽq‚Ć‚ľ‚āCƒGƒXƒgƒƒQƒ“‚Č‚Ç‘Ů“ŕ‚Ěƒzƒ‹ƒ‚ƒ“ŠÂ‹Ť‚ĚŠÖ—^‚ލl‚Ś‚ç‚ęC•ęe‚Ě”N—îC”DPŠúŠÔ’†‚ĚˆŤSi‚‚í‚čj‚Ě’ö“xC”DPŠúŠÔ’†‚̏oŒŒC•ęe‚Ě‹i‰ŒC”DPŠúŠÔ‚Ě’ˇ‚łCośŽ™‚Ě‘ĚdCVśŽ™‰Šát‚Č‚Ç‚Ş‚ ‚é1-3, 11jB•ęe‚Ě”N—î‚Ş15-19 Î‚Ěę‡‚̓ŠƒXƒN‚Ş–ń2 ”{‚É‚Č‚čC’á‘̏dŽ™i2,500 g –˘–žj‚Ü‚˝‚Í2 TŠÔˆČă‘‚­oŽY‚ľ‚˝ę‡C•ęe‚Ş”DP12 ƒJŒŽ‘O‚É”đ”D–ň‚đ“ŕ•ž‚ľ‚Ä‚˘‚˝ę‡‚ŕƒŠƒXƒN‚Ş‚â‚⍂‚­‚Č‚é11jB’´‘ŽYi22-29 Tj‚Ĺ‚ÍƒŠƒXƒN‚Ş3.95 ”{‚Ć‚Ě•ń‚ŕ‚ ‚é12jBˆę•űC–k‰˘Še‘‚̉uŠw’˛¸‚Š‚çC•ęe‚Ě‹i‰Œ—Ś‚Ɛ¸‘ƒŽîᇂ̔­ś—Ś‚Ş‘ŠŠÖ‚ľ‚Ä‚˘‚˝‚ށC‚ť‚ĚŒă‚ĚŒ¤‹†‚Š‚ç‚Í–žŠm‚ČŠÖ˜A‚Í‚Ý‚ç‚ę‚Č‚Š‚Á‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é13, 14jB

HŽ–‚â‘ĚŠi‚Ć‚ĚŠÖ˜A‚Ě•ń‚ŕ‚ ‚é15-17jBƒ`[ƒYC‹“űCƒKƒ‰ƒNƒg[ƒX‚đ‘˝‚­ŰŽć‚ˇ‚é‚ĆƒŠƒXƒN‚ލ‚‚­‚Č‚é16jCg’ˇ‚ލ‚‚˘‚Ɛ¸‘ƒŽîᇂ̃ŠƒXƒN‚ލ‚‚­‚Č‚čCŹŽ™Šú‚̉h—{ó‘Ô‚ŞŠÖ˜A‚ˇ‚é17jC‚g’ˇ‚Í—LˆÓ‚ČƒŠƒXƒN18j‚Ć•ń‚ł‚ę‚Ä‚˘‚éB

–{–M‚É‚¨‚˘‚Ä‚ŕC¸‘ƒŽîᇊłŽŇ‚É’â—Ż¸‘ƒE”A“š‰ş—ôE• –Œâó“Ë‹N‚Ě•sŠŽ‘S•Â˝‚Č‚Ç‚Ě—LˆÓ‚Č•p“x‚̍‡•šÇ‚Ş‚Ý‚ç‚ęC’â—Ż¸‘ƒEŽüŽYŠúˆöŽqE‰Ć‘°ˆöŽq‚ŞŠëŒŻˆöŽq‚É‚Č‚é‚Š‚ŕ‚ľ‚ę‚Č‚˘‚Ć‚Ě•ń‚Ş‚ ‚é19jB

y•śŒŁz

1jRichiardi L, Pettersson A, Akre O. Genetic and environmental risk factors for testicular cancer. Int J Androl. 2007G30i4jF230-40.iⅥj

2j Dieckmann, KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World J Urol. 2004G22F2-14.iⅥj

3j Garner MJ, Turner MC, Ghadirian P, et al. Epidemiology of testicular cancerFan overview. Int J Cancer. 2005G116F331-9.iⅥj

4j Crockford GP, Linger R, Hockley S, et al. Genome-wide linkage screen for testicular germ cell tumour susceptibility loci. Hum Mol Genet. 2006G15F443-51.iⅤj

5j McGlynn KA, Graubard BI, Klebanoff MA, et al. Risk factors for cryptorchism among populations at differing risks of testicular cancer. Int J Epidemiol. 2006G35i3jF787-95.iⅣbj

6j Pettersson A, Richiardi L, Nordenskjold A, et al. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. 2007G356F1835-41.iⅣaj

7j Schnack TH, Poulsen G, Myrup C, et al. Familial coaggregation of cryptorchidism, hypospadias, and testicular germ cell cancerFa nationwide cohort study. J Natl Cancer Inst. 2010G102F187-92.iⅣaj

8j Raman JD, Nobert CF, Goldstein M. Increased incidence of testicular cancer in men presenting with infertility and abnormal semen analysis. J Urol. 2005G174i5jF1819-22.iⅣbj

9j Doria-Rose VP, Biggs ML, Weiss NS. Subfertility and the risk of testicular germ cell tumorsiUnited Statesj. Cancer Causes Control. 2005G16i6jF651-6.iⅣbj

10j Peng X, Zeng X, Peng S, et al. The association risk of male subfertility and testicular cancerFa systematic review. PLoS One. 2009G4i5jFe5591. doiF10.1371/journal. pone. 0005591. Epub 2009 May 18.iⅥj

11j Coupland CA, Forman D, Chilvers CE, et al. Maternal risk factors for testicular cancerFa population-based case-control studyiUKj. Cancer Causes Control. 2004G15i3jF277-83.iⅣbj

12j Crump C, Sundquist K, Winkleby MA, et al. Gestational age at birth and risk of testicular cancer. Int J Cancer. 2012G131F446-51.iⅣaj

13j Pettersson, A., Kaijser, M., Richiardi, L., et al. Women smoking and testicular cancerFone epidemic causing another?. Int J Cancer. 2004G109F941-4.iⅣaj

14j Pettersson, A., Akre, O., Richiardi, et al. Maternal smoking and the epidemic of testicular cancerFa nested case-control cancer. Int J Cancer. 2007G120F2044-6.iⅣbj

15j Garner MJ, Birkett NJ, Johnson KC, et al. Dietary risk factors for testicular carcinoma. Int J Cancer. 2003G106i6jF934-41.iⅣbj

16j Stang A, Ahrens W, Baumgardt-Elms C, et al. Adolescent milk fat and galactose consumption and testicular germ cell cancer. Cancer Epidemiol Biomarkers Prev. 2006G15F2189-95.iⅣbj

17j Dieckmann KP, Pichlmeier U. Is risk of testicular cancer related to body size?. Eur Urol. 2002G42F564-9.iⅣbj

18j McGlynn KA, Sakoda LC, Rubertone MV, et al. Body size, dairy consumption, puberty, and risk of testicular germ cell tumors. Am J Epidemiol. 2007G165F355-63.iⅣbj

19j Kanto S, Hiramatsu M, Suzuki K, et al. Risk factors in past histories and familial episodes related to development of testicular germ cell tumor. Int J Urol. 2004G11F640-6.iⅣbj


CQ 2

œ¸‘ƒŽîᇂ̌´”­‘ƒ‚̐f’f‚É‚¨‚˘‚āC‚ǂ̂悤‚Č‰ć‘œŒŸ¸–@‚ސ„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

A
’´‰š”gŒŸ¸‚ÍŒ´”­‘ƒ‚̐f’f‚É‹É‚ß‚Ä—L—p‚Ĺ‚ ‚éB‹ÇŠ‚ĚŒŒ—Ź‚Ş•]‰ż‰Â”\‚ČƒJƒ‰[ƒhƒbƒvƒ‰[’´‰š”gŒŸ¸‚Ş—L—p‚Ĺ‚ ‚éB

„§ƒOƒŒ[ƒh

B
’´‰š”gŒŸ¸ˆČŠO‚ł́CMRI ‚ŕ—L—p‚Ĺ‚ ‚éB
y‰đ ŕz

‰A囊•”’´‰š”gŒŸ¸*‚͐¸‘ƒŽîᇂ̏‰Šúf’f‚É—L—p‚Ĺ‚ ‚čCŽîᇂ̑˝‚­‚Í’áƒGƒR[—Ěˆć‚Ć‚ľ‚ÄŒŸo‚ł‚ę‚é1jB¸‘ƒŽîᇂ̑˝‚­‚͈ŤŤ‚Ĺ‚ ‚čCƒJƒ‰[ƒhƒbƒvƒ‰[’´‰š”gŒŸ¸‚Č‚ç‚Ń‚ÉMRI ‚́C[ŽŔŤ‚ĚˆŤŤŽîᇂɂ¨‚Ż‚鍂‚˘vascularity ‚đŒŸo‚ˇ‚é‚ą‚Ć‚Ş‰Â”\‚Ĺ‚ ‚é2-5jB•\”ç囊–Eiepidermal cystj‚Ě“Á’Ľ‚Ć‚ľ‚āC’´‰š”gŒŸ¸‚ʼnQŠŞ‚Ťó‚ ‚邢‚Í“ŻS‰~ó‚đ‚Č‚ˇ‚ƒGƒR[—Ěˆć‚Ć’áƒGƒR[—Ěˆć‚Ě“Á’Ľ“I‚Č‘wó\‘˘3j‚đŽŚ‚ľCMRI ‚Ĺ‚ÍT2 ’áM†‚Ĺ‘˘‰eŒř‰Ę‚Ě‚Č‚˘”í–Œ‚Ć‚Ů‚Ú‹Ďˆę‚ČT2 ‚M†—Ěˆć4j‚Ş‹“‚°‚ç‚ę‚éB

‹ß”NC‘gD‚̍d“x‚𔝒股‚é‚˝‚ß‚Éreal time sonoelastography ‚މA囊‚É‚ŕŽg‚í‚ę‚Ä‚˘‚éB‚Ü‚ž’P“Ć‚Ĺ‚Ě•]‰ż‚Í“ď‚ľ‚­CƒJƒ‰[ƒhƒbƒvƒ‰[’´‰š”gŒŸ¸‚đ•š‚š‚čs‚¤‚ą‚ƂŐf’f—Ś‚đă‚°‚Ä‚˘‚é6, 7jB

*ŒŸ¸‚É‚Í7.5MHz ‚Ěƒvƒ[ƒu‚đ—p‚˘‚éB

y•śŒŁz

1jDohle GR, Schröder FH. Ultrasonographic assessment of the scrotum. Lancet. 2000G356i9242jF1625-6.iⅣj

2j Howlett DC, Marchbank ND, Sallomi DF. Pictorial review. Ultrasound of the testis. Clin Radiol. 2000G55i8jF595-601.iⅣj

3j Basu S, Howlett DC. High-resolution ultrasound in the evaluation of the nonacute testis. Abdom Imaging. 2001G26i4jF425-32.iⅣj

4j Watanabe Y, Dohke M, Ohkubo K, et al. Scrotal disordersFevaluation of testicular enhancement patterns at dynamic contrast-enhanced subtraction MR imaging. Radiology. 2000G217i1jF219-27.iⅣj

5j Tsili AC, Argyropoulou MI, Giannakis D, et al. MRI in the characterization and local staging of testicular neoplasms. AJR Am J Roentgenol. 2010G194i3jF682-9.iⅢj

6j Goddi A, Sacchi A, Magistretti G, et al. Real-time tissue elastography for testicular lesion assessment. Eur Radiol. 2012G22i4jF721-30.iⅢj

7j Aigner F, De Zordo T, Pallwein-Prettner L, et al. Real-time sonoelastography for the evaluation of testicular lesions. Radiology. 2012G263i2jF584-9.iⅢj


CQ 3

œ‘Α¤¸‘ƒ‚ĚITMGCiintratubular malignant germ cellsjf’f‚Ě‚˝‚߂̐śŒŸ‚͐„§‚ł‚ę‚Ä‚˘‚é‚ŠH


„§ƒOƒŒ[ƒh

C2
‘Α¤¸‘ƒ‚ɑ΂ľ‚āCITMGC f’f–Ú“I‚ŐśŒŸ‚đs‚¤‚ą‚Ć‚Ě—L—pŤ‚đĎ‹É“I‚ÉŽxŽ‚ˇ‚é–žŠm‚ČŞ‹’‚Í–R‚ľ‚˘B
y‰đ ŕz

ˆČ‰ş‚ÉŽŚ‚ˇ——R‚Š‚çC¸‘ƒśŒŸ‚ĹITMGCiintratubular malignant germ cellsj‚đf’f‚ˇ‚é‚ą‚Ć‚Ě—L—pŤ‚Í–ž‚ç‚Š‚Ĺ‚Í‚Č‚­C‘Α¤śŒŸ‚Ě—Ő°“IˆÓ‹`‚ɂ‚˘‚Ä–žŠm‚ČŞ‹’‚Í‚Č‚˘‚Ć”ť’f‚ł‚ę‚éB

  1. 1jITMGC ‚Ɛf’f‚ł‚ę‚Ä‚ŕC‚ť‚ĚŒă‚̑Ήž‚ɂ‚˘‚Ä–žŠm‚ČŠî€‚Ş‚Č‚˘‚ą‚Ć1jB
  2. 2jITMGC ‚Ě—L–ł‚ÉŠÖ‚í‚炸‚ť‚ĚŒă‚ĚŒo‰ßŠĎŽ@‚Ş•K—v‚Ĺ‚ ‚é‚ą‚Ć1, 2jB
  3. 3jˆŮŽž”­ś—á‚ĚŽĄ—ÐŹŃ‚ޗǍD‚Ĺ‚ ‚é‚ą‚Ć1jB
  4. 4j95“‚ĚÇ—á‚É‚Ć‚Á‚Ä•K—v‚Č‚˘ŒŸ¸‚Ĺ‚ ‚é‚ą‚Ć3jB

¸‘ƒśŒŸ‚É‚ć‚čITMGC ‚ŞŒŸo‚ł‚ę‚é•p“x‚Í2-5“’ö“x‚Ĺ‚ ‚é‚Ć‚Ě•ń‚Ş‘˝‚˘B534 —á‚Ě•s”D’jŤ‚ÉŠÖ‚ľ‚ÄŽ{s‚ł‚ę‚˝—ź‘¤¸‘ƒśŒŸ‚Ĺ‚ĚITMGC ŒŸo—Ś‚Í2.4“4jC2,318 —á‚̐¸‘ƒgerm cell tumor Ç—á‚É‚¨‚˘‚āC‘Α¤‚ĚITMGC ‚Í119 —ái5.1“j‚ÉŒŸo‚ł‚ę‚Ä‚˘‚é5jB‚ˆĘ¸‘ƒ“EœpŒă‚ɑΑ¤śŒŸ‚đŽ{s‚ľ‚˝55 Ç—á‚ĚŒŸ“˘‚ł́C2 —ái3.6“j‚ÉITMGC ‚ŞŒŸo‚ł‚ę‚Ä‚˘‚é3jB

‚ľ‚Š‚ľCITMGC ”­ś‚ĚƒnƒCƒŠƒXƒNÇ—á‚ÉŒŔ‚Á‚ĐśŒŸ‚đŽ{s‚ˇ‚é‚ą‚Ć‚đ‘Ă“–‚Ć‚ˇ‚éˆÓŒŠ‚ŕ‚ ‚é2, 6jBITMGC ”­ś‚ĚƒŠƒXƒNˆöŽq‚Ć‚ľ‚ẮC¸‘ƒˆŢkC’â—Ż¸‘ƒ‚ĚŠů‰C‘˘¸‹@”\áŠQ‚Č‚Ç‚Ş‹“‚°‚ç‚ę‚é3-5jB

y•śŒŁz

1j Hentrich M, Weber N, Bergsdorf T, et al. Management and outcome of bilateral testicular germ cell tumorsFTwenty-five year experience in Munich. Acta Oncol. 2005G44F529-36.iⅢj

2j Heidenreich A. Contralateral testicular biopsy in testis cancerFcurrent concepts and controversies. BJU Int. 2009G104F1346-50.iⅢj

3j ›“Ą@“NC•˝źł‹`C’|“ŕ@WC‘źD¸‘ƒŽîᇑΑ¤¸‘ƒśŒŸ‚É‚¨‚˘‚ÄCarcinoma in situ ‚Ɛf’f‚ł‚ę‚˝Ç—á‚ĚŒŸ“˘D“ú”ĺ”A‰ďŽD2004G95F35-41DiⅣbj

4j McLachlan RI, Rajpert-De Meyts E, Hoei-Hansen CE, et al. Histological evaluation of the human testis--approaches to optimizing the clinical value of the assessmentFmini review. Hum Reprod. 2007G22F2-16.iⅢj

5j Dieckmann KP, Kulejewski M, Pichlmeier U, et al. Diagnosis of contralateral testicular intraepithelial neoplasiaiTINjin patients with testicular germ cell cancerFsystematic two-site biopsies are more sensitive than a single random biopsy. Eur Urol. 2007G51F 175-83.iⅢj

6j Dieckmann KP, Kulejewski M, Heinemann V, et al. Testicular biopsy for early cancer detection--objectives, technique and controversies. Int J Androl. 2011G34Fe7-13.iⅢj


CQ 4

œ¸‘ƒŽîᇂ̕aŠúf’f‚É‚¨‚˘‚āC‚ǂ̂悤‚Č‰ć‘œŒŸ¸–@‚ސ„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

A
‰Šú‚Ě•aŠúf’f‚É‚¨‚˘‚ẮC‹š•”E• •”Eœ”Ő•”CT ‚Í•K{‚Ĺ‚ ‚éB

„§ƒOƒŒ[ƒh

B
”]MRICœƒVƒ“ƒ`ƒOƒ‰ƒtƒB‚́C‚ť‚Ě“]ˆÚ‚Ş‹^‚í‚ę‚éę‡‚ɍs‚¤B
y‰đ ŕz

‹ß”N‚ĚCT ƒXƒLƒƒƒ“‚̐¸“xŒüă‚Í–ÚŠo‚Ü‚ľ‚­C‹š•”E• •”Eœ”Ő•”‚ĚCT ƒXƒLƒƒƒ“‚́C‰Šú•aŠúf’f‚Ě‚˝‚ß‚Ě‰ć‘œŒŸ¸‚Ć‚ľ‚Ä•K{‚Ĺ‚ ‚éB‚ľ‚Š‚ľCƒZƒ~ƒm[ƒ}‚Ĺ• •”ƒŠƒ“ƒpß“]ˆÚ‚Ě‚Č‚˘Ç—á‚ÉŠÖ‚ľ‚ẮC‹š•”CT ‚ÍČ—Ş‚Ĺ‚Ť‚é‚Š‚ŕ‚ľ‚ę‚Č‚˘B”x‚¨‚ć‚яcŠu•a•Ď‚ÉŠÖ‚ľ‚ẮC‹š•”CT ‚Í‹š•”’PƒX üŽB‰e‚ć‚č‚ੴ“x‚ލ‚‚˘‚˝‚߁C“]ˆÚ‘ƒ‚ĚŒŸő‚Ć‚ľ‚Ä‚Í‹š•”CT ‚đs‚¤‚ׂŤ‚Ĺ‚ ‚éB‚ľ‚Š‚ľC1 cm ˆČ‰ş‚Ě”x•a•Ď‚ɂ‚˘‚ẮC‹U—zŤ‚Ěę‡‚Ş‚ ‚é‚ą‚Ć‚đ’m‚Á‚Ä‚¨‚­‚ׂŤ‚Ĺ‚ ‚é1-7jB

CT f’f‘•’u‚̐¸“xŒüă‚É‚ŕ‚Š‚Š‚í‚炸C• •”CT ‚Ĺ‚Í”÷Ź“]ˆÚ‚␳íƒTƒCƒY‚Ě•a•Ď‚đ“]ˆÚ‚Ɛf’f‚ˇ‚é‚ą‚Ć‚Í‚Ĺ‚Ť‚Č‚˘‚˝‚߁C‹U‰AŤ—Ś‚Ş”äŠr“I‚‚­‚Č‚Á‚Ä‚ľ‚Ü‚¤ę‡‚Ş‚ ‚éB‚ť‚Ě‚˝‚߁CŽîᇃ}[ƒJ[‚ސłí‚Ěę‡CStage Ⅰ‚ĆStage ⅡAi‰˘•Ä‚Ĺ‚Ě•Ş—Ţ‚Ĺ2 cm –˘–ž‚Ě“]ˆÚj‚Ć‚ĚŠÓ•Ę‚Í˘“ď‚Čę‡‚Ş‚ ‚é8, 9jB

• •”MRI ‚́CCT ˆČă‚̏î•ń‚Ş“ž‚ç‚ę‚Č‚˘‚˝‚߁C‘˘‰eÜ‚ŞŽg—p‚Ĺ‚Ť‚Č‚˘ŠłŽŇC•úŽËü”픘‚đ‹‘”Ű‚ˇ‚銳ŽŇ‚ɐ„§‚ł‚ę‚é10, 11jB

FDG-PET ƒXƒLƒƒƒ“‚́C‰Šú•aŠúf’f‚Ě‰ć‘œŒŸ¸–@‚Ć‚ľ‚āC„§‚ł‚ę‚é–žŠm‚Č ƒGƒrƒfƒ“ƒX‚Í‚Č‚˘12, 13jB

”]MRI ‚⍜ƒVƒ“ƒ`ƒOƒ‰ƒtƒB‚́C‚ť‚Ě“]ˆÚ‚Ş‹^‚í‚ę‚éę‡‚âÇó‚Ş‚ ‚éę‡C‚Ü ‚˝‚́C”ńí‚É‘ĺ‚Ť‚Č“]ˆÚ‘ƒ‚â‘˝‘ŸŠí‚É“]ˆÚ‚đ”F‚ß‚éę‡‚âCŽîᇃ}[ƒJ[‚Ş”ńí ‚ɍ‚’l‚Č‚ÇŽîᇂ̐is‚ލ‚“x‚Čę‡‚ɍs‚¤14, 15jB

y•śŒŁz

1j White PM, Howard GC, Best JJ, et al. The role of computed tomographic examination of the pelvis in the management of testicular germ cell tumours. Clin Radiol. 1997G52F124-9.iⅣaj

2j Meyer CA, Conces DJ. Imaging of intrathoracic metastases of nonseminomatous germ cell tumors. Chest Surg Clin N Am. 2002G12F717-38.iⅥj

3j White PM, Adamson DJ, Howard GC, et al. Imaging of the thorax in the management of germ cell testicular tumours. Clin Radiol. 1999G54F207-11.iⅣaj

4j Lashley DB, Lowe BA. A rational approach to managing stage Ⅰ nonseminomatous germ cell cancer. Urol Clin North Am. 1998G25F405-23.iⅥj

5j Leibovitch I, Foster RS, Kopecky KK, et al. Identification of clinical stage A nonseminomatous testis cancer patients at extremely low risk for metastatic diseaseFa combined approach using quantitative immunohistochemical, histopathologic, and radiologic assessment. J Clin Oncol. 1998G16F261-8.iⅣaj

6j Barentsz J, Takahashi S, Oyen W, et al. Commonly used imaging techniques for diagnosis and staging. J Clin Oncol. 2006G24F3234-44.iⅥj

7j Sohaib SA, Koh DM, Husband JE. The role of imaging in the diagnosis, staging, and management of testicular cancer. Am J Roentgenol. 2008G191F387-95.iⅥj

8j McLeod DG, Weiss RB, Stablein DM, et al. Staging relationships and outcome in early stage testicular cancerFa report from the Testicular Cancer Intergroup Study. J Urol. 1991G145F1178-83Gdiscussion 1182-3.iⅣaj

9j Leibovitch I, Foster RS, Kopecky KK, et al. Improved accuracy of computerized tomography based clinical staging in low stage nonseminomatous germ cell tumor using size criteria of retroperitoneal lymph nodes. J Urol. 1995G154F1759- 63.iⅣaj

10j Hogeboom WR, Hoekstra HJ, Mooyart EL, et al. Magnetic resonance imaging of retroperitoneal lymph node metastases of nonseminomatous germ cell tumors of the testis. Eur J Surg Oncol. 1993G19F429-37.iⅤj

11j Sohaib SA, Hoh DM, Barbachano Y, et al. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clinical Radiology. 2009G64F, 362-7.iⅣbj

12j de Wit M, Brenner W, Hartmann M, et aml. 18Fn-FDG-PET in clinical stage Ⅰ/Ⅱ non-seminomatous germ cell tumoursFresults of the German multicentre trial. Ann Oncol. 2008G19F1619-23.iⅣbj

13j Huddart RA, OfDoherty MJ, Padhani A, et al. 18fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with high-risk, clinical stage Ⅰ nonseminomatous germ cell tumorsFpreliminary report of MRC Trial TE22--the NCRI Testis Tumour Clinical Study Group. J Clin Oncol. 2007G25F3090-5.iⅣaj

14j Bokemeyer C, Nowak P, Haupt A, et al. Treatment of brain metastases in patients with testicular cancer. J Clin Oncol. 1997G15F1449-54.iⅣbj

15j Fosså SD, Bokemeyer C, Gerl A, et al. Treatment outcome of patients with brain metastases from malignant germ cell tumors. Cancer. 1999G85F988-97.iⅣbj


Column1

‰ťŠw—Ă–@ŒăhCG ’l‚ŞŠŽ‘S‚ɉAŤ‰ť‚ľ‚Č‚˘ę‡‚Ě’ˆÓ“_

hCG ‘Ş’č‚É‚¨‚Ż‚é‹U—zŤ‚Ć‚ľ‚ẮC]—ˆ‚ÍLH ‚Ć‚ĚŒđˇ”˝‰ž‚Ş–â‘č‚Ć‚ł‚ę‚Ä‚˘‚˝B‚ľ‚Š‚ľCLH ‚Ć‚ĚŒđˇŤ‚ÉŠÖ‚ľ‚ẮChCG ‚ɑ΂ˇ‚é“ÁˆŮŤ‚̍‚‚˘R ‘Ě‚Ş—p‚˘‚ç‚ę‚Ä‚˘‚éĹ‹ß‚Ě‘Ş’č–@‚Ĺ‚Í–â‘č‚É‚Č‚č‚É‚­‚˘‚Ć‚ł‚ę‚Ä‚˘‚éBˆę•ű‚ĹĹ‹ßC‰ťŠw—Ă–@Ž{s’†CŽ{sŒă‚ɍ‚•p“x‚ÉŒŠ‚ç‚ę‚鐸‘ƒ‹@”\•s‘Só‘Ԃł́C‰ş‚‘Ě‚ć‚čhCG ‚ŞŽYś‚ł‚ę‚é‚ą‚Ć‚Ş‚í‚Š‚Á‚Ä‚Ť‚˝B

‚ą‚̉ş‚‘ĚhCG ‚́CĹ‹ß‚Ě‘Ş’č–@‚Ĺ‚ŕ‹U—zŤ‚ĚŒ´ˆö‚Ć‚Č‚č‚Ś‚é1jB“Á‚ɁC‰ťŠw—Ă–@Ž{s’†‚ÉhCG ‚ĚŒ¸Š‚Ş’á’l‚Č‚Ş‚ç‚ŕƒvƒ‰ƒg[‚Ć‚Č‚Á‚˝ę‡‚É‚Í’ˆÓ‚Ş•K—v‚Ĺ‚ ‚éBŽîᇗR—ˆ‚̐^‚ĚhCG ‚Ƃ̊ӕʂɂ́CƒeƒXƒgƒXƒeƒƒ“•‰‰×ƒeƒXƒg‚Ş—L—p‚Ĺ‚ ‚é1, 2jB

y•śŒŁz

1j Gilligan TD, Seidenfeld J, Basch EM, et al. American Society of Clinical Oncology. American Society of Clinical Oncology Clinical Practice Guideline on uses of serum tumor markers in adult males with germ cell tumors. J Clin Oncol. 2010G28F3388-404.

2j Hoshi S, Suzuki K, Ishidoya S, et al. Significance of simultaneous determination of serum human chorionic gonadotropinihCGjand hCG-beta in testicular tumor patients. Int J Urol. 2000G7F218-23.iⅣbj


CQ 5

œ¸‘ƒŽîᇂ̎îᇃ}[ƒJ[‚Ć‚ľ‚āC‰˝‚ސ„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

A
ƒż-‘ŮŽ™Ťƒ^ƒ“ƒpƒNialpha-fetoproteinFAFPj‚¨‚ć‚ŃƒqƒgăO–ѐŤŤ‘BŽhŒƒƒzƒ‹ƒ‚ƒ“ihuman chorionic gonadotropinFhCGj‚́Căó×–EŽîᇂ̐f’f‚¨‚ć‚ŃŽĄ—Ă‚ĚŒř‰Ę”ť’č‚É•K{‚Ĺ‚ ‚éB

„§ƒOƒŒ[ƒh

B
AFP •Ş‰ćiAFP-L3j‚́CŽž‚É•a¨‚𔽉f‚ľCŽQl‚É‚Č‚éB

„§ƒOƒŒ[ƒh

A
“űŽ_’E…‘fy‘filactic dehydrogenaseFLDHj‚́C¸‘ƒŽîᇂɓÁˆŮ“I‚Ĺ‚Í‚Č‚˘‚ށC—zŤ—Ś‚͍‚‚­C“Á‚ɃZƒ~ƒm[ƒ}‚Ĺ‚Í—L—p‚Ĺ‚ ‚éB‚Ü‚˝CIGCCC ‚Ě”ť’č‚É•K{‚Ĺ‚ ‚éB
y‰đ ŕz

¸‘ƒŽîᇂ̎îᇃ}[ƒJ[‚Ć‚ľ‚Ä‚ĚAFPChCGCLDH ‚̏d—vŤ‚ÍŠm—§‚ł‚ę‚Ä‚¨‚čC1997 ”N‚ÉIGCCCiInternational Germ Cell Concensus Classificationj‚Ş•ń‚ł‚ę‚ÄˆČ—ˆC•aŠúf’fCŽĄ—ĂŒř‰Ę”ť’čCŒo‰ßŠĎŽ@‚É•K{‚Č‚ŕ‚Ě‚Ć‚Č‚Á‚Ä‚˘‚é1jB‚ą‚ĚIGCCC ‚É‚¨‚Ż‚éŽîᇃ}[ƒJ[‚Ě•]‰żŽžŠú‚͏‰fŽž‚ƍl‚Ś‚Ş‚ż‚Ĺ‚ ‚é‚ŞC¸‘ƒ“EœŒăi‰ťŠw—Ă–@‘Oj‚Ĺ‚ ‚é‚ą‚Ć‚É—ŻˆÓ‚ˇ‚ׂŤ‚Ĺ‚ ‚éB‚ł‚āC‘S¸‘ƒŽîᇂ̂¤‚ż–ń50“‚Í1 ‚‚Ȃ˘‚ľ2 ‚‚̎îᇃ}[ƒJ[‚Şă¸‚ľ‚Ä‚˘‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é2, 3jB‚ą‚ę‚ç3 Ží—Ţ‚Ěƒ}[ƒJ[‚́C“]ˆÚ‚đ—L‚ˇ‚é”ńƒZƒ~ƒm[ƒ}‚ł́C“Á‚ÉŽĄ—ĂŒă‚ĚÄ”­‚̏‰Šú’ĽŒó‚ƂȂ肤‚é‚˝‚ߏd—v‚Ĺ‚ ‚éB

LDH ‚đAFP ‚âhCG ‚Ć”äŠr‚ˇ‚é‚ƁC¸‘ƒŽîᇂɎžŠł“ÁˆŮŤ‚Ş‚ ‚é‚í‚Ż‚Ĺ‚Í‚Č‚˘‚ށCisŠŕ‚âÄ”­‚ĚÇ—á‚ŏ㏸‚ŞŒŠ‚ç‚ę‚é‚˝‚ß‚É—L—p‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚é4jBŠĚŽžŠł‚Č‚Ç‚Ě‘źŽžŠł‚Ĺ‚ŕă¸‚ľ‚¤‚é‚˝‚߁C‚ť‚̉đŽß‚É‚Í’ˆÓ‚Ş•K—v‚Ĺ‚ ‚éBVenkitaraman ‚ç‚Í499 –ź‚ĚStage Ⅰ¸‘ƒŽîᇂ̌o‰ßŠĎŽ@‚Ĺ‚ĚLDH ‘Ş’č‚ĚˆÓ‹`‚ɂ‚˘‚ÄŒŸ“˘‚ľ‚˝4jB‚ť‚ĚŒ‹‰ĘCÄ”­ŠłŽŇ15 –ź’†6 –ź‚ÉLDH ă¸‚đ”F‚ß‚˝‚ށCŽ‘ą“I‚Č‹U—zŤ‚Ş9.1“‚ÉŒŠ‚ç‚ęCŒ‹‰Ę“I‚ÉŠ´“x‚Í40“C“ÁˆŮ“x‚Í90.5“Cpositive predictive value ‚Í12.8“‚Ĺ‚ ‚čCŒo‰ßŠĎŽ@’†‚ĚLDH ‘Ş’č‚Í—L—p‚Ĺ‚ ‚é‚ŞC‚ť‚̉đŽß‚É‚Í’ˆÓ‚đ—v‚ˇ‚é‚Ć•ń‚ľ‚˝4jB

AFP ‚Í‚˘‚¸‚ę‚ĚStage ‚É‚¨‚˘‚Ä‚ŕ‘ŮŽ™ŤŠŕ‚â—‘‰Š囊Žîᇂŏ㏸‚ˇ‚é‚ŞCŠĚŽžŠł‚Ĺ‚ŕă¸‚ˇ‚é‚ą‚Ć‚Ş‚ ‚éBAFP ‚Í”ńƒZƒ~ƒm[ƒ}‚Ě50-70“‚ŏ㏸‚ˇ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚éBBeck ‚ç‚Í779 –ź‚Ě”ńƒZƒ~ƒm[ƒ}ŠłŽŇ‚ŁCŒă•űŽ‹“I‚ɐ¸‘ƒ“Eœp‘O‚ĚŒŒ´’†‚ĚAFP ’l‚ĆƒŔ-hCG ’l‚¨‚ć‚ŃŽîᇌa‚ŞŒă• –ŒƒŠƒ“ƒpßŠs´‚Ě•a—Šw“I•aŠú‚đ—\‘Ş‚Ĺ‚Ť‚é‚Š‚đŒŸ“˘‚ľ‚˝‚Ć‚ą‚ëCp‘OƒŔ-hCG ’l‚ĆŽîᇌa‚Í—\‘Ş‚Ĺ‚Ť‚Č‚Š‚Á‚˝‚ށCp‘OAFP ’l‚ÍŒă• –ŒƒŠƒ“ƒpß‚Ĺ‚Ě•a—Šw“I•aŠú‚đ—\‘Ş‚Ĺ‚Ť‚˝‚Ć•ń‚ľ‚˝5jBAFP ‚ĚŒŒ’†”źŒ¸Šú‚Í5-7 “ú‚Ĺ‚ ‚čCŒÂX‚ĚÇ—á‚ĚAFP ’l‚Ě”źŒ¸Šú‚đŒvŽZ‚ˇ‚é‚ą‚ƂŁC¸‘ƒŽîᇂ̎c‘ś‚Ě—L–ł‚𔝒股‚éŰ‚ĚŽQl‚Ć‚Č‚éBŽž‚ɁC•a—Šw“I‚Épure seminoma ‚Ɛf’f‚ł‚ę‚Ä‚ŕAFP ‚Şă¸‚ľ‚Ä‚˘‚é‚ą‚Ć‚Ş‚ ‚éB‚ť‚̂悤‚Čę‡‚́CŒŸo‚Ĺ‚Ť‚Ä‚˘‚Č‚˘”ńƒZƒ~ƒm[ƒ}Ź•Ş‚Ş‘śÝ‚ˇ‚é‚ƍl‚Ś‚ç‚ę‚éB

‚Ü‚˝CŽĄ—ĂŒă‚ÉAFP ‚ŞŒy“xă¸‚ľ‚Ä‚˘‚éę‡‚Ş‚ ‚čCŽc‘śŽîᇂ̗L–ł‚Ě”ť’f‚É–Ŕ‚¤ę‡‚Ş‚ ‚éB‚ť‚Ěę‡‚́CAFP •Ş‰ć‚Ě‚¤‚żAFP-L3 ‚𑪒股‚é‚ą‚Ć‚âƒRƒ“ƒJƒiƒoƒŠƒ“A Œ‹‡AFP ”ä‚𑪒股‚é‚ą‚ƂŁCŠĚŽžŠł“™‚Š‚çŠÓ•Ę‚ˇ‚é‚ą‚Ć‚Ş‰Â”\‚Ć•ń‚ł‚ę‚Ä‚˘‚é6, 7jB

hCG ‚̓ż˝‚ĆƒŔ˝‚Š‚ç‚Č‚éB’ʏí‚Í”ńƒZƒ~ƒm[ƒ}‚Ě40-60“‚ŏ㏸‚ˇ‚é‚ŞCAFP ‚Ć“Ż—l‚ɃZƒ~ƒm[ƒ}‚Ɛf’f‚ł‚ę‚˝ę‡‚Ĺ‚ŕă¸‚ˇ‚é‚ą‚Ć‚Ş‚ ‚éBhCG ‚Ě‘Ş’č‚É‚Í‚˘‚낢‚ë‚ČƒLƒbƒg‚Ş‘śÝ‚ˇ‚é‚̂ŁC‚ť‚Ě•]‰ż‚É‚Í’ˆÓ‚Ş•K—v‚Ĺ‚ ‚é8jB‚ˇ‚Č‚í‚żC‚í‚Ş‘‚Ĺ‚ÍhCG ‚ĚƒŔ˝‚Ě‘Ş’č‚É‚Ífree ƒŔ-hCG ‚Ě‘ź‚Étotal ƒŔ-hCG ‚âtotal HCG ‚Ş‚ ‚čC‚Ü‚˝free ƒŔ-hCG ‚đ‘Ş’č‚ľ‚Č‚˘intact hCG ‚Ş‚ ‚éBfree ƒŔ-hCG ‚݂̂𑪒股‚éƒLƒbƒg‚ÍIGCC •Ş—Ţ‚ÉŽg—p‚Ĺ‚Ť‚Č‚˘‚˝‚߁C‘Ş’čƒLƒbƒg‚Ě’PˆĘ‚ŞmIU/mL ‚ĚƒLƒbƒg‚đ—p‚˘‚é‚ą‚Ć‚Ş•K—v‚Ĺ‚ ‚éB‚˝‚ž‚ľCŽĄ—ĂŒo‰ß‚đŠĎŽ@‚ľ‚Ä‚˘‚­ă‚ł́Ctotal ƒŔ-hCG ‚ŕfree ƒŔ-hCG ‚ŕ‚ť‚ę‚ź‚ęŽîᇃ}[ƒJ[‚Ć‚ľ‚Ä•a¨•]‰ż‚É—L—p‚Ĺ‚ ‚é‚Ć‚˘‚¤•ń‚ŕ‚ ‚č9, 10j“ŻˆęƒLƒbƒg‚đŒp‘ą“I‚ÉŽg—p‚ľ‚ÄŒo‰ßŠĎŽ@‚ˇ‚é‚ą‚Ć‚Şd—v‚Ĺ‚ ‚éBiƒRƒ‰ƒ€2 ŽQĆj

‚ť‚Ě‘ź‚ĚŽîᇃ}[ƒJ[‚Ć‚ľ‚ẮC‘ٔՐŤƒAƒ‹ƒJƒŠƒtƒHƒXƒtƒ@ƒ^[ƒ[iPLAPj11jC‚Şpure seminoma ‚ĚŒo‰ßŠĎŽ@‚É—L—p‚Čę‡‚Ş‚ ‚čC•K—v‚ɉž‚ś‚Ä‘Ş’č‚ˇ‚ׂŤ‚ĆEAU ‚ĚƒKƒCƒhƒ‰ƒCƒ“‚É‚Í‹L‚ł‚ę‚Ä‚˘‚é12jB‚Ü‚˝C”’l‚É‘˝‚˘¸‘ƒCIS ‚Ěƒ}[ƒJ[‚Ć‚ľ‚Ästem cell factoric-kit ligandj‚âOCT3/4 ‚Ş—L—p‚Ć‚˘‚¤•ń13j‚âGlypican 314jzŠÂŒŒ’†‚Ěmitochodrial DNA15j‚ސ¸‘ƒŽîᇂ̃}[ƒJ[‚Ć‚ľ‚Ä—L—p‚Ć‚˘‚¤•ń‚ŕ‚ ‚é‚ŞC‚˘‚¸‚ę‚ŕ‚ť‚Ě—LŒřŤ‚ÍŠm—§‚ľ‚Ä‚˘‚Č‚˘B

y•śŒŁz

1j J Clin Oncol. International Germ Cell Consensus ClassificationFa prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol. 1997G15F594-603.iⅤj

2j Wanderås EH, Tretli S, Fosså SD. Trends in incidence of testicular cancer in Norway 1955-1992. Eur J Cancer. 1995G31AF2044-8.iⅢj

3j Germa-Lluch JR, Garcia del Muro X, Maroto P, et al. Spanish Germ-Cell Cancer GroupiGGj. Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testisFthe experience of the Spanish Germ-Cell Cancer GroupiGGj. Eur Urol. 2002G42F553-62.iⅢj

4j Venkitaraman R, Johnson B, Huddart RA, et al. The utility of lactate dehydrogenase in the follow-up of testicular germ cell tumours. BJU Int, 2007G100F30-2.iⅣbj

5j Beck SD, Foster RS, Bihrle R, et al. Significance of primary tumor size and preorchiectomy serum tumor marker level in predicting pathologic stage at retroperitoneal lymph node dissection in clinical stage S nonseminomatous germ cell tumors. Urology, 2007G69F557-9.iⅣbj

6j Kamoto T, Satomura S, Yoshiki T, et al. Lectin-reactive alpha-fetoproteiniAFP-L3“jcurability and prediction of clinical course after treatment of non-seminomatous germ cell tumors. Jpn J Clin Oncol, 2002G32F472-6.iⅣbj

7j Mora J, Gascon N, Tabernero JM, et al. Alpha-fetoprotein-concanavalin A binding as a marker to discriminate between germ cell tumours and liver diseases. Eur J Cancer, 1995G31AF2239-42.iⅣbj

8j “ú–{”ĺ”AŠí‰ČŠw‰ďE“ú–{•a—Šw‰ď•ŇD¸‘ƒŽîᇎ戵‚˘‹K–ńi‘ć3 ”ŁjD‹ŕŒ´o”Łi“Œ‹žjG2005D

9j Lempi ä inen A, Stenman UH, Blomqvist C, et al. Free beta-subunit of human chorionic gonadotropin in serum is a diagnostically sensitive marker of seminomatous testicular cancer. Clin Chem, 2008G54F1840-3.iⅣbj

10j Hoshi S, Suzuki K, Ishidoya S, et al. Significance of simultaneous determination of serum human chorionic gonadotropinihCGjand hCG-beta in testicular tumor patients. Int J Urol, 2000G7F218-23.iⅣbj

11j Torabi-Pour N, Nouri AM, Chineguwndo F, et al. Standardization and potential use of HPLC for detection of cellular placental alkaline phosphatase using tumor cell lines and fresh tumour biopsies. Urol Int, 1999G63F234-41.iⅣbj

12j Albers P, Albrecht W, Algaba F, et alFGuidelines on Testicular Cancer. European Association of Urology. 2012F7-7.

13j Stoop H, Honecker F, van de Geijin GJ, et al. Stem cell factor as a novel diagnostic marker for early malignant germ cells. J Pathol, 2008G216F43-54.iⅣbj

14j Zynger DL, MaCallum JC, Luan C, et al. Glypican 3 has a higher sensitivity than alpha-fetoprotein for testicular and ovarian yolk sac tumorFimmunohistochemical investigation with analysis of histological growth patterns. Histopathol, 2010G56F750-7.iⅣbj

15j Ellinger J, Albers P, Muller SC, et al. Circulating mitochondrial DNA in the serum of patients with testicular germ cell cancer as a novel noninvasive diagnostic marker. BJU Int, 2009G104F48-52.iⅣbj


Column2

hCG ‘Ş’č‚É‚ÍmIU/mL •\‹L‚Ě‚ŕ‚Ě‚đ—p‚˘‚é

hCG ‘Ş’čƒLƒbƒg‚ɂ́CŽŸ‚̂悤‚ÉŽíX‚ĚƒLƒbƒg‚Ş‚ ‚éB

  1. intact hCGFƒż˝‚ĆƒŔ˝‚ŞŒ‹‡‚ľ‚˝ó‘Ô‚Ěintact hCG ‚݂̂𑪒股‚éƒLƒbƒg
  2. free ƒŔ-hCGFƒż˝‚Ɖ𗣂ľ‚ăŔ˝‚Ě‚Ý‚Ĺ‘śÝ‚ˇ‚éfree ƒŔ-hCG ‚݂̂𑪒股‚éƒLƒbƒg
  3. total hCGFintact hCG ‚Ćfree ƒŔ-hCG ‚¨‚ć‚Ń‚ť‚Ě‘ź‚ĚhCG ŠÖ˜A•ŞŽq‚đŠÜ‚Ţtotal hCG ‚𑪒股‚éƒLƒbƒg

Ĺ‚ŕ’ˆÓ‚ˇ‚ׂŤ‚ą‚Ƃ́Cfree ƒŔ-hCG ‚Íng/mL ’PˆĘ‚Ĺ•\‹L‚ł‚ęC‚ą‚Ěfree ƒŔhCG ’l‚Š‚çIGCCCG •Ş—Ţ‚Ĺ—p‚˘‚ç‚ę‚émIU/mL ‚Ö‚ĚŠˇŽZ‚Ş‚Ĺ‚Ť‚Č‚˘‚ą‚Ć‚Ĺ‚ ‚éB‚ą‚Ě‚˝‚߁C‰ťŠw—Ă–@ŠJŽn‘O‚Éfree ƒŔ-hCG ‚Ě‚Ý‚ľ‚Š‘Ş’č‚ľ‚Ä‚˘‚Č‚˘ę‡‚́C—˜_ăCIGCCCG •Ş—Ţ‚đ—p‚˘‚é‚ą‚Ć‚Ş‚Ĺ‚Ť‚Č‚˘B“Á‚ɁCng/mL ’PˆĘ‚Ĺ•\‹L‚ł‚ę‚Ä‚˘‚éę‡‚Í’ˆÓ‚đ—v‚ˇ‚éB

Œťó‚É‚¨‚˘‚āCintact hCG ‚Ćtotal hCG ‚Ě‚Ç‚ż‚ç‚Ş—L—p‚Š‚ɂ‚˘‚ẮC–žŠm‚Čƒf[ƒ^‚Í‚Č‚˘BƒZƒ~ƒm[ƒ}‚Ĺintact hCG ‚ĚŽYś”\‚Ş’á‚­Cfree ƒŔ-hCG ‚Ě‚Ý‚đŽYś‚ˇ‚éÇ—á‚Ş‚ ‚čC‚ť‚ĚˆÓ–Ą‚Ĺ‚Ífree ƒŔ-hCG ‚đ‡‚í‚š‚Ä‘Ş’č‚ˇ‚étotal hCG ‚ĚŠ´“x‚Ş‚ć‚č‚‚˘‚ą‚Ć‚ŞŠú‘Ň‚ł‚ę‚éB

ăó×–EŽîˆČŠO‚ĚŠŕŽî‚Ĺ‚ŕC’á’l‚Č‚Ş‚çfree ƒŔ-hCG ‚đŽYś‚ˇ‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚¨‚č1jC‚ť‚ĚˆÓ–Ą‚ł́Ctotal hCG ‚Ěăó×–EŽî“ÁˆŮŤ‚Íintact hCG ‚ć‚č’Ⴂ‚ƍl‚Ś‚ç‚ę‚éB‚ť‚Ě‚˝‚߁Cburned out Ç—á‚␍‘BŠOăó×–EÇ—á‚ŐśŒŸ‚É‚ć‚é‘gDf’f‚ލ˘“ď‚Č‚˝‚߁ChCG ‘Ş’č’l‚Ě‚Ý‚Ĺăó×–EŽî‚Ě—Ő°f’f‚đs‚¤ę‡‚́Cintact hCG ‚Ćtotal hCG ‚ ‚邢‚Íintact hCG ‚Ćfree ƒŔ-hCG ‚Č‚Ç‚Ě•Ą”‚Ě‘Ş’č–@‚ĹŠm”F‚ľ‚Ä‚¨‚­‚ą‚Ć‚Ş–]‚Ü‚ľ‚˘B

ť‘˘Œł ŽŽ–ň–ź Žg—p‹@Ší–ź ‘Ş’č”ÍˆÍ ‘Ş’č‘ÎŰ ‘Ş’čŒŸ‘Ě
intact
HCG
total
HCG
free ƒŔ ŒŒ´/
ŒŒŸ÷
”A
ƒƒVƒ…
ƒ_ƒCƒAƒOƒmƒXƒeƒBƒNƒX
ƒGƒNƒ‹[ƒVƒXŽŽ–ň
HCG‡U@STAT
ƒRƒoƒX/
ƒGƒNƒ‹[ƒVƒX
0.5`10,000
›     ›
›
ƒGƒNƒ‹[ƒVƒXŽŽ–ňHCG{β 0.1`10,000   › ›  
“Œƒ\[ E ƒeƒXƒguTOSOHvⅡ
iƒŔHCGj
AIA 0.5`400
  › ›
 
E ƒeƒXƒguTOSOHvⅡ
iHCG‡Uj
ŒŒ‰tF0.5`2,000
”AF2.5`10,000
›     › ›
ƒV[ƒƒ“ƒXƒwƒ‹ƒXƒPƒA
ƒ_ƒCƒAƒOƒmƒXƒeƒBƒNƒX
ƒPƒ~ƒ‹ƒ~ACS-HCG‡U ADVIA
Centaur
2.0`1000   ›   ›  
ƒAƒ{ƒbƒg ƒA[ƒLƒeƒNƒgEƒŔHCG
ƒA[ƒLƒeƒNƒg
1.2`15,000
  ›
  ›
 
βHCGEƒAƒ{ƒbƒg ƒAƒLƒVƒ€ 2`1000   ›   ›  
•xŽmƒŒƒr ƒIƒ‹ƒ~ƒpƒ‹ƒX@ƒŔHCG ƒ‹ƒ~ƒpƒ‹ƒX 1.5`1,000   ›   ›  
ƒVƒXƒƒbƒNƒXE
ƒrƒIƒƒŠƒ…[
ƒoƒCƒ_ƒXƒAƒbƒZƒCƒLƒbƒg
HCG
ƒoƒCƒ_ƒX 2`1500 ›     › ›
“ú…ť–ň ƒGƒoƒeƒXƒgHCG ƒGƒoƒlƒbƒg
EV20
2`1000 ›     › ›
ƒI[ƒ\ƒNƒŠƒjƒJƒ‹
ƒ_ƒCƒAƒOƒmƒXƒeƒBƒNƒX
ƒrƒgƒƒXHCG‡U ƒrƒgƒƒX 2.39`15,000   ›   ›  
ŽO•H‰ťŠwƒƒfƒBƒGƒ“ƒX ƒpƒXƒtƒ@[ƒXƒgHCG ƒpƒXƒtƒ@[ƒXƒg 5`500   ›   › ›
ť‘˘Œł ŽŽ–ň–ź Žg—p‹@Ší–ź ‘Ş’č”͈Í
ing/mLj
intact
HCG
total
HCG;
free ƒŔ ŒŒ´/
ŒŒŸ÷
”A
ƒV[ƒƒ“ƒXƒwƒ‹ƒXƒPƒA
ƒ_ƒCƒAƒOƒmƒXƒeƒBƒNƒX
ƒV[ƒƒ“ƒXEƒCƒ€ƒ‰ƒCƒY
ƒtƒŠ[ƒŔHCG‡Ui–j
ƒCƒ€ƒ‰ƒCƒY 0.04`80     › ›  
ƒZƒeƒB[E
ƒƒfƒBƒJƒ‹ƒ‰ƒ{
ƒ{[ƒ‹ƒGƒ‹ƒUi–j —pŽč–@ 0.1`50 › ›  

–‰ş‚Ě2 ’i‚ĚƒLƒbƒg‚Í‘Ş’čŒ‹‰Ę‚ށung/mLv‚Ĺ•\ŽŚ‚ł‚ę‚éB‚ą‚ę‚ç‚ĚƒLƒbƒg‚Ě‚Ý‚Ĺ‘Ş’č‚ˇ‚é‚ą‚Ć‚Í”đ‚Ż‚é‚ׂŤ

y•śŒŁz

1j Marcillac I, Troalen F, Bidart JM, et al. Free human chorionic gonadotropin beta subunit in gonadal and nongonadal neoplasms. Cancer Res. 1992G52F3901-7.


CQ 6

œIGCCCiInternational Germ Cell Consensus Classificationj‚Í—\Œă—\‘Ş‚É—L—p‚ŠH


„§ƒOƒŒ[ƒh

A
IGCCC ‚́CisŤ¸‘ƒŽîᇂ̗\Œă‚¨‚ć‚ŃŽĄ—Ă–@‚đŒˆ’č‚ˇ‚é‚˝‚߂ɁC•K—v•s‰ÂŒ‡‚Ĺ‚ ‚éB
‚˝‚ž‚ľCĹ‹ß‚ĚŒŸ“˘‚Ĺ‚Ípoor prognosis ‚Ĺ‚ ‚Á‚Ä‚ŕC—\Œă‰ü‘P‚ĚŒXŒü‚Ş‚ ‚éB‚Ü‚˝CƒTƒ‹ƒx[ƒW‰ťŠw—Ă–@Žž‚̐V‚ľ‚˘—\Œă—\‘ރ‚ƒfƒ‹‚̍\’z‚Ş‹ß”NŽŽ‚Ý‚ç‚ę‚Ä‚˘‚éB
y‰đ ŕz

1997 ”N‚ÉIGCCCG ‚Š‚çCIGCCCi•t•\2 ŽQĆj‚Ş•ń‚ł‚ę‚ÄˆČ—ˆ1jCisŤ¸‘ƒŽîᇂ́CIGCCC ‚ÉŠî‚Ă‚˘‚Ä“ą“ü‰ťŠw—Ă–@‚Ě‘I‘đ‚⎥—Ă•űj‚ĚŒˆ’č‚Ş‚Č‚ł‚ę‚é‚悤‚É‚Č‚čCIGCCC ‚Ě—L—pŤ‚ɂ‚˘‚Ä‚Í‹^‚¤—]’n‚Í‚Č‚˘B‚ľ‚Š‚ľCIGCCC ‚Ş•ń‚ł‚ę‚Ä‚Š‚ç15 ”NˆČă‚ŞŒo‰ß‚ľCŽĄ—Ă–@‚̐i•ŕ‚âÇ—á‚̏W–ń‚É‚ć‚čCŒťó‚Ć‚Ě‚¸‚ę‚Şś‚ś‚Ä‚˘‚éB‚ť‚Ě‚˝‚߁CIGCCC ‚Ě—LŒřŤ‚ɂ‚˘‚Ä‚ĚÄŒŸ“˘‚Ş‚Č‚ł‚ęC“Á‚Époor prognosis ‚đƒTƒuƒOƒ‹[ƒv‰ť‚ľC‚ć‚č—\Œă‚𔽉f‚ˇ‚鎎‚Ý‚Ş‚Č‚ł‚ę‚˝B

Dijk ‚ç‚́C1989 ”NˆČ~‚ĚÇ—á‚ɂ‚˘‚Ä‹LÚ‚ł‚ę‚˝10 ˜_•ś‚đŒŸ“˘‚ľC1,775 —á‚ĚNSGCTinon-seminomatous germ cell tumorj‚ɂ‚˘‚Ämeta-analysis ‚đs‚Á‚˝B‚ť‚ĚŒ‹‰ĘCgood prognosisCintermediate prognosisCpoor prognosis ‚ĚŠeŒQ‚Ě—\Œă‚ށC94“C83“C71“‚Ĺ‚ ‚čC‹ß”N‚̉ťŠw—Ă–@‚̐i•ŕ‚É‚ć‚époor prognosis ‚Ě—\Œă‰ü‘P‚Ş’˜‚ľ‚˘‚ą‚Ć‚đŽŚ‚ľ‚˝2jB–{–M‚Ĺ‚ŕ‘˝Ž{Ý‹¤“ŻŒ¤‹†‚ލs‚í‚ęC296 —á‚ɂ‚˘‚ÄŒŸ“˘‚Ş‚Č‚ł‚ęCIGCCC poor prognosis ‚Ě—\Œă‰ü‘P‚Ş’˜‚ľ‚˘Œ‹‰Ę‚đ•ń‚ľ‚Ä‚˘‚é3jBƒTƒuƒOƒ‹[ƒv‰đÍ‚ł́CDijk ‚ç‚́CIGCCC ‚Ě–â‘č“_‚Ć‚ľ‚āC—p‚˘‚˝riskfactor ‚đ‹“‚°‚Ä‚˘‚éBIGCCCG ‚Š‚ç’ń‹Ÿ‚ł‚ę‚˝3,048 —á‚ĚNSGCT ‚Ěƒf[ƒ^‚đCox regression model ‚đ—p‚˘‚ĉđÍ‚ľCIGCCC ‚đă‰ń‚é‚ą‚Ć‚Ş‚Ĺ‚Ť‚Č‚Š‚Á‚˝‚ށCpoor prognosis ‚Ĺ‚Í3 ƒOƒ‹[ƒv‚ɍוމť‚މ”\‚Ĺ‚ ‚čCŒv5 ‚‚Ěrisk group ‚É•Ş—Ţ‚ˇ‚é‚ą‚ƂŁC‚ć‚č—\Œă‚𔽉f‚ˇ‚é‚Ć‚ľ‚˝4jB

‚Ü‚˝CKollmannsberger ‚ç‚́C332 —á‚Ěpoor prognosis ŒQ‚đCARTiclassification and regression-treejanalysis ‚đ—p‚˘‚ÄŒŸ“˘‚ľ‚˝B‚ą‚̉đÍ‚ł́C¸‘ƒ‚Ü‚˝‚ÍŒă• –ŒŒ´”­‚ŠcŠuŒ´”­‚ŠC”xˆČŠO‚ĚŽŔŽż‘ŸŠí“]ˆÚ‚Ě—L–łCŒă• –Œ“]ˆÚ‘ƒ‚Ş10 cm –˘–ž‚Š”Ű‚ŠC“]ˆÚ‘ƒ‚̐”CAFPChCG-ƒŔCLDH ‚Ě’l‚đrisk factor ‚Ć‚ľ‚Ä—p‚˘Cgvery poorhŒQ‚𓯒股‚é‚ą‚Ć‚Ş‰Â”\‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚˝5jB

‚Ü‚˝CInternational prognostic factors study group ‚̓VƒXƒvƒ‰ƒ`ƒ“ƒx[ƒX‚Ě1st line ‰ťŠw—Ă–@Œă‚Ě’ďR—áC‚Ü‚˝‚͍Ĕ­—á‚ĹƒTƒ‹ƒx[ƒW‰ťŠw—Ă–@‚đŽ{s‚ľ‚˝1,594 —á‚đ‘ÎŰ‚Ć‚ľ‚ÄŒă•űŽ‹“I‚ɃTƒ‹ƒx[ƒW‰ťŠw—Ă–@Ž{sŽž‚̐V‚ľ‚˘—\Œă—\‘ރ‚ƒfƒ‹‚̍\’z‚đŽŽ‚Ý‚˝6jBƒpƒ‰ƒ[ƒ^‚Ć‚ľ‚ÄŒ´”­•”ˆĘC1st line ‰ťŠw—Ă–@‚ĚƒŒƒXƒ|ƒ“ƒXCÄ”­‚Ü‚Ĺ‚ĚŠúŠÔCƒTƒ‹ƒx[ƒW‰ťŠw—Ă–@‘O‚ĚAFP ’lCHCG ’lCŠĚEœE”]“]ˆÚ‚Ě—L–łCpure seminoma ‚Š”Ű‚Š‚đƒXƒRƒA‰ť‚ľCvery lowClowCintermediateChighCvery high ‚Ě5 ŒQ‚É•Ş‚Ż‚é•ű–@‚đ’ńĽ‚ľ‚˝i•t•\3 ŽQĆjBĄŒăC‚ą‚Ě•Ş—Ţ‚É‚ć‚čƒTƒ‹ƒx[ƒWŽž“_‚Ĺ‚Ě—\Œă—\‘ށCƒTƒ‹ƒx[ƒWŽĄ—Ă‚Ě•]‰ż‚ލs‚í‚ę‚é‰Â”\Ť‚ŕ‚ ‚éB

IGCCC ‚ÍŒťÝ‚Ĺ‚ŕ”ńí‚É—L—p‚Ĺ‚ ‚čC—\Œă‚đ‚ć‚­”˝‰f‚ˇ‚é‚ŞCĄŒăpoor prognosis ‚ÉŠÖ‚ľ‚ẮCƒTƒuƒOƒ‹[ƒv‰ť‚ľ‚˝‚¤‚Ś‚ŁCŽĄ—Ă•űj‚Ě•ĎX‚Č‚Ç‚đl—ś‚ľ‚Ä‚ŕ‚悢‚ƍl‚Ś‚ç‚ę‚éB

y•śŒŁz

1j J Clin Oncol. International Germ Cell Consensus ClassificationFa prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group.1997G15F594-603.iⅤj

2j van Dijk MR, Steyerberg EW, Habbema JD. Survival of non-seminomatous germ cell cancer patients according to the IGCC classificationFAn update based on meta-analysis. Eur J Cancer. 2006G42i7jF820-6.iⅠj

3j Shintaku I, Satoh M, Okajima E, et al. Jpn J Clin Oncol. 2008G38i4jF281-7.iⅣbj

4j van Dijk MR, Steyerberg EW, Stenning SP, et al. Survival of patients with nonseminomatous germ cell cancerFa review of the IGCC classification by Cox regression and recursive partitioning. Br J Cancer. 2004G90F1176-83.iⅣaj

5j Kollmannsberger C, Nichols C, Meisner C, et al. Identification of prognostic subgroups among patients with metastaticeIGCCCG poor-prognosisfgerm-cell cancerFan explorative analysis using cart modeling. Ann Oncol. 2000G11F1115-20.iⅣaj

6j The international prognostic factors study group, Lorch A, Beyer J, et al. Prognostic factors in patients with metastatic germ cell tumors who experienced treatment failure with cisplatin-based first-line chemotherapy. J Clin Oncol. 2010G28F594-603.iⅣbj


CQ 7

œStage Ⅰ‚ĚƒZƒ~ƒm[ƒ}‚ɑ΂ľ‚ďpŒă•â•ŽĄ—Â͐„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

B
Stage ⅠƒZƒ~ƒm[ƒ}‚ɑ΂ľC‚ˆĘ¸‘ƒ“EœpŒă‚ÉŒo‰ßŠĎŽ@iƒT[ƒxƒCƒ‰ƒ“ƒXj‚Ş‘I‘đ‚ł‚ę‚˝ę‡CÄ”­—Ś‚Í15-20“‚Ĺ‚ ‚éB‚ľ‚Š‚ľCÄ”­‚ľ‚˝ę‡‚Ĺ‚ŕ‚Ů‚Ú98-99“‚ÍŽĄ–ü‰Â”\‚Ĺ‚ ‚čCpŒă•â•—Ă–@‚É‚ć‚é•s•K—v‚ČŽĄ—Ă‚â•›ě—p‚đ”đ‚Ż‚ç‚ę‚é‚̂ŁCŒo‰ßŠĎŽ@‚͐„§‚Ĺ‚Ť‚éB

„§ƒOƒŒ[ƒh

B
pŒă•úŽËüŽĄ—Ă‚ÍÄ”­—Ś‚đ–ń5“ˆČ‰ş‚ɒቺ‚ł‚š‚é‚ą‚Ć‚Ş‚Ĺ‚ŤCŒo‰ßŠĎŽ@‚Ş‘I‘đ‚ł‚ę‚Č‚Š‚Á‚˝ę‡‚Ě‘I‘đŽˆ‚Ć‚ľ‚Đ„§‚Ĺ‚Ť‚éB‚ľ‚Š‚ľC“ńŽŸŠŕ”­ś‚Č‚Ç‚Ě’ˇŠú“I‚Č–â‘č‚Ş‚ ‚éB

„§ƒOƒŒ[ƒh

B
ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“’PÜ‚É‚ć‚é•â•‰ťŠw—Ă–@‚͍Ĕ­—Ś‚đ–ń5“ˆČ‰ş‚ɒቺ‚ł‚š‚é‚ą‚Ć‚Ş‚Ĺ‚ŤCÄ”­—\–hŒř‰Ę‚Í•úŽËüŽĄ—Ă‚Ć“Ż“™‚ŁCŒo‰ßŠĎŽ@‚Ş‘I‘đ‚ł‚ę‚Č‚Š‚Á‚˝ę‡‚Ě‘I‘đŽˆ‚Ć‚ľ‚Đ„§‚Ĺ‚Ť‚éBˆŔ‘SŤ‚ŕŠm—§‚ł‚ę‚‚‚ ‚é‚ŞC10 ”NˆČă‚É‚í‚˝‚é‘ĺ‹K–Í‚Č’ˇŠúŹŃ‚Í“ž‚ç‚ę‚Ä‚˘‚Č‚˘B
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ƒZƒ~ƒm[ƒ}‚Ě–ń75“‚Í“]ˆÚ‚đ—L‚ł‚Č‚˘Stage Ⅰ‚ĚƒŒƒxƒ‹‚Őf’f‚ł‚ę‚é1jBStage Ⅰ‚̐¸‘ƒŽîᇂɑ΂ľ‚Ä‚Ě‚ˆĘ¸‘ƒ“EœpŒă‚ĚƒIƒvƒVƒ‡ƒ“‚Ć‚ľ‚āC①Œo‰ßŠĎŽ@C②•â••úŽËü—Ă–@C③1 ‚Ü‚˝‚Í2 ƒR[ƒX‚Ě•â•ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“—Ă–@‚Ć‚˘‚¤3 ‚‚̑I‘đŽˆ‚Ş‚ ‚éB3 ‚‚̑I‘đŽˆ‚Ě‚Ç‚ę‚đ‘I‚ń‚Ĺ‚ŕCĹI“I‚É‚ÍŽžŠł“ÁˆŮ“Iś‘ś—Ś‚Í‚Ů‚Ú98-99“‚É‹y‚Ô2-5jB‚ľ‚˝‚Ş‚Á‚āCStage Ⅰ‚ĚƒZƒ~ƒm[ƒ}‚ɑ΂ˇ‚鎥—Ă•űj‚́C’ZŠú“I‚É‚ŕ’ˇŠú“I‚É‚ŕNP‚̏­‚Č‚˘ŽĄ—Ă‚đ‘I‘đ‚ˇ‚é‚Š‚ŞĹ“_‚Ĺ‚ ‚éB•űj‘I‘đ‚É‚ ‚˝‚Á‚ẮCŠe‘I‘đŽˆ‚Ě—Ő°ƒf[ƒ^‚đ\•Ş”z—ś‚ˇ‚é•K—v‚Ş‚ ‚éB

①Œo‰ßŠĎŽ@‚đ‘I‘đ‚ľ‚˝ę‡

Ä”­—Śi‘Α¤¸‘ƒŽîᇔ­ś‚Íde novo ‚Ć‚ľ‚ÄŠÜ‚ß‚Č‚˘ę‡j‚́CŒo‰ßŠĎŽ@ŠúŠÔ‚É‚ŕ‚ć‚é‚ŞC13-20“‚Ĺ‚ ‚é2-5, 7, 8jBÄ”­‚Ě–ń7 Š„‚Í2 ”NˆČ“ŕ‚É‹N‚ą‚čCÄ”­‚Ü‚Ĺ‚Ě’†‰›’l‚Í14-16 ƒJŒŽ‚Ĺ‚ ‚é2, 8jB‚ľ‚Š‚ľC6.6“‚ĚÄ”­‚Í6 ”NˆČ~‚É‹N‚ą‚č3jC10 ”NˆČ~‚ĚÄ”­‚ŕ‚ ‚肤‚éBŒo‰ßŠĎŽ@‚Ĺ‚ĚÄ”­•”ˆĘ‚Ě80-100“‚Ş• •”‚Ě–T‘ĺ“Ž–Ź—Ěˆć‚Ĺ‚ ‚é2, 7, 8jB‚ľ‚Š‚ľCÄ”­Œă‚ŕÄ”­Žž‚ĚStage ‚ɉž‚ś‚˝“KŘ‚ČŽĄ—Ă‚Şs‚í‚ę‚ę‚΁CŽĄ—ĂŠÖ˜AŽ€‚ŕŠÜ‚ß‚Ä‚ŕC¸‘ƒŽîᇊ֘AŽ€‚Í1“’ö“x‚Ĺ‚ ‚é2-5, 7, 8jB

Ä”­‚Ě—\ŒăˆöŽq‚ɂ‚˘‚ẮC¸‘ƒŽîᇌa‚Ş4 cm ‚đ’´‚Ś‚éCrete testis ‚ւ̐Z‚Ş‚ ‚éę‡‚ŁC2 ‚Â‚ĚŠëŒŻˆöŽq‚Ş–ł‚˘ę‡C1 ‚—L‚čC2 ‚—L‚č‚Ě5 ”NÄ”­—Ś‚́C‚ť‚ę‚ź‚ę12“C16“C32“‚Ć‚Ě•ń‚Ş‚ ‚é3jB‚ą‚ĚÄ”­‚Ě—\ŒăˆöŽq‚ÉŠî‚Ă‚˘‚˝‚ˆĘ¸‘ƒ“EœŒă‚Ě‘I‘đŽˆ‚đŒˆ’č‚ˇ‚é‘OŒü‚ŤŒ¤‹†‚ŕ‚ ‚é‚Ş9jCƒŠƒXƒN•Ş—Ţ‚É‚ć‚é•â•ŽĄ—Ă‘I‘đ‚͏\•Ş‚ɃGƒrƒfƒ“ƒX‚Ş‚ ‚é‚Ć‚Í‚˘‚Ś‚Č‚˘10, 11jB

②•â••úŽËü—Ă–@‚đ‘I‘đ‚ľ‚˝ę‡

•â••úŽËü—Ă–@‚É‚ć‚čCÄ”­—Ś‚Í‚Ů‚Ú5“ˆČ‰ş‚É—}‚Ś‚ç‚ę‚éB‘ĺ‹K–̓‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Ěƒf[ƒ^‚É‚ć‚é‚ƁCÄ”­—Ś‚Í4.1“iTE19FEORTC20982 Œ¤‹†CŠĎŽ@ŠúŠÔ’†‰›’l6.4 ”NCn904jC4.0“iTE18/19FEORTC30942 Œ¤‹†CŠĎŽ@ŠúŠÔ’†‰›’l7 ”NCn1,094jC4.2“iTE10 Œ¤‹†F–T‘ĺ“Ž–Ź—ĚˆćĆŽËCŠĎŽ@ŠúŠÔ’†‰›’l12 ”NCn236j‚ŁC‚˘‚¸‚ę‚ŕ5.0“ˆČ‰ş‚Ĺ‚ ‚é6jBƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Ĺ‚Í‚Č‚˘‚ށC245 —á‚̏pŒă•â••úŽËüŽĄ—ĂŒQi25 Gyj‚ƁC226 —á‚ĚŒo‰ßŠĎŽ@ŒQ‚Ě”äŠr“I‘ĺ‹K–Í‚ČŠĎŽ@Œ¤‹†‚ŁC•úŽËüŽĄ—ĂŒQiŠĎŽ@ŠúŠÔ’†‰›’l9.7 ”Nj‚Ĺ‚ÍÄ”­‚Ş14 —ái5.7“j‚Ć—}‚Ś‚ç‚ę‚˝‚̂ɑ΂ľ‚āCŒo‰ßŠĎŽ@ŒQiŠĎŽ@ŠúŠÔ’†‰›’l7.7 ”Nj‚Ĺ‚Í37 —ái16.4“j‚ĚÄ”­‚Ş‚ ‚Á‚˝12jB

ĆŽË—Ę‚Ć‚ľ‚ẮC20 Gy ‚Ć30 Gy ‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒąi”ń—ň¨ŽŽŒąCTE18/19FEORTC30942 Œ¤‹†j‚É‚ć‚Á‚Ä”ńÄ”­—Ś‚ɍˇ‚Ş‚Č‚˘‚ą‚Ć‚ŞŽŚ‚ł‚ęi5 ”N”ńÄ”­—ŚCŠeX97“C95“jCŒťÝ20 Gy ‚ސ„§‚ł‚ę‚é6, 13jBĆŽË–ě‚ÉŠÖ‚ľ‚ẮCŠł‘¤‚Ě’°œ—Ěˆć‚đ‰Á‚Ś‚˝dogleg Œ^‚Ć–T‘ĺ“Ž–Ź—Ěˆć‚Ě‚Ý‚Ě30 Gy ‚É‚ć‚éĆŽË–ě‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒąiTE10 Œ¤‹†j‚É‚ć‚Á‚āCˇ‚Ş‚Č‚˘‚ą‚Ć‚ŞŽŚ‚ł‚ę‚˝‚˝‚߁CŒťÝ‚Ĺ‚Í–T‘ĺ“Ž–Ź—Ěˆć‚Ě‚Ý‚ĚĆŽË‚Ş„§‚ł‚ę‚é6, 14jB

•úŽËüŽĄ—ĂŒă‚Ě—LŠQŽ–Ű‚ɂ‚˘‚ẮC’ZŠú“I‚É‚Ímortality ‚âd‚˘morbidity ‚É‚Í‚Ů‚Ć‚ń‚ÇŒo‰ßŠĎŽ@‚ƍˇ‚Ş‚Č‚˘‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚éB’ˇŠú‚̍‡•šÇ‚â—LŠQŽ–Ű‚ɂ‚˘‚ẮC25 Gy ‚ĚĆŽË‚Ĺ‚ĚŠĎŽ@ŠúŠÔ’†‰›’l15 ”N‚Ě•ń‚ł́C‚˛‚­­”—á‚ĚˆÝ’°áŠQ‚Ş‚ ‚Á‚˝‚݂̂ŁC•úŽËüŽĄ—Ă‚ĚˆŔ‘SŤ‚ŞŽĺ’Ł‚ł‚ę‚Ä‚˘‚é15jB‚ľ‚Š‚ľC•úŽËüŽĄ—ĂŒăC“ńŽŸŠŕ‚Ě”­ś—Ś‚Ş‘‰Á‚ˇ‚é‚Ć‚Ě•ń‚â16-19jC•úŽËü—Ă–@‚É”ş‚¤ˆęŽž“I‚Č•s”D‚Ě–â‘č20jCSŒŒŠÇŒn‡•šÇƒŠƒXƒNă¸‚̉”\Ť19j‚ŕ‚ ‚éBĆŽË–ě‚̏kŹ‚âĆŽËü—ĘŒ¸—Ę‚Č‚Ç‚Ş‚Č‚ł‚ę‚Ä‚˘‚éŒťÝ‚ĚŽĄ—Ă‚É‚ć‚Á‚āC‚ą‚ę‚ç‚̏”–â‘č‚Ş‰đŒˆ‚ł‚ę‚é‚Š‚Í–žŠm‚Ĺ‚Í‚Č‚˘B‚ľ‚˝‚Ş‚Á‚āCŽá”NŽŇ‚É‘˝‚˘¸‘ƒŽîᇂł́C•â••úŽËü—Ă–@‚͐Td‚É‘I‘đ‚ˇ‚×‚Ť‚Ĺ‚ ‚éB‚Č‚¨ĆŽË–ě‚âü—ʂɂ‚˘‚Ắw•úŽËüŽĄ—ĂŒv‰ćƒKƒCƒhƒ‰ƒCƒ“2016 ”N”Łx21j‚đŽQl‚É‚ľCŽĄ—Ă‚É‚ ‚˝‚é•úŽËü‰Čˆă‚Ə\•Ş‚ɃRƒ“ƒZƒ“ƒTƒX‚đ‚Ć‚é‚ׂŤ‚Ĺ‚ ‚éB

③•â•ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“—Ă–@‚Ş‘I‘đ‚ł‚ę‚˝ę‡

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ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“ŒQ‘S‘Ě‚Ě5 ”N”ńÄ”­—Ś‚Í94.7“‚ž‚ށCƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“‚ŞAUC7 ‚Ĺ“Š—^‚ł‚ę‚˝ę‡‚Ě5 ”N”ńÄ”­—Ś‚Í96.1“C•úŽËüŽĄ—ĂŒQ‚Ě5 ”N”ńÄ”­—Ś‚Í96“‚Ĺ‚ ‚Á‚˝6, 22jB‚ł‚ç‚ɁCƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“ŒQ‚͑Α¤‚Ě“ńŽŸ¸‘ƒŽîᇂ̔­ś—Ś‚Ş—LˆÓ‚É’á‚Š‚Á‚˝6, 22jBˆę•űC400 mg/m2‚Ě1 ƒR[ƒX“Š—^•ű–@‚ł́C‚ť‚ĚÄ”­—Ś‚Í8“i93 —áj‚â0“i25 —áj‚Ć‚Ě•ń‚Ş‚ ‚é23, 24jB

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”ńƒ‰ƒ“ƒ_ƒ€‰ť‚ĚŒ¤‹†‚Ĺ‚ ‚é‚ŞC93 —á‚Ě1 ƒR[ƒXi400 mg/m2jŽ{sŒQ‚Ć32 —á‚Ě2 ƒR[ƒXŽ{sŒQ‚Ě”äŠr‚ł́CÄ”­—Ś‚Í1 ƒR[ƒXŽ{sŒQ‚Ĺ8.6“i8 —ájC2 ƒR[ƒXŽ{sŒQ‚Í0“‚Ĺ‚ ‚čC—LŠQŽ–Ű‚Í2 ƒR[ƒX‚Ĺ‚ŕŒy”÷‚Ĺ‚ ‚Á‚˝24jB‚ľ‚˝‚Ş‚Á‚āCƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“400 mg/m2‚Ěƒf[ƒ^‚ÉŒŔ‚ç‚ę‚é‚ŞC2 ƒR[ƒXŽ{s‚ލĔ­—Ś‚đ’ቺ‚ł‚š‚ç‚ę‚é‰Â”\Ť‚Ş‚ ‚éB‚Ü‚˝‘Oq‚ľ‚˝TE19/EORTC30982 ŽŽŒą‚Ĺ‚ŕCAUC7 ˆČă‚Ş“Š—^‚ł‚ę‚˝—á‚ĆAUC7 –˘–ž‚Ě—á‚Ĺ‚Í—LˆÓˇ‚Ş‚Č‚˘‚ŕ‚̂́CÄ”­—Ś‚Éˆá‚˘‚Ş‚ ‚é‚ą‚Ć‚ŞŽw“E‚ł‚ę‚Ä‚¨‚č6, 22jCƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“‚Ě“Š—^—Ę‚â“Š—^‰ń”‚ލĔ­—Ś‚ɉe‹ż‚ˇ‚é‰Â”\Ť‚Ş‚ ‚éB

ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“•â•—Ă–@‚ĚˆŔ‘SŤ‚ɂ‚˘‚ẮC’ZŠú“I‚É‚Í•Ą”‚ĚŒ¤‹†‚ĹŽŚ‚ł‚ę‚Ä‚˘‚é6, 22j, 25, 26jB”äŠr“I’ˇŠú‚É‚í‚˝‚é‚ŕ‚̂ł́C199 —á‚ĚƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“’PÜ“Š—^‚ĚŠĎŽ@ŠúŠÔ’†‰›’l9 ”N‚Ě•ń‚Ş‚ ‚čC‘SŽ€–S—ŚCzŠÂŠíŒnŽžŠł‚É‚ć‚鎀–S—ŚC¸‘ƒŽîᇈȊO‚Ě“ńŽŸŠŕ”­ś—Ś‚Č‚Ç‚Í‘‰Á‚ľ‚Ä‚˘‚Č‚˘27jB‚ľ‚Š‚ľC’ˇŠúŹŃ‚â”ÓŠú‡•šÇ‚ɂ‚˘‚Ä‚Ěƒf[ƒ^‚͕⏕•úŽËü—Ă–@‚Ć”äŠr‚ˇ‚é‚Ə\•Ş‚Ĺ‚Í‚Č‚˘BĄŒăÄ”­—ŚC—LŠQŽ–ŰC‚ ‚邢‚ÍĹ“KƒR[ƒX”‚Ȃǂɂ‚˘‚āC’ˇŠúŠÔ‚Ěƒf[ƒ^’~Ď‚Ş‘Ň‚˝‚ę‚éB

‚ą‚̂悤‚ɁCă‹L‚Ě①②③‚Ě‚Ç‚Ě‘I‘đŽˆ‚É‚ŕ—˜‰v‚Ć•s—˜‰v‚Ş‚ ‚é‚ŞCĹI“I‚ČŽžŠł“ÁˆŮ“Iś‘ś—ŚC‘Sś‘ś—Ś‚ɍˇ‚Ş‚Č‚˘‚ą‚Ć‚Š‚çCŒťÝ‚ł͉˘•ÄC“Á‚Ƀˆ[ƒƒbƒp‚ĚƒKƒCƒhƒ‰ƒCƒ“‚Ĺ‚ÍŒo‰ßŠĎŽ@‚đ‘ćˆę‘I‘đ‚Ć‚ľ‚Ä‚˘‚é4, 10, 28jBStage Ⅰ‚ĚƒZƒ~ƒm[ƒ}‚ĚŠłŽŇ‚Éˆę—Ľ‚ɕ⏕—Ă–@‚đs‚¤‚É‚ ‚˝‚čC80-85“‚ĚŠłŽŇ‚É•s—p‚ČŽĄ—Ă‚đs‚¤‚ą‚ƁC‚ł‚ç‚É‚˘‚¸‚ę‚Ě•â•—Ă–@‚đs‚Á‚Ä‚ŕ4-5“‚ĹÄ”­‚ˇ‚é‚ą‚ƁC’ˇŠúŒo‰ßŠĎŽ@‚Ş•K—v‚Č‚ą‚ƁC•úŽËü—Ă–@‚É‚ć‚é“ńŽŸŠŕ‚̉”\Ť‚Ş‚ ‚é‚ą‚ƁCƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ““Š—^‚Ě’ˇŠú“I‚ȍ‡•šÇi“ńŽŸŠŕ‚âSŒŒŠÇŽžŠłj‚Ě‘‰Á‚Ş•s–ž‚Č‚ą‚Ć‚đl‚Ś‚é‚ƁC‚Ü‚¸Œo‰ßŠĎŽ@‚đ‘I‘đŽˆ‚Ć‚ľ‚ÄŠŠ‚ß‚Ä—Ç‚˘‚ƍl‚Ś‚ç‚ę‚é4, 10, 28jB‚ľ‚Š‚ľCŠłŽŇ”wŒi‚âˆÓŒü‚đ\•Ş‰Á–Ą‚ˇ‚é‚ׂŤ‚Ĺ‚ ‚čC•â•ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“—Ă–@‚â•â••úŽËü—Ă–@‚ŕ‘I‘đŽˆ‚Ć‚Č‚éB

y•śŒŁz

1j van As NJ, Gilbert DC, Money-Kyrle J, et al. Evidence-based pragmatic guidelines for the follow-up of testicular cancerFoptimising the detection of relapse. Br J Cancer. 2008G98F1894-902.

2j von der Maase H, Specht L, Jacobsen GK, et al. Surveillance following orchidectomy for stage Ⅰ seminoma of the testis. Eur J Cancer. 1993G29AF1931-4.iⅣaj

3j Warde P, Specht L, Horwich A, et al. Prognostic factors for relapse in stage Ⅰ seminoma managed by surveillanceFa pooled analysis. J Clin Oncol. 2002G20F4448-52.iⅣaj

4j Oldenburg J, Fosså SD, Nuver J, et al. Testicular seminoma and non-seminomaFESMO Clinial Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013GSupple 6F125-32.

5j Kamba T, Kamoto T, Okubo K, et al. Outcome of different post-orchiectomy management for stage Ⅰ seminomaFJapanese multi-institutional study including 425 patients. Int J Urol. 2010G17F980-7.iⅣaj

6j Mead GM, Fosså SD, Oliver RT, et al. Randomized trials in 2466 patients with stage Ⅰ seminomaFpatterns of relapse and follow-up. J Natl Cancer Inst. 2011G103F241-9.iⅡj

7j Horwich A, Alsanjari N, AfHern R, et al. Surveillance following orchidectomy for stage Ⅰ testicular seminoma. Br J Cancer. 1992G65F775-8.iⅣaj

8j Cummins S, Yau T, Huddart R, et al. Surveillance in stage Ⅰ seminoma patientsFa long-term assessment. Eur Urol. 2010G57F673-8.iⅣaj

9j Aparicio J, Germa JR, Garcia del Muro X, et al. Risk-adapted management for patients with clinical stage Ⅰ seminomaFthe Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol. 2005G23F8717-8723.iⅣaj

10j National Comprehensive Cancer NetworkiNCCNj. org. NCCN Clinical practice guidelines in oncologyFtesticular cancer. Ver.@1. 2014.

11j Chung P, Warde P. Stage Ⅰ seminomaFadjuvant treatment is effective but is it necessary?. J Natl Cancer Inst. 2011G103F194-196.iⅥj

12j Warde P, Gospodarowicz MK, Panzarella T, et al. Long term outcome and cost in the management of stage Ⅰ testicular seminoma. Can J Urol. 2000G7F967-972Gdiscussion 973.iⅣaj

13j Jones WG, Fosså SD, Mead GM et al. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage Ⅰ Testicular SeminomaFa report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942iISRCTN18525328j. J Clin Oncol. 2005G23F1200-1208.iⅡj

14j Fosså SD, Horwich A, Russell JM, et al. Optimal planning target volume for stage Ⅰ testicular seminomaFA Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group. J Clin Oncol. 1999G17F1146.iⅡj

15j Garcia-Serra AM, Zlotecki RA, Morris CG, et al. Long-term results of radiotherapy for early-stage testicular seminoma. Am J Clin Oncol. 2005G28F119-24.iⅣaj

16j Travis LB, Curtis RE, Storm H, et al. Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst. 1997G89F1429-39.iⅣaj

17j Travis LB, Fosså SD, Schonfeld SJ, et al. Second cancers among 40,576 testicular cancer patientsFfocus on long-term survivors. J Natl Cancer. Inst 2005G97F1354-65.iⅣaj

18j van Leeuwen FE, Stiggelbout AM, van den Belt-Dusebout AW, et al. Second cancer risk following testicular cancerFa follow-up study of 1,909 patients. J Clin Oncol. 1993G11F 415-24.iⅣaj

19j Zagars GK, Ballo MT, Lee AK, et al. Mortality after cure of testicular seminoma. J Clin Oncol. 2004G22F640-647.iⅣaj

20j Gordon W, Jr., Siegmund K, Stanisic TH, et al. A study of reproductive function in patients with seminoma treated with radiotherapy and orchidectomyFiSWOG-8711j. Southwest Oncology Group. Int J Radiat Oncol Biol Phys. 1997G38F83-94.iⅣaj

21j “ú–{•úŽËüŽîᇊw‰ď•ŇD•úŽËüŽĄ—ĂŒv‰ćƒKƒCƒhƒ‰ƒCƒ“2016 ”N”ŁD‹ŕŒ´o”Łi“Œ‹žjG2016D

22j Oliver RT, Mead GM, Rustin GJ, et al. Randomized trial of carboplatin versus radiotherapy for stage Ⅰ seminomaFmature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 studyiISRCTN27163214j. J Clin Oncol. 2011G29F957-62.iⅡj

23j Oliver RT, Edmonds PM, Ong JY, et al. Pilot studies of 2 and 1 course carboplatin as adjuvant for stage Ⅰ seminomaFshould it be tested in a randomized trial against radiotherapy? Int J Radiat Oncol Biol Phys. 1994G29F3-8.iⅣaj

24j Dieckmann KP, Bruggeboes B, Pichlmeier U, et al. Adjuvant treatment of clinical stage Ⅰ seminomaFis a single course of carboplatin sufficient?. Urology. 2000G55F102-6.iⅢj

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26j Steiner H, Scheiber K, Berger AP, et al. Retrospective multicentre study of carboplatin monotherapy for clinical stage Ⅰ seminoma. BJU Int. 2011G107F1074-9.iⅣaj

27j Powles T, Robinson D, Shamash J, et al. The long-term risks of adjuvant carboplatin treatment for stage Ⅰ seminoma of the testis. Ann Oncol. 2008G19F443-447.iⅣaj

28j Albers P, Albrecht W, Algaba F, et al. EAU guidelines on testicular cancerF2011 update. Eur Urol. 2011G60F304-19.iⅢj


CQ 8

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A
–ŹŠÇZ‚Ě—L–ł‚ށCöÝ“I‚Č“]ˆÚ‚Ě‘śÝ‚âŒo‰ßŠĎŽ@’†‚É‚¨‚Ż‚éÄ”­‚đ—\‘Ş‚ˇ‚éCĹ‚ŕd—v‚Č—\ŒăˆöŽq‚Ĺ‚ ‚éBB
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Stage Ⅰ”ńƒZƒ~ƒm[ƒ}‚́C¸‘ƒ“EœŒă‚ĚŒo‰ßŠĎŽ@’†‚É30“‚ĹÄ”­‚Ş”F‚ß‚ç‚ęCÄ”­—á‚Ě80“‚Í12 ƒJŒŽˆČ“ŕ‚ɍĔ­‚ˇ‚é1-3jB‚Ü‚˝CStage Ⅰ”ńƒZƒ~ƒm[ƒ}‚ĚÇ—á‚ɑ΂ľ‚ÄŒă• –ŒƒŠƒ“ƒpßŠs´‚đs‚Á‚˝ę‡‚ɂ́C30“‚Ĺ•a—Šw“IƒŠƒ“ƒpß“]ˆÚ‚Ş”F‚ß‚ç‚ę‚é4-6jB

‰ć‘œf’f‚Ĺ‚Í”F‚ß‚ç‚ę‚Č‚˘öÝ“I‚Č“]ˆÚ‚Ě‘śÝ‚âCŒo‰ßŠĎŽ@’†‚É‚¨‚Ż‚éÄ”­‚đ—\‘Ş‚ˇ‚éĹ‚ŕd—v‚ČˆöŽq‚Í–ŹŠÇZ‚Ĺ‚ ‚čCStage Ⅰ”ńƒZƒ~ƒm[ƒ}‚Ě–ń1/3 ‚ĚÇ—á‚Ĺ–ŹŠÇZ‚đ—L‚ˇ‚é4, 7jB–ŹŠÇZ‚đ—L‚ˇ‚éÇ—á‚ɑ΂ľ‚Ä“Á‹@—Ă–@‚đs‚Á‚˝ę‡‚É50“‚É“]ˆÚ‚ޏoŒť‚ˇ‚é‚̂ɑ΂ľ‚āC–ŹŠÇZ‚Ş‚Č‚˘Ç—á‚ĚÄ”­—Ś‚Í15-20“‚Ĺ‚ ‚é2, 4jB

–ŹŠÇZ‚Ć‘g‚ݍ‡‚í‚š‚čĔ­—\‘Ş‚Ě¸“x‚đŒüă‚ł‚š‚éˆöŽq‚Ć‚ľ‚ẮC‘ŮŽ™ŤŠŕ‚Ş—D¨‚Ĺ‚ ‚é‚ą‚Ć1-11jC–ƉuőF‚É‚Ä‘BˆöŽq‚Ěmindbomb homolog 1iMIB-1j—zŤ—Ś‚Ş70“ˆČă‚Ĺ‚ ‚é‚ą‚Ć4-6j‚Ş•ń‚ł‚ę‚Ä‚˘‚éB

–ŹŠÇZ‚ĚÄ”­ƒŠƒXƒN‚ÉŠî‚Ă‚­ŽĄ—Ă‘I‘đ‚đs‚Á‚˝‘OŒü‚Ť”äŠrŽŽŒą‚ލs‚í‚ę‚Ä‚¨‚čC’჊ƒXƒNŒQ‚ɑ΂ˇ‚éŒo‰ßŠĎŽ@—Ă–@‚¨‚ć‚э‚ƒŠƒXƒNŒQ‚ɑ΂ˇ‚éƒAƒWƒ…ƒoƒ“ƒg‰ťŠw—Ă–@‚Ě—L—pŤ‚Ş•ń‚ł‚ę‚Ä‚˘‚é8-12jB

y•śŒŁz

1j Freedman LS, Parkinson MC, Jones WG, et al. Histopathology in the prediction of relapse of patients with stage Ⅰ testicular teratoma treated by orchidectomy alone. Lancet. 1987G2F294-8.iⅣaj

2j Read G, Stenning SP, Cullen MH, et al. Medical Research Council prospective study of surveillance for stage Ⅰ testicular teratoma. Medical Research Council Testicular Tumors Working Party. J Clin Oncol. 1992G10F1762-8.iⅣaj

3j Sogani PC, Perrotti M, Herr HW, et al. Clinical stage Ⅰ testis cancerFLong-term outcome of patients on surveillance. J Urol. 1998G159F855-8.iⅣaj

4j Albers P, Siener R, Kliesch S, et al, Risk factors for relapse in clinical stage Ⅰ nonseminomatous testicular germ cell tumorsFresults of the German Testicular Cancer Study Group Trial. J Clin Oncol. 2003G21F1505-12.iⅣaj

5j Albers P, Ulbright TM, Albers J, et al. Tumor proliferative activity is predictive of pathological stage in clinical stage A nonseminomatous testicular germ cell tumors. J Urol. 1996G155F579-86.iⅤj

6j Heidenreich A, Schenkmann NS, Sesterhenn IA, et al, Immunohistochemical expression of Ki-67 to predict lymph node involvement in clinical stage Ⅰ nonseminomatous germ cell tumors. J Urol. 1997G158F620-5.iⅤj

7j Sturgeon JF, Moore MJ, Kakiashvili DM, et al. Non-risk-adapted surveillance in clinical stage Ⅰ nonseminomatous germ cell tumorsFthe Princess Margaret Hospitalfs experience. Eur Urol. 2011G59F556-62.iⅤj

8j Pont J, Höltl W, Kosak D, et al. Risk-adapted treatment choice in stage Ⅰ nonseminomatous testicular germ cell cancer by regarding vascular invasion in the primary tumorFa prospective trial. J Clin Oncol. 8F16-20, 1990.iⅣaj

9j Klepp O, Dahl O, Flodgren P, et al. Risk-adapted treatment of clinical stage 1 non-seminoma testis cancer. Eur J Cancer. 1997G33F1038-44.iⅣaj

10j Ondrus D, Matoska J, Belan V, et al. Prognostic factors in clinical stage Ⅰ nonseminomatous germ cell testicular tumorsFrationale for different risk-adapted treatment. Eur Urol. 1998G33F562-6.iⅣbj

11j Maroto P, García del Muro X, Aparicio J, et al. Multicentre risk-adapted management for stage Ⅰ non-seminomatous germ cell tumours. Ann Oncol. 2005G16F1915-20.iⅣbj

12j Tandstad T, Dahl O, Cohn-Cedermark G, et al. Risk-adapted treatment in clinical stage Ⅰ nonseminomatous germ cell testicular cancerFthe SWENOTECA management program. J Clin Oncol. 2009G27F2122-8.iⅢj


CQ 9

œStage Ⅰ”ńƒZƒ~ƒm[ƒ}¸‘ƒŽîᇂɂ͂ǂ̂悤‚ČŽĄ—Ă‚Ş„§‚ł‚ę‚é‚ŠH


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‚ƒŠƒXƒNi–ŹŠÇNP‚ ‚čj‚Ěę‡CBEP —Ă–@2 ƒR[ƒX‚đs‚¤‚ą‚Ć‚Ş„§‚ł‚ę‚éB‰ťŠw—Ă–@‚đŠó–]‚ľ‚Č‚˘C‚Ü‚˝‚͍˘“ď‚Čę‡‚́CŒo‰ßŠĎŽ@‚â_Œo‰ˇ‘śŒă• –ŒƒŠƒ“ƒpßŠs´p‚ŕ‘I‘đŽˆ‚Ć‚Č‚éB

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ő Ĺ‹ß‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́C’჊ƒXƒNi–ŹŠÇNP‚Č‚ľj‚ʼnťŠw—Ă–@‚đ‘I‘đ‚ˇ‚éę‡‚ÍBEP —Ă–@1ƒR[ƒXC‚ƒŠƒXƒNi–ŹŠÇNP‚ ‚čj‚Ĺ‚ÍBEP —Ă–@1-2 ƒR[ƒXC‚ސ„§‚ł‚ę‚Ä‚˘‚éi2017 ”NEAU ƒKƒCƒhƒ‰ƒCƒ“C2017 ”NNCCN ƒKƒCƒhƒ‰ƒCƒ“‚đŽQĆj

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”ńƒZƒ~ƒm[ƒ}¸‘ƒŽîᇂĚ65“‚ÍStage Ⅰ‚Ĺ‚ ‚é‚ŞC‚ť‚Ě‚¤‚ż–ń30“‚ÍŒ°”÷‹ž“I“]ˆÚ‚Ş‚ ‚é‚Ć‚ł‚ęCŒo‰ßŠĎŽ@‚Ě‚Ý‚Ĺ‚ÍÄ”­‚đ‚Ť‚˝‚ˇB‚ˆĘ¸‘ƒ“EopŒă‚̒ljÁŽĄ—Ă‚Ć‚ľ‚ẮC‰ťŠw—Ă–@CŒă• –ŒƒŠƒ“ƒpßŠs´iRPLNDj‚Ş‚ ‚čC‚Ç‚Ě•ű–@‚Ĺ‚ ‚ę95“ˆČă‚̍‚‚˘ŽĄ—ÐŹŃ‚đŽŚ‚ˇ‚ą‚Ć‚ć‚čCŠłŽŇ‚ĚƒRƒ“ƒvƒ‰ƒCƒAƒ“ƒXCQOL ‚đdŽ‹‚ľ‚˝ŽĄ—Ă–@‚Ě‘I‘đ‚ŞŠŠ‚ß‚ç‚ę‚éB

Stage Ⅰ‚Ĺ‚ ‚ę‚΁C”÷Ź“]ˆÚ‚Í25-35“‚É‘śÝ‚ˇ‚éB‚‚܂čC‰˝‚Š’ljÁŽĄ—Ă‚đs‚¤‚ą‚Ć‚Í65-75“‚ĚŠłŽŇ‚ɑ΂ľ‚Ä‚Í‰ßčŽĄ—Ă‚đs‚Á‚˝‚ą‚Ć‚É‚Č‚éB‚Ü‚˝C“]ˆÚÄ”­‚Ş‹N‚ą‚Á‚˝‚Ć‚ľ‚Ä‚ŕC‚Ů‚Ú‘S—á‚Ş‰ťŠw—Ă–@‚ĹŽĄ–ü‚Ĺ‚Ť‚é1j‚˝‚߁C“Á‚ɍĔ­‚ĚƒŠƒXƒN‚Ş’á‚˘ŠłŽŇ‚ł͐ϋɓIŒo‰ßŠĎŽ@‚ŞŽxŽ‚ł‚ę‚éB

Ä”­‚ĚƒŠƒXƒN‚Ć‚ľ‚Ä‚Í–ŹŠÇNPC‘ŮŽ™ŤŠŕ—DˆĘCpT ƒXƒe[ƒWCŹnŠďŒ`ŽîŹ•Ş‚Č‚ľC—‘‰Š囊ŽîŹ•Ş‚Č‚ľC‚—îCp‘OAFP 80 ng/dL ˆČă1-6j‚Č‚Ç‚Ş•ń‚ł‚ę‚Ä‚˘‚éB‚ŕ‚Á‚Ć‚ŕ‹­‚˘ˆöŽq‚Í–ŹŠÇNP‚Ĺ‚ ‚čCNP‚Č‚ľ‚Í15-20“‚ĚÄ”­—ŚC‚ ‚č‚Í50-75“‚Ć‚ł‚ę1jC–ŹŠÇNP‚Ş‚Č‚Ż‚ę‚ÎŒo‰ßŠĎŽ@‚ŞŠŠ‚ß‚ç‚ę‚éB

Œo‰ßŠĎŽ@Žž‚Ě—ÝĎÄ”­—Ś‚Í–ń30“‚ŁC‚ť‚Ě‚¤‚ż1 ”N–Ú‚É80“C2 ”N–Ú‚É12“C3 ”N–Ú‚É6“‚ލĔ­‚ˇ‚é2, 7jBÄ”­‚Ě15-35“‚̓}[ƒJ[‚ސłí’l‚Ĺ‚ ‚é‚˝‚߁CCT ŒŸ¸‚Í•K{‚Ĺ‚ ‚é8jBƒRƒXƒg‚đ—}‚Ś‚é‚˝‚ß‚É‚ŕCCT ŽB‰e‚Í•K—vĹŹŒŔ‚É‚ˇ‚é‚ׂŤ‚Ĺ‚ ‚čC’჊ƒXƒNŒQ‚Ĺ‚ ‚ę‚Î1 ”N–Ú‚Í3 ƒJŒŽ–ځC12 ƒJŒŽ–Ú‚Ě2 ‰ń‚ĚCT ‚ŏ\•Ş‚Ĺ‚ ‚é‚ŞC’†-‚ƒŠƒXƒNŒQ‚Ĺ‚Í‚ŕ‚¤­‚ľ•p‰ń‚Ĺ‚ŕ—Ç‚˘‚Ĺ‚ ‚낤9jBFDG-PET ‰AŤ‚Ĺ‚ŕC1 ”NŠÔ‚Ĺ37“Ä”­‚ˇ‚é‚ą‚Ć‚ć‚čPET ‚͐„§‚ł‚ꂸ10jCĄ‚Ě‚Ć‚ą‚ëCTCŽîᇃ}[ƒJ[ˆČŠO‚ĚŒŸ¸‚Ĺ‚Í—L—p‚Č‚ŕ‚Ě‚Í‚Č‚˘B

Œo‰ßŠĎŽ@‚đŠó–]‚ľ‚Č‚˘ę‡‚âC’čŠú“IŽóf‚ލ˘“ď‚Čę‡‚ɂ́CŒă• –ŒƒŠƒ“ƒpßŠs´piRPLNDj‚âBEP —Ă–@‚ŕ‘I‘đŽˆ‚Ć‚Č‚éB‘OŒü‚ŤŒ¤‹†‚ɂāCRPLND ‚ĆŒo‰ßŠĎŽ@‚ĚŽĄ—ÐŹŃ‚ɍˇ‚Í‚Č‚Š‚Á‚˝11jBStage ⅠŽčpÇ—á‚Ě30“‚ɃŠƒ“ƒpß“]ˆÚ‚Ş”F‚ß‚ç‚ęC“]ˆÚ‚Ş‚Č‚Š‚Á‚˝Ç—á‚Ĺ‚ŕ–ń10“‚͉“Šu“]ˆÚ‚Ĺ‚ĚÄ”­‚đ”F‚ß‚é6jBƒŠƒ“ƒpß“]ˆÚ‚Ş‚ ‚Á‚˝ę‡CŠs´‚Ě‚Ý‚Ĺ‚Í30“‚ލĔ­‚ľC2 ƒR[ƒX‚ĚƒuƒŒƒIƒ}ƒCƒVƒ“CƒGƒgƒ|ƒVƒhCƒVƒXƒvƒ‰ƒ`ƒ“‚đ—p‚˘‚˝BEP —Ă–@‚đ’ljÁ‚ˇ‚é‚ą‚Ć‚É‚ć‚Á‚Ä2“‚Ć‚Č‚é12-14jBiCQ25 ŽQĆj

ŠJ• ‚Ć• o‹ž‚É‚ć‚éRPLND ‚Ě”äŠr‚ł́C• o‹ž‚Ě•ű‚މń•œ‚Ş‘‚­QOL ‚ŕ‚‚˘B‚Ü‚˝C§ŠŕŒř‰Ę‚ŕ“Ż“™‚Ć•ń‚ł‚ę‚Ä‚˘‚é‚ŞC• o‹ž‰ş‚Ĺ‚ĚŽčp‚ÍŒoŒą–L‚Š‚ČŽ{Ý‚ōs‚¤‚ą‚Ć‚ŞŠŠ‚ß‚ç‚ę‚é7, 15jB_Œo‰ˇ‘śŽčp‚́C“KŘ‚ɍs‚Ś‚΋ǏŠÄ”­‚ĚŠëŒŻ‚Í‚Ů‚Ć‚ń‚Ç‚Č‚˘i2“–˘–žj16jB1 ƒR[ƒX‚ĚBEP ‚ŕ‚ľ‚­‚ÍRPLND ‚ĚRCT ‚ł́C2 ”NŠÔ”ńÄ”­ś‘ś—Ś‚ÍBEP ŒQ‚Ĺ99.46“CŽčpŒQ‚Ĺ91.87“‚ƁC1 ƒR[ƒX‚ĚBEP —Ă–@‚Ě•ű‚ŞŽčp‚ć‚č—D‚Á‚Ä‚˘‚˝17jB

‚ƒŠƒXƒNŠłŽŇ‚Ĺ‚ÍpŒă‰ťŠw—Ă–@‚ސ„§‚ł‚ę‚é18-20jB‰ťŠw—Ă–@‚đŠó–]‚ľ‚Č‚˘C‚Ü‚˝‚͍˘“ď‚Čę‡‚́CŒo‰ßŠĎŽ@‚â_Œo‰ˇ‘śRPLND ‚ŕ‘I‘đŽˆ‚Ć‚Č‚éBThe Swedish-Norwegian Testicular Cancer ProjectiSWENOTECAj‚́C1 ƒR[ƒX‚ĚBEP —Ă–@‚ĹÄ”­—Ś3.2“‚Ć—ÇD‚ȐŹŃ‚đ•ń‚ľ‚Ä‚˘‚é‚Ş21jC1 ƒR[ƒX‚Ć2 ƒR[ƒX‚ĚBEP —Ă–@‚𒟐ڔäŠr‚ľ‚˝ŽŽŒą‚Í‚Č‚­CŒťŽž“_‚Ĺ‚Í2 ƒR[ƒX‚ĚBEP —Ă–@‚ŞŽxŽ‚ł‚ę‚Ä‚˘‚éB‚Ü‚˝C2 ƒR[ƒX‚ĚBEP ‚Ĺ‚Í”D›s”\‚␍Šˆ“Ž‚ւ̉e‹ż‚Í‚Ů‚Ć‚ń‚Ç‚Č‚˘‚Ć‚ł‚ę‚é22, 23j‚ށC’ˇŠú‚́C“Á‚ɐSŒŒŠÇŒn‚Ö‚Ě•›ě—p‚ɂ‚˘‚Ä‚Í—ŻˆÓ‚Ş•K—v‚Ĺ‚ ‚낤24jB

CT ¸“x‚ĚŒüăC‰ťŠw—Ă–@‚̐i•ŕCŽčpŽč‹Z‚̉ü‘P‚Č‚Ç‚Š‚ç”ńƒZƒ~ƒm[ƒ}¸‘ƒŽîá‡Stage Ⅰ‚Ĺ‚ÍÄ”­‚ľ‚˝‚Ć‚ľ‚Ä‚ŕŽĄ–ü‚̉”\Ť‚ލ‚‚˘‚˝‚߁C‚ˇ‚×‚Ä‚ĚÇ—á‚ĹŒo‰ßŠĎŽ@iNon-risk-adapted surveillancej‚đs‚¤‚ą‚Ć‚ŕ‚ ‚é25jB‚ľ‚Š‚ľCŒťŽž“_‚Ĺ‚ÍŠłŽŇ‚ĆŽĄ—ĂƒIƒvƒVƒ‡ƒ“CÄ”­ƒŠƒXƒN‚ɂ‚˘‚ď\•Ş‘Š’k‚ľ‚ÄŽĄ—Ă•űj‚đŒˆ’č‚ˇ‚é•K—v‚Ş‚ ‚é‚ž‚낤B

y•śŒŁz

1j Choueiri TK, Stephenson AJ, Gilligan T, et al. Management of clinical stage Ⅰ nonseminomatous germ cell testicular cancer. Urol Clin North Am. 2007G34F137-48.iⅠj

2j Divrik RT, Akdoğan B, Ozen H, et al. Outcomes of surveillance protocol of clinical stage Ⅰ nonseminomatous germ cell tumors-Is shift to risk adapted. J Urol. 2006G176F1424-30.iⅣbj

3j Nicolai N, Miceli R, Necchi A, et al. Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage Ⅰ nonseminomatous germ cell tumoursFlong-term outcome and analysis of risk factors of recurrence. Eur Urol. 2010G58F912-8.iⅣaj

4j Amato RJ, Ro JY, Ayala AG, et al. Risk-adapted treatment for patients with clinical stage Ⅰ nonseminomatous germ cell tumor of the testis. Urology. 2004G63F144-9.iⅢj

5j Vergouwe Y, Steyerberg EW, Eijkemans MJ, et al. Predictors of occult metastasis in clinical stage Ⅰ nonseminomaFA systematic review. J Clin Oncol. 2003G21F4092-9.iⅠj

6j Albers P, Siener R, Kliesch S, et al. Risk factors for relapse in clinical stage Ⅰ nonseminomatous testicular germ cell tumorsFresults of the German Testiculcar Cancer Study Group Trial. J Clin Oncol. 2003G21F1505-12.iⅣaj

7j Oliver RT, Ong J, Shamash J, et al. Long-term results of laparoscopic retroperitoneal lymph node dissectionFA single-center 10-year experience. Urology. 2004G63F556-61.iⅤj

8j Segal R. Surveillance programs for stage Ⅰ nonseminomatous germ cell tumors of the testis. Urol Oncol. 2006G24F68-74.iⅣaj

9j Rustin GJ, Mead GM, Stenning SP, et al. Randomized trial of two or five Computed Tomography Scans in the surveillance of patients with Stage Ⅰ nonseminomatous germ cell tumors of the testisFMedical Research Council Trial TE08, ISRCTN56475197-The National Cancer Research Institute Testis Cancer Clinical Studies Group. J Clin Oncol. 2007G25F1310-5.iⅡj

10j Huddart RA, OfDoherty MJ, Padhani A, et al. 18Fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with High-risk, clinical stage Ⅰ nonseminomatous germ cell tumorsFPreliminary report of MRC Trial TE22-The NCRI Testis Tumour Clinical Study Group. J Clin Oncol. 2007G25F3090-5.iⅣaj

11j Spermon JR, Roeleveld TA, van der Poel HG, et al. Comparison of surveillance and retroperitoneal lymph node dissection in Stage Ⅰ nonseminomatous germ cell tumors. Urology. 2002G59F923-9.iⅣaj

12j Klepp O, Olsson AM, Henrikson H, et al. Prognostic factors in clinical stage Ⅰ nonseminomatous germ cell tumours of the testisFmultivariate analysis of a prospective multicenter study. J Clin Oncol 1990G8F509-18.iⅢj

13j Foster RS, Roth BJ. Clinical stage Ⅰ nonseminomaFsurgery versus surveillance. Semin Oncol 1998G25F145-53.iⅢj

14j Foster RS, Donohue JP. Retroperitoneal lymph node dissection for the management of clinical stage Ⅰ nonseminoma. J Urol. 2000G163F1788-92.iⅢj

15j Rassweiler JJ, Scheitlin W, Heidenreich A, et al. Laparoscopic retroperitoneal lymph node dissectionFdoes it still have a role in the management of clinical stage Ⅰ nonseminomatous testis cancer? A European perspective. Eur Urol. 2008G54F1004-15.iⅠj

16j Heidenreich A, Albers P, Hartmann M, et al. Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage Ⅰ nonseminomatous germ cell tumors of the testisFexperience of the German Testicular Cancer Study Group. J Urol. 2003G169F1710-4.iⅣaj

17j Albers P, Siener R, Krege S, et al. German Testicular Cancer Study Group. Randomized phase Ⅲ trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage Ⅰ Nonseminomatous testicular germ cell tumorsFAUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol 2008G26F2966-72.iⅡj

18j Pont J, Albrecht W, Postner G, et al. Adjuvant chemotherapy for high-risk clinical stage Ⅰ nonseminomatous testicular germ cell cancerFlong-term results of a prospective trial. J Clin Oncol. 1996G14F441-8.iⅣaj

19j Studer UE, Burkhard FC, Sonntag RW. Risk adapted management with adjuvant chemotherapy in patients with high risk clinical stage i nonseminomatous germ cell tumor. J Urol. 2000G163F1785-7.iⅣaj

20j Bohlen D, Borner M, Sonntag RW, et al. Long-term results following adjuvant chemotherapy in patients with clinical stage Ⅰ testicular nonseminomatous malignant germ cell tumors with high risk factors. J Urol. 1999G161F1148-52.iⅣaj

21j Tandstad T, Dahl O, Cohn-Cedermark G, et al. Risk-adapted treatment in clinical stage Ⅰ nonseminomatous germ cell testicular cancerFthe SWENOTECA management program. J Clin Oncol 2009G27F2122-8.iⅢj

22j Chevreau C, Mazerolles C, Soulie M, et al. Long-term efficacy of two cycles of BEP regimen in High-risk stage Ⅰ nonseminomatous testicular germ cell tumors with embyonal carcinoma and/or vascular invasion. Eur Urol. 2004G46F209-15.iⅣaj

23j Böhlen D, Burkhard FC, Mills R, et al. Fertility and sexual function following orchidectomy and 2 cycles of chemotherapy for stage Ⅰ high risk nonseminomatous germ cell cancer. J Urol 2001G165F441-4.iⅣaj

24j Huddart RA, Norman A, Shahidi M, et al. Cardiovascular disease as a long-term complication of treatment for testicular cancer. J Clin Oncol 2003G21F1513-23.iⅢj

25j Kollmannsberger C, Moore C, Chi KN, et al. Non-risk-adapted surveillance for patients with stage Ⅰ nonseminomatous testicular germ-cell tumorsFdiminishing treatment-related morbidity while maintaining efficacy. Ann Oncol. 2010G21F1296-301.iⅢj


CQ 10

œ”ńƒZƒ~ƒm[ƒ}¸‘ƒŽîᇂŁC¸‘ƒ“EœŒă‚ÉŽîᇃ}[ƒJ[‚̍‚’l‚ŞŽ‘ą‚ˇ‚éę‡i—Տ°•aŠúIS ŠúCcISjC‚ǂ̂悤‚ČŽĄ—Ă‚ŞŠŠ‚ß‚ç‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

C1
BEP —Ă–@3 ƒR[ƒX‚Ü‚˝‚ÍEP —Ă–@4 ƒR[ƒX‚đs‚¤‚ą‚Ć‚Ş„§‚ł‚ę‚éB
y‰đ ŕz

—Տ°•aŠúIS ŠúicISj‚́C“ú–{”ĺ”AŠí‰ČŠw‰ď•aŠú•Ş—Ţ‚Ĺ‚ÍⅢ0 Šú‚Ć•Ş—Ţ‚ł‚ę‚éBStage Ⅰ”ńƒZƒ~ƒm[ƒ}¸‘ƒŽîᇁiNSGCTj‚É‚¨‚˘‚ẮC¸‘ƒ“EœŒă‚ÍŽîᇃ}[ƒJ[‚Ş”źŒ¸Šú‚ɉˆ‚Á‚ĉş~‚ˇ‚é‚ŞCłí’l‚Ć‚Č‚é‚Ü‚Ĺ’ˆÓ[‚­ŠĎŽ@‚ˇ‚é‚ą‚Ć‚Şd—v‚Ĺ‚ ‚éB¸‘ƒ“EœŒă‚ÉŽîᇃ}[ƒJ[‚Şă¸‚ľ‚Ä‚­‚écIS Ç—á‚́C‰ć‘œŠŒŠ‚މAŤ‚Ĺ‚ŕŽc‘ś•a•Ď‚Ş‚ ‚é‚ƍl‚Ś‚ç‚ę‚éBcIS Ç—á‚ɑ΂ľ‚Ä‚Í“–‰CŒă• –ŒƒŠƒ“ƒpßŠs´piRPLNDj‚ŞŽŽ‚Ý‚ç‚ę‚˝1-2jB‚ľ‚Š‚ľCpŒă‚É37-100“‚ƍ‚—Ś‚É‘SgŤÄ”­‚Ş”F‚ß‚˝‚ą‚Ć‚Š‚çCcIS ‚đ‘SgŤ•a•Ď‚Ć‚Ć‚ç‚ŚCBEP —Ă–@3 ƒR[ƒX‚Ü‚˝‚ÍEP —Ă–@4 ƒR[ƒX‚đs‚¤‚ą‚Ć‚Ş„§‚ł‚ę‚Ä‚˘‚é1-4jBĹ‹ß‚ł́CEP —Ă–@3 ƒR[ƒX‚Ĺ‚ŕ“Ż—l‚É—D‚ę‚˝ŹŃ‚Ć—LŠQŽ–Ű‚ĚŒyŒ¸‚Ş•ń‚ł‚ę‚Ä‚˘‚é3jB

cIS Ç—á‚̉ťŠw—Ă–@’P“Ć‚ĚŽĄ–ü—Ś‚Í71-75“‚Ć•ń‚ł‚ę‚˝1, 2, 4jB‰ťŠw—Ă–@Œă‚Ě‚Ů‚Ć‚ń‚Ç‚ĚÄ”­‚ÍŒă• –Œo‚ÉŒŠ‚ç‚ę‚éBIndiana ‘ĺŠw‚ĚƒOƒ‹[ƒv‚́CcIS ‚Ě24 —á’†8 —ái33“j‚ÉŠďŒ`Žî‚Ş‘śÝ‚ľ‚˝‚Ć•ń‚ľ‚Ä‚˘‚é4jBcIS ‚ɑ΂ˇ‚鎥—Є§‚ĚŞ‹’‚Ć‚Č‚Á‚˝•ń‚Ě‘˝‚­‚Í1990 ”N‘ă‚Ě˜_•ś‚Ĺ‚ ‚čCÇ—ᐔ‚ŕ­‚Č‚­CƒGƒrƒfƒ“ƒXƒŒƒxƒ‹‚ŕ‚‚­‚Č‚˘BĹ‹ßC‰ć‘œf’f‚̐i•ŕ‚Č‚Ç‚Š‚çCRPLND ‚ĚˆÓ‹`‚đŒŠ’ź‚ˇ•ń‚ŕo‚Ä‚˘‚éBHarvard Medical School ‚ĚƒOƒ‹[ƒv‚́CcIS ‚Ě24 —á‚ÉˆęŽŸŽĄ—Ă‚Ć‚ľ‚ÄRPLND ‚đŽ{s‚ľC‰ťŠw—Ă–@ćs—á‚Ć“Ż“™‚̐ŹŃ‚đ•ń‚ľ‚Ä‚˘‚é5jB‘˝‚­‚ĚÇ—á‚ʼnťŠw—Ă–@‚đČ—Ş‚Ĺ‚Ť‚é‚ž‚Ż‚Ĺ‚Č‚­CŒo‰ßŠĎŽ@Žž‚ĚCT ŒŸ¸‚Ě”í”˜‚đŒ¸‚ç‚ˇƒƒŠƒbƒg‚ŕŽw“E‚ľ‚Ä‚˘‚éBˆęŽŸŽĄ—Ă‚Ć‚ľ‚Ä‚ĚRPLND ‚Í‚Ü‚žŒ¤‹†’iŠK‚Ĺ‚ ‚čCŒoŒą–L‚Š‚ČŽ{Ý‚ĹÇ—á‚đ‘I‚ń‚ōs‚¤‚ą‚Ć‚Ş–]‚Ü‚ľ‚˘B

y•śŒŁz

1j Davis BE, Herr HW, Fair WR, et al.FThe management of patients with nonseminomatous germ cell tumors of the testis with serologic disease only after orchiectomy. J Urol. 1994G152F111-4.iⅣbj

2j Saxman SB, Nichols CR, Foster RS, et al. The management of patients with clinical stage Ⅰ non-seminomatous testicular tumors and persistently elevated serologic markers. J Urol. 1996G155F587-9.iⅣbj

3j Mezvrishvili Z, Managadze L. Three cycles of etoposide and cisplatin chemotherapy in clinical stage IS nonseminomatous testicular cancer. Int Urol Nephrol. 2006G38F621-4.iⅣbj

4j Dash A, Carver BS, Stasi J, et al.FThe indication for postchemotherapy lymph node dissection in clinical stage IS nonseminomatous germ cell tumor. Cancer. 2008G112F800-5.iⅣbj

5j Williams SB, Steele GS, Richie JP. Primary retroperitoneal lymph node dissection in patients with clinical stage IS testis cancer. J Urol. 2009G182F2716-20.iⅣbj


CQ 11

œStage ⅡAi“ú–{”ĺ”AŠí‰ČŠw‰ď•aŠú•Ş—ށFŒă• –Œ“]ˆÚ‘ƒ‚ŞĹ‘ĺŒa5 cm –˘–žjƒZƒ~ƒm[ƒ}‚ɑ΂ľ‚āC‚ǂ̂悤‚ČŽĄ—Ă‚Ş„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

A
‚ˆĘ¸‘ƒ“EœpŒă‚ɉťŠw—Ă–@‚Ü‚˝‚Í•úŽËü—Ă–@‚Ě‚˘‚¸‚ę‚Š‚đs‚¤B
y‰đ ŕz

“ú–{”ĺ”AŠí‰ČŠw‰ď‚̐¸‘ƒŽîᇕaŠú•Ş—Ţ‚É‚¨‚Ż‚éStage ⅡA ƒZƒ~ƒm[ƒ}iŒă• –Œ“]ˆÚ‘ƒ‚ŞĹ‘ĺŒa5 cm –˘–žj‚́CTNM •Ş—Ţ‚Ĺ‚ĚStage ⅡAiŒă• –Œ“]ˆÚ‘ƒ‚Ş2 cm –˘–žj‚¨‚ć‚ŃⅡB ƒZƒ~ƒm[ƒ}iŒă• –Œ“]ˆÚ‘ƒ‚ŞĹ‘ĺŒa2 cm ˆČă5 cm ˆČ‰şj‚ŞŠÜ‚Ü‚ę‚Ä‚˘‚éB‰˘•Ä‚̐¸‘ƒŽîᇃKƒCƒhƒ‰ƒCƒ“‚Ĺ‚ ‚éEAU Guideline2012 ‚âNCCN Guidelinei2012Cversion 1j‚É‚¨‚˘‚Ä‚ŕCStage ⅡA/B ƒZƒ~ƒm[ƒ}‚̂悤‚Č“]ˆÚ‘ƒ‚ĚŽîá‡—Ę‚ŞŹ‚ł‚˘‚ŕ‚̂ł́C‚ť‚ĚŽĄ—Ă‚Ě‘ćˆę‘I‘đ‚Í•úŽËü—Ă–@‚Ć‚Č‚Á‚Ä‚˘‚é1, 2jB‚ť‚ľ‚āCStage ⅡB ƒZƒ~ƒm[ƒ}‚Ěˆę•”‚ĚŠłŽŇ‚ł͉ťŠw—Ă–@‚Ş‘I‘đ‚ł‚ę‚Ä‚˘‚éB‚ť‚ĚŞ‹’‚Ć‚ľ‚ẮC•úŽËü—Ă–@‚ĚŽĄ—ÐŹŃ‚Ş—Ç‚˘‚ą‚Ć‚âC‚ŕ‚ľ•úŽËü—Ă–@‚ĹÄ”­‚ľ‚Ä‚ŕC‹~Ď‰ťŠw—Ă–@‚Ě—LŒřŤ‚ލ‚‚˘‚Š‚ç‚Ĺ‚ ‚éBˆę•űC‚í‚Ş‘‚ł́C•úŽËü—Ă–@‚͔ӊú‡•šÇ‚Ć‚ľ‚Ä‚Ě“ńŽŸ”­Šŕ‚Ş–â‘č‚Ć‚Č‚é‚ą‚Ć3, 4j‚âC‰˘•Ä‚ĆˆŮ‚Č‚č”ĺ”AŠí‰Čˆă‚މťŠw—Ă–@‚đ’S“–‚ľ‚Ä‚˘‚鎖î‚ŕ‚ ‚čC‰ťŠw—Ă–@‚Ş‘I‘đ‚ł‚ę‚é‚ą‚Ć‚Ş‘˝‚˘B

ˆę”ʂɁC‰ťŠw—Ă–@Ü‚Ć‚ľ‚Ă̓uƒŒƒIƒ}ƒCƒVƒ“CƒGƒgƒ|ƒVƒhCƒVƒXƒvƒ‰ƒ`ƒ“‚ĚBEP —Ă–@‚Ş3 ‚Č‚˘‚ľ4 ƒR[ƒX‘I‘đ‚ł‚ę‚é‚ą‚Ć‚Ş‘˝‚˘BGarcia-del-Muro ‚ç‚ÍStage ⅡA/B ƒZƒ~ƒm[ƒ}‚ɑ΂ľC•úŽËü‚Ě‘ă‘Ö—Ă–@‚Ć‚ľ‚Ä72 –ź‚ĚŠłŽŇ‚É4 ƒR[ƒX‚ĚEP —Ă–@‚Š3 ƒR[ƒX‚ĚBEP —Ă–@‚đs‚˘C’†‰›’l71.5 ƒJŒŽ‚ĚŠĎŽ@ŠúŠÔ‚ĹCR ‚Ş83“CPR ‚Ş17“‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚˝5jB‚Ü‚˝5 ”N–ł‘ˆŤś‘ś—Ś‚́CStage ⅡA ƒZƒ~ƒm[ƒ}‚ĆⅡB ƒZƒ~ƒm[ƒ}‚ŁC‚ť‚ę‚ź‚ę100“‚Ć87“‚Ĺ‚ ‚Á‚˝Bˆę•űCKrege ‚ç‚ÍStage ⅡA/B ƒZƒ~ƒm[ƒ}‚ɑ΂ľ‚āCƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“’P“ƁiAUC 7 mg.min/mLj‚Ĺ4 T–ˆ‚É3 ‚Č‚˘‚ľ4 ƒR[ƒXŽĄ—Ă‚ľ‚ÄŒř‰Ę‚đŒŸ“˘‚ľ‚˝6jB‚ť‚ĚŒ‹‰ĘCCR ‚Ş88/108i81“jCPR ‚Ş17/108i16“j‚Ĺ‚ ‚Á‚˝‚ށC’†‰›’l28 ƒJŒŽ‚ĚŒo‰ßŠĎŽ@‚Ĺ14/108i13“j‚ɍĔ­‚Ş‹N‚ą‚čCĹI“I‚É‚Í‘S‘Ě‚Ě18“‚Ş–łŒř‚Ĺ‚ ‚Á‚˝‚ą‚Ć‚Š‚çCStage ⅡA/B ƒZƒ~ƒm[ƒ}‚ɑ΂ˇ‚éƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“’P“Ć—Ă–@‚Í•s\•Ş‚Ć•ń‚ľ‚˝6jB

•úŽËü—Ă–@‚ɂ‚˘‚ẮC•úŽËü—Ă–@‚ĹÄ”­‚ľ‚Ä‚ŕƒvƒ‰ƒ`ƒiťÜ‚É‚ć‚é‹~Ď‰ťŠw—Ă–@‚Ş—LŒř‚Ĺ‚ ‚é‚ą‚Ć‚Š‚çCĆŽË–ě‚âĆŽËü—Ę‚đŒ¸‚ś‚éŒXŒü‚É‚ ‚é1, 7, 8jBClassen ‚ç‚̓hƒCƒc‘“ŕ‚Ě30 Ž{Ý‚ĹStage ⅡA ƒZƒ~ƒm[ƒ}66 —á‚ĆⅡB ƒZƒ~ƒm[ƒ}21 —á‚đ‘ÎŰ‚ÉC]—ˆ‚ć‚č‚ŕ­—Ę‚Ě•úŽËü—Ă–@‚É‚ć‚é‘OŒü‚ŤŒ¤‹†‚đŽŔŽ{‚ľC‚ť‚ĚŒř‰Ę‚đŒŸ“˘‚ľ‚˝1jB‚ˇ‚Č‚í‚żCĆŽË–ě‚đ‰ĄŠu–Œ‰ş‚Ě–T‘ĺ“Ž–ŹƒŠƒ“ƒpß‚Ć“Ż‘¤’°œƒŠƒ“ƒpß‚Ě‚˘‚í‚ä‚édogleg ó‚Ě—Ěˆć‚ɍi‚čCStage ⅡA ƒZƒ~ƒm[ƒ}‚Ĺ‚Í30 Gy ‚đCⅡBƒZƒ~ƒm[ƒ}‚É‚Í36 Gy ‚đĆŽË‚ľ‚˝B‚ť‚ĚŒ‹‰ĘC6 ”N”ńÄ”­ś‘ś—Ś‚Í‚ť‚ę‚ź‚ę95.3“‚Ć88.9“‚Ĺ‚ ‚Á‚˝B‚Ü‚˝Ä”­‚Í‚ť‚ę‚ź‚ę‚ĚStage ‚Ĺ2 —Ⴘ‚‚݂ç‚ęC‘Sˆő‚ރvƒ‰ƒ`ƒiťÜ‚ĹŽĄ—Ă‚ł‚ę‚˝BĹ‹ß‚͍˝œăâ|‚Ö‚Ě—\–hĆŽË‚̓ƒŠƒbƒg‚ޏ­‚Č‚­CŽ{s‚ł‚ę‚Č‚˘•űŒü‚Ć‚Č‚Á‚Ä‚˘‚éB

‚ą‚̂悤‚ČŒ‹‰Ę‚Š‚çCƒhƒCƒc‚̐¸‘ƒăó×–EŽîᇃRƒ“ƒZƒ“ƒTƒXƒKƒCƒhƒ‰ƒCƒ“‚ł́CĆŽË–ě‚Ć‚ľ‚āCStage ⅡA ƒZƒ~ƒm[ƒ}‚É‚ÍŒă• –Œ“]ˆÚ‘ƒ‚¨‚ć‚Ń–T‘ĺ“Ž–ŹƒŠƒ“ƒpßC“Ż‘¤’°œƒŠƒ“ƒpß‚ÉĆŽË‚ľCĆŽË—ʂ́CƒŠƒ“ƒpß“]ˆÚ‚ĚŒa‚Ş2 cm ˆČ‰şiⅡAj‚Č‚ç‚Î30 GyC2-5 cmiⅡBj‚Č‚ç‚Î36 Gy ‚Ć‚ľ‚Ä‚˘‚é7, 9jB‚ą‚ę‚ç‚Ě•ń‚Š‚ç•úŽËü—Ă–@‚ĚÄ”­—Ś‚͈ę”Ę‚ÉStage ⅡA ‚Ĺ–ń5 ‚Č‚˘‚ľ6“‚ŁCoverall survival ‚Í‚Ů‚Ú100“‚Ĺ‚ ‚é‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚éB‚ľ‚˝‚Ş‚Á‚āCƒAƒƒŠƒJ‚ĚNCCN ‚Ĺ‚ŕ‚ą‚ĚClassen ‚Ě•ű–@‚đŽxŽ‚ľ‚Ä‚˘‚éBˆę•űCƒJƒiƒ_‚ĚChung ‚ç‚ŕ25-35 Gy ‚ĚĆŽË—Ę‚đ“]ˆÚ‘ƒ‚¨‚ć‚Ń–T‘ĺ“Ž–ŹƒŠƒ“ƒpßC“Ż‘¤’°œƒŠƒ“ƒpß‚ÉĆŽË‚ľC5 ”N”ńÄ”­ś‘ś—Ś‚Í91“C5 ”NŠŕ“ÁˆŮś‘ś—Ś‚Í97“‚Ĺ‚ ‚čCś˝œăâ|‚âcŠu‚Ö‚Ě—\–hĆŽË‚Í•K—v‚Č‚˘‚Ć•ń‚ľ‚˝10jBChung ‚ç‚Í‚Ü‚˝•úŽËü—Ă–@Œă‚ĚÄ”­•”ˆĘ‚Ć‚ľ‚ẮCś˝œăâ|C”xCcŠuCœC–T‘ĺ“Ž–ŹƒŠƒ“ƒpßCŠĚ‚Ş‘˝‚˘‚Ć•ń‚ľ‚Ä‚˘‚é11jB

•úŽËü—Ă–@‚ƉťŠw—Ă–@‚đ”äŠr‚ľ‚˝ŒŸ“˘‚ł́CWarde ‚ç‚ÍStage ⅡA ‚¨‚ć‚ŃⅡB ƒZƒ~ƒm[ƒ}‚Ĺ•úŽËü—Ă–@80 –źiⅡA 64 –źCⅡB 16 –źj‚ƉťŠw—Ă–@19 –źiⅡA 5–źCⅡB 14 –źj‚ĚŽĄ—ĂŒř‰Ę‚Ě”äŠr‚đs‚˘C•úŽËü—Ă–@‚Ĺ‚Í16/80i20“j‚ލĔ­‚ľ‚˝‚ށC‰ťŠw—Ă–@‚Ĺ‚Í1 –ź‚ŕÄ”­‚ľ‚Č‚Š‚Á‚˝‚ą‚Ć‚đ•ń‚ľC‰ťŠw—Ă–@‚Ě—DˆĘŤ‚đŽŚ‚ľ‚˝12jB

ˆę•ű‚ŁC•úŽËü—Ă–@‚ƉťŠw—Ă–@‚đ•š—p‚ľ‚˝•ń‚ŕ‚ ‚éBPatterson ‚ç‚̓Jƒ‹ƒ{ƒvƒ‰ƒ`ƒ“•š—p•úŽËü—Ă–@‚Ć•úŽËü’P“Ć‚Ĺ‚ť‚ĚŒř‰Ę‚đ”äŠr‚ľC•š—pŒQ‚Ě5 ”N”ńÄ”­ś‘ś—Ś‚Ş96.9“‚Ĺ‚ ‚Á‚˝‚̂ɑ΂ľC•úŽËü’P“ĆŒQ‚Í80.7“‚Ĺ‚ ‚čC•š—pŒQ‚Ě•ű‚ލĔ­‚đ’x‚ç‚š‚é‚Ć•ń‚ľ‚˝13jBˆę•űCDetti ‚ç‚Í1965 ”N‚Š‚ç2005 ”N‚Ü‚Ĺ‚Ě40 ”NŠÔC106 –ź‚Ěstage ⅡƒZƒ~ƒm[ƒ}‚ĚŽĄ—ÐŹŃ‚đ‚܂Ƃ߁CStage ⅡA ‚ĆⅡB ‚Ě5 ”N”ńÄ”­ś‘ś—Ś‚Í94“‚¨‚ć‚Ń72.5“‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚˝14jB‚ť‚Ě’†‚Ĺ13 –ź‚Ş•š—p—Ă–@‚đ‚ľ‚˝‚Ć•ń‚ľ‚Ä‚˘‚éB

ˆČă‚Š‚çCStage ⅡA ƒZƒ~ƒm[ƒ}i“ú–{”ĺ”AŠí‰ČŠw‰ď•aŠú•Ş—ށj‚ĚŽĄ—Âɂ́C‚ˆĘ¸‘ƒ“EœpŒă‚̉ťŠw—Ă–@‚Ü‚˝‚Í•úŽËü—Ă–@‚ސ„§‚ł‚ę‚éB

y•śŒŁz

1j Classen J, Schmidberger H, Meisner C, et al. Radiotherapy for stage ⅡA/B testicular seminomaFFinal report of a prospective multicenter clinical trial. J Clin Oncol. 2003G21F1101-6.iⅢj

2j Schmidberger H, Bamberg M, Meisner C, et al. Radiotherapy in stage ⅡA and ⅡB testicular seminoma with reduced portalsFA prospective multicenter study. Int J Radiat Oncol Biol Phys. 1997G39F321-6.iⅢj

3j Bokemeyer C, Schmoll HJ. Secondary neoplasms following treatment of malignant germ cell tumors. J Clin Oncol. 1993G11F1703-9.iⅣbj

4j Travis LB, Curtis RE, Storm H, et al. Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst. 1997G89F1429-39.iⅣaj

5j Garcia-del-Muro X, Maroto P, Guma J, et al. Chemotherapy as ab alternative to radiotherapy in the treatment of stage ⅡA and ⅡB testicular seminomaFA Spanish Germ Cell Cancer Group Study. J Clin Oncol. 2008G26F5416-21.iⅢj

6j Krege S, Boergermann C, Baschek R, et al. Single agent carboplatin for CS Ⅱ A/B testicular seminoma, A phase Ⅱ study of the German Testicular Cancer Study GroupiGTCSGj. Ann Oncol. 2006G17F276-80. Epub 2005 Oct 27.iⅢj

7j Classen J, Souchon R, Hehr T, et al. Radiotherapy for early stages testicular seminomaFpattern of case study in Germany. Radiother Oncol. 2002G63F179-86.iⅣbj

8j Wilder RB, Buyyounouski MK, Efstathiou JA, et al. Radiotherapy treatment planning for testicular seminoma. Int J Radiat Oncol Biol Phys. 2012G83Fe445-2.iⅠj

9j Krege S, Souchon R, Schmoll HJ. Interdisciplinary consensus on diagnosis and treatment of testicular germ cell tumorsFresults of an update conference on evidence-based medicineiEBMj. Eur Urol. 2001G40F373-91.iⅠj

10j Chung PW, Warde PR, Panzarella TP, et al. Appropriate radiation volume for Stage ⅡA/B testicular seminoma. Int J Radiat Oncol Biol Phys. 2003G56F746-8.iⅣbj

11j Chung PW, Gospodarowicz MK, Panzarella T, et al. Stage Ⅱ testicular seminomaFPatterns of recurrence and outcome of treatment. Eur Urol. 2004G754-9.iⅣaj

12j Warde P, Gospodarowicz MK, Panzarella T, et al. Management of stage Ⅱ testicular seminoma. J Clin Oncol. 1998G16F290-4.iⅣbj

13j Patterson H, Norman AR, Mitra SS, et al. Combination carboplatin and radiotherapy in the management of stage Ⅱ testicular seminomaFcomparison with radiotherapy treatment alone. Radiother Oncol. 2001G59F5-11.iⅢj

14j Detti B, Livi L, Scoccianti S, et al. Management of stage Ⅱ testicular seminoma over a period of 40 years. Urol Oncol. 2009G27F534-8.iⅣbj


CQ 12

œStage ⅡAi“ú–{”ĺ”AŠí‰ČŠw‰ď•aŠú•Ş—ށFŒă• –Œ“]ˆÚ‘ƒ‚ŞĹ‘ĺŒa5 cm –˘–žj”ńƒZƒ~ƒm[ƒ}‚ɑ΂ľ‚āC‚ǂ̂悤‚ČŽĄ—Ă‚Ş„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

A
Stage ⅡA ”ńƒZƒ~ƒm[ƒ}‚Ě‚¤‚żCŒă• –ŒƒŠƒ“ƒpß“]ˆÚ‘ƒ‚Ş2-5 cm ‚ĚÇ—á‚ɑ΂ľ‚ÄBEP —Ă–@‚ސ„§‚ł‚ę‚éB

„§ƒOƒŒ[ƒh

B
ćsRPLNDiŒă• –ŒƒŠƒ“ƒpßŠf´pj‚́CŽîᇃ}[ƒJ[‚ސłí”ÍˆÍ‚Ĺ‚Č‚¨‚Š‚Â2 cm ˆČ‰ş‚ĚŒă• –ŒƒŠƒ“ƒpß“]ˆÚ‚đ—L‚ˇ‚éÇ—á‚ɑ΂ľ‚Ä—L—p‚É‚Č‚é‰Â”\Ť‚Ş‚ ‚éB

„§ƒOƒŒ[ƒh

C1
ćs‚¨‚ć‚щťŠw—Ă–@Œă‚ĚRPLND ‚́C• o‹ž‰şŽčp‚ŕ—L—p‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚éB
y‰đ ŕz

]—ˆ‚Š‚çCStage ⅡA ”ńƒZƒ~ƒm[ƒ}‚ɑ΂ľ‚ẮC‰ťŠw—Ă–@‚đćs‚ˇ‚éˆÓŒŠ‚ĆRPLND ‚đćs‚ˇ‚éˆÓŒŠ‚Ş‚ ‚čC—źŽŇ‚Ě”äŠr‚ɂ‚˘‚Ä‚Í1995 ”N‚É•ń‚ł‚ę‚˝Indiana ‘ĺŠw‚Ĺ‚ĚŒŸ“˘‚É‚ć‚é‚ƁCĹI“I‚ɉťŠw—Ă–@‚ĆRPLND ‚Ě—źŽĄ—Ă‚Ş•K—v‚É‚Č‚éÇ—á‚â‘S‘Ě‚ĚŽĄ–ü—Ś‚Í“Ż“™‚Ć‚ł‚ę‚é1jB‚˝‚ž‚ľCRPLND ‚đćs‚ł‚š‚˝ę‡C23“‚É•a—Šw“I‚ɃŠƒ“ƒpß“]ˆÚ‚Ş”F‚ß‚ç‚ę‚Ä‚˘‚Č‚˘B‚Ü‚˝C2000 ”N‚É•ń‚ł‚ę‚˝Stage ⅡA/BiAJCC •Ş—ށjNSGCT ‚đ‘ÎŰ‚Ć‚ľ‚˝‘OŒü‚Ť”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Ĺ‚ŕC—źŽĄ—Ă–@Œă‚Ě•˝‹Ď3 ”NŠÔ‚ĚƒtƒHƒ[ƒAƒbƒvŠúŠÔ‚ĹÄ”­—Ś‚É—LˆÓˇ‚Í”F‚ß‚Č‚Š‚Á‚˝‚Ć‚ľ‚Ä‚˘‚éiÄ”­—ŚGćsRPLNDF7“Cćs‰ťŠw—Ă–@F11“j2jB

EGCCCGiEuropean Germ Cell Cancer Consensus Groupj‚Ě•ń‚ł́C”ńƒZƒ~ƒm[ƒ}Ç—á‚Ě‚¤‚żC2-5 cm ‚ĚŒă• –ŒƒŠƒ“ƒpß•a•Ď‚đ—L‚ˇ‚éÇ—á‚ɑ΂ľ‚Ä‚ÍIGCCC ƒŠƒXƒN•Ş—Ţ‚É€‚ś‚ÄBEP —Ă–@‚ސ„§‚ł‚ę‚Ä‚˘‚é3jBˆę•űC2 cm –˘–ž‚ĚŒă• –ŒƒŠƒ“ƒpß•a•Ď‚đ—L‚ľC‚ˆĘ¸‘ƒ“EœŒă‚ĚŽîᇃ}[ƒJ[‚ސłí’l‚Ĺ‚ ‚éÇ—á‚ɑ΂ľ‚ẮCRPLND ‚Ü‚˝‚ÍŒo‰ßŠĎŽ@i6 T–ˆ‚ĚŒľdŒo‰ßŠĎŽ@j‚ސ„§‚ł‚ę‚Ä‚˘‚éB2 cm –˘–ž‚Ĺ‚ ‚Á‚Ä‚ŕC‚ˆĘ¸‘ƒ“EœpŒă‚ŕŽîᇃ}[ƒJ[‚Şă¸‚ľ‚Ä‚˘‚éÇ—á‚ɑ΂ľ‚Ä‚ÍBEP —Ă–@‚đs‚˘C‚ť‚ĚŒă‚ĚŽc‘ś•a•Ď‚ɑ΂ľ‚Ä‚ŕCRPLND ‚đs‚¤•űj‚ސ„§‚ł‚ę‚Ä‚˘‚é3jB

RPLND ‚đćs‚ľ‚˝ę‡C12“‚Ş•a—Šw“IiPSjⅠ‚Ɛf’f‚ł‚ęCŽc‚č‚Ě88“‚ŞPSⅡAi•a—Šw“IStage ⅡACAJCC •Ş—ށj‚Ɛf’f‚ł‚ę‚éBPSⅡA ‚Ɛf’f‚ł‚ę‚˝Ç—á‚ɂ́CŒo‰ßŠĎŽ@‚Ü‚˝‚͕⏕‰ťŠw—Ă–@‚Ě‘I‘đŽˆ‚Ş‚ ‚éBRPLND ‚ĚŒ‹‰ĘCPSⅡiAJCC •Ş—ށj‚Ɛf’f‚ł‚ę‚˝Ç—á‚ɑ΂ˇ‚éŒo‰ßŠĎŽ@‚Ĺ‚Í–ń30-50“‚ɍĔ­‚đ”F‚ß‚Ä‚¨‚č4jC’ljÁ‰ťŠw—Ă–@‚Ş•K—v‚Ć‚ł‚ę‚éBMSKCC ‚Š‚ç‚Ě•ń‚ł́CRPLND ‚ĚŒ‹‰ĘPSⅡiAJCC •Ş—ށj‚Ĺ‚ ‚Á‚˝Ç—á‚ɑ΂ˇ‚é•â•—Ă–@‚Ć‚ľ‚ÄEP —Ă–@2 ƒR[ƒX‚Ě—L—pŤ‚đŒŸ“˘‚ľC’†‰›’l8 ”N‚ĚŠĎŽ@‚ĹÄ”­—Ś‚Í1“‚Ĺ‚ ‚Á‚˝5jBˆę”Ę“I‚ɁC•â•‰ťŠw—Ă–@‚đŽ{s‚ľ‚˝Ç—á‚ĚÄ”­—Ś‚Í0-7“‚Ć‚ł‚ę‚éB‚ľ‚Š‚ľCt‹@”\áŠQ‚Ć‚˘‚Á‚˝ŽĄ—ĂŠÖ˜A—LŠQŽ–Ű6j‚â’x”­ŤŒăˆâÇ‚đl—ś‚ˇ‚é‚ƁCćsRPLND Œă‚ɕ⏕‰ťŠw—Ă–@‚đs‚Á‚˝Ç—á‚Ě50-70“‚Şover-treatment ‚ľ‚Ä‚˘‚é‰Â”\Ť‚Ş‚ ‚éB

Ĺ‹ß‚Ě•ń‚ł́CćsRPLND ‚Ě“K‰ž‚ɂ‚˘‚ẮC‚ˆĘ¸‘ƒ“EœŒă‚ĚŽîᇃ}[ƒJ[‚ސłí’l‚ŁC2 cm –˘–ž‚ĚŒă• –ŒƒŠƒ“ƒpß•a•Ď‚đ—L‚ˇ‚é”ńƒZƒ~ƒm[ƒ}Ç—á‚Ě‚Ý‚đ‘I‘đ‚ˇ‚é‚ą‚Ć‚ŞC”ńÄ”­—Ś‚̉ü‘P‚É‚Â‚Č‚Ş‚č7, 8jC2-5 cm ‚ĚŒă• –ŒƒŠƒ“ƒpß•a•Ď‚đ—L‚ˇ‚éÇ—á‚ɑ΂ľ‚Ä‚ÍIGCCC ‚ɏ€‚śCBEP —Ă–@‚ސ„§‚ł‚ę‚Ä‚˘‚éB

‚Ü‚˝CŠs´”͈͂Ɋւľ‚Ä‚ÍŠg‘ĺ‹y‚яkŹ‚Ě•ń‚Ş‚ ‚é‚ŞCˆę’č‚ĚŒŠ‰đ‚Í“ž‚ç‚ę‚Ä‚˘‚Č‚˘9-11jBRPLND ‚Ě•ű–@‚ÉŠÖ‚ľ‚ẮC• o‹ž‰şŽčp‚Ş’áNP‚Ő؏œ”͈͂¨‚ć‚ŃŒ‹‰Ę‚ÉŠÖ‚ľ‚Ä‚ŕ–ž‘Ť‚Ş‚˘‚­‚ŕ‚Ě‚Ĺ‚ ‚čC‰Â”\‚ČŽ{Ý‚É‚¨‚˘‚Ă͐„§‚ł‚ę‚é12, 13jB

y•śŒŁz

1j Donohue JP, Thornhill JA, Foster RS, et al. Clinical stage B non-seminomatous germ cell testis cancerFthe Indiana University experiencei1965-1989jusing routine primary retroperitoneal lymph node dissection. Eur J Cancer. 1995G31AF1599-604.iⅡj

2j Weissbach L, Bussar-Maatz R, Flechtner H, et al. RPLND or primary chemotherapy in clinical stage ⅡA/B nonseminomatous germ cell tumors? Results of a prospective multicenter trial including quality of life assessment. Eur Urol. 2000G37F582-94.iⅢj

3j Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancerFa report of the second meeting of the European Germ Cell Cancer Consensus groupiEGCCCGjFpart ‡T. Eur Urol. 2008G53F478-96.iⅠj

4j Williams SD, Stablein DM, Einhorn LH, et al. Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage Ⅱ testicular cancer. N Engl J Med. 1987G317F1433-8.iⅡj

5j Kondagunta GV, Sheinfeld J, Mazumdar M, et al. Relapse-free and overall survival in patients with pathologic stage Ⅱ nonseminomatous germ cell cancer treated with etoposide and cisplatin adjuvant chemotherapy. J Clin Oncol. 2004G22F464-7.iⅢj

6j Fosså SD, Aass N, Winderen M, et al. Long-term renal function after treatment for malignant germ-cell tumours. Ann Oncol. 2002G13F222-8.iⅣbj

7j Stephenson AJ, Bosl GJ, Bajorin DF, et al. Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion. J Urol. 2005G174F557-60.iⅣbj

8j Stephenson AJ, Bosl GJ, Motzer RJ, et al. Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage ⅡA and ⅡB nonseminomatous germ cell testicular cancer. J Clin Oncol. 2007G25F5597-602.iⅢj

9j Carver BS, Shayegan B, Eggener S, et al. Incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy retroperitoneal lymph node dissection. J Clin Oncol. 2007G25F4365-9.iⅢj

10j Eggener SE, Carver BS, Sharp DS, et al. Incidence of disease outside modified retroperitoneal lymph node dissection templates in clinical stage Ⅰ or ⅡA nonseminomatous germ cell testicular cancer. J Urol. 2007G177F937-42.iⅢj

11j Steiner H, Peschel R, Bartsch G. Retroperitoneal lymph node dissection after chemotherapy for germ cell tumoursFis a full bilateral template always necessary?. BJU Int. 2008G102F310-4.iⅣbj

12j Steiner H, Zangerl F, Stöhr B, et al. Results of bilateral nerve sparing laparoscopic retroperitoneal lymph node dissection for testicular cancer. J Urol. 2008G180F1348-52.iⅣbj

13j Rassweiler JJ, Scheitlin W, Heidenreich A, et al. Laparoscopic retroperitoneal lymph node dissectionFdoes it still have a role in the management of clinical stage Ⅰ nonseminomatous testis cancer? A European perspective. Eur Urol. 2008G54F1004-15.iⅠj


CQ 13

œ‰‰ń‰ťŠw—Ă–@‚Ć‚ľ‚ÄBEP —Ă–@‚͐„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

A
‰ťŠw—Ă–@ŠJŽn‘O‚ÉInternational Germ Cell Consensus ClassificationiIGCCCj‚ɏ€‚ś‚Ä—\Œă•Ş—Ţ‚đs‚¤‚ą‚Ć‚Ş„§‚ł‚ę‚éB

„§ƒOƒŒ[ƒh

A
—\Œă—ǍDŒQ‚É‚ÍBEPiƒuƒŒƒIƒ}ƒVƒCƒ“CƒGƒgƒ|ƒVƒhCƒVƒXƒvƒ‰ƒ`ƒ“j—Ă–@3ƒR[ƒX‚ށC—\Œă’†ŠÔŒQ‚¨‚ć‚Ń—\Œă•s—ÇŒQ‚É‚ÍBEP —Ă–@4 ƒR[ƒX‚Ş•W€“I‚Č“ą“ü‰ťŠw—Ă–@‚Ć‚ľ‚Đ„§‚ł‚ę‚éB
y‰đ ŕz

BEP —Ă–@i•\j‚́CŒťŽž“_‚ł̐isŤ¸‘ƒŽîᇏ‰‰ń‰ťŠw—Ă–@‚É‚¨‚Ż‚é•W€ŽĄ—Ă‚Ćl‚Ś‚ç‚ę‚é1jB¸‘ƒŽîᇂł͎Ą—Ă‘O—\ŒăˆöŽq‚đ—p‚˘‚˝—\Œă•Ş—Ţ‚Ş’ńĽ‚ł‚ęC‚ť‚ę‚ɉž‚ś‚˝ŽĄ—Ă‚ĚŒÂ•Ę‰ť‚ސ„i‚ł‚ę‚Ä‚Ť‚˝BIGCCC ‚Í“]ˆÚ‚đ—L‚ˇ‚éăó×–EŽî‚ĚŽĄ—Ă‘O—\ŒăˆöŽq‚É‚ŕ‚Ć‚Ă‚˘‚˝•Ş—Ţ–@2j‚ō‘Ű“I‚ÉĹ‚ŕL‚­—p‚˘‚ç‚ę‚Ä‚˘‚éBIGCCC ‚Ĺ—\Œă—ǍDŒQ‚É•Ş—Ţ‚ł‚ę‚˝Ç—á‚ɑ΂ˇ‚鏉‰ń‰ťŠw—Ă–@‚Ć‚ľ‚ẮCBEP —Ă–@‚đ3 ƒR[ƒXs‚¤‚ą‚Ć‚Ş„§‚ł‚ę‚é3, 4jB—\Œă—ǍDŒQ‚ɑ΂ˇ‚鉝Šw—Ă–@‚ĚŽ{s‰ń”‚ɂ‚˘‚ẮCEORTC ‚É‚ć‚čBEP —Ă–@3 ƒR[ƒX‚ƁCBEP —Ă–@3 ƒR[ƒX{EP —Ă–@1 ƒR[ƒX‚É‚ć‚郉ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ލs‚í‚ę‚˝BŒ‹‰Ę‚Ć‚ľ‚Ä—źŽŇ‚ĚŽĄ—ÐŹŃ‚Ş“Ż“™‚Ĺ‚ ‚é‚ą‚Ć‚ŞŽŚ‚ł‚ęC—\Œă—ǍDŒQ‚ɑ΂ľ‚Ä‚ÍBEP —Ă–@3 ƒR[ƒX‚ޏ\•Ş‚ČŽĄ—Ă‚Ĺ‚ ‚é‚ą‚Ć‚ŞŠm”F‚ł‚ę‚˝3jBˆę•űC—\Œă—ǍDŒQ‚ł́C‰ťŠw—Ă–@‚ĚŒyŒ¸‰ťC“Á‚É”x“ŐŤ‚Ö‚Ě”z—ś‚Š‚çƒuƒŒƒIƒ}ƒCƒVƒ“‚ĚČ—Ş‚ŞŽŽ‚Ý‚ç‚ę‚˝‚ށCBEP —Ă–@3 ƒR[ƒX‚ĆEP —Ă–@3 ƒR[ƒX‚đ”äŠr‚ľ‚˝ę‡‚ɂ́CŒăŽŇ‚ĚŽĄ—ÐŹŃ‚Ş—LˆÓ‚É•s—Ç‚Ĺ‚ ‚é‚ą‚Ć‚ŞŽŚ‚ł‚ę‚˝4jB‚ą‚ę‚ɑ΂ľ‚ÄBEP —Ă–@3 ƒR[ƒX‚ĆEP —Ă–@4 ƒR[ƒX‚Ě”äŠr‚ł́C—źŽŇ‚ĚŽĄ—ÐŹŃ‚É—LˆÓˇ‚Í‚Č‚Š‚Á‚˝5jB‚ľ‚˝‚Ş‚Á‚āC”äŠr“I‚—îŽŇ6, 7ji40-50 ÎˆČăj‚ât‹@”\•s—Ç—á6j‚Č‚Ç‚ĚƒuƒŒƒIƒ}ƒCƒVƒ“”xáŠQ‚ĚƒŠƒXƒN‚̍‚‚˘Ç—á‚ɂ́CEP —Ă–@4 ƒR[ƒX‚ŞBEP —Ă–@3 ƒR[ƒX‚Ě‘ă‘Ö‚Ć‚ľ‚Ä“K‰ž‚ľ‚¤‚é5jB

ˆę•űC—\Œă’†ŠÔŒQC•s—ÇŒQ‚ɑ΂ˇ‚鏉‰ń‰ťŠw—Ă–@‚Ć‚ľ‚ẮCBEP —Ă–@4 ƒR[ƒX‚Ş•W€ŽĄ—Ă‚Ć‚ľ‚Đ„§‚ł‚ę‚é1jB—\Œă•s—ÇŒQ‚ɑ΂ľ‚Ä‚ÍBEP —Ă–@4 ƒR[ƒX‚ĆBEP —Ă–@2 ƒR[ƒX{‘ĺ—ʉťŠw—Ă–@2 ƒR[ƒX‚đ—p‚˘‚˝“ą“ü—Ă–@‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ލs‚í‚ę‚˝‚Ş‘ĺ—ʉťŠw—Ă–@‚Ě—L—pŤ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝8jB“Ż—l‚ÉBEP —Ă–@4 ƒR[ƒX‚ĆVIPiƒGƒgƒ|ƒVƒhCƒCƒzƒXƒtƒ@ƒ~ƒhCƒVƒXƒvƒ‰ƒ`ƒ“j—Ă–@4 ƒR[ƒX‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Ĺ‚ŕC—źŽŇ‚ĚŽĄ—ÐŹŃ‚É—LˆÓˇ‚Í‚Č‚­CVIP —Ă–@‚ōœ‘—}§‚Ş‘‹­‚ˇ‚éŒXŒü‚Ş”F‚ß‚ç‚ę‚˝9jB‚ą‚Ě—Ő°ŽŽŒą‚ł́C‚ť‚ĚŒă‚̒ǐՒ˛¸10j‚Ĺ‚ŕ’ˇŠúŹŃ‚É—LˆÓˇ‚Ş‚Č‚˘‚ą‚Ć‚Š‚çCƒuƒŒƒIƒ}ƒCƒVƒ“”xáŠQ‚ĚƒŠƒXƒN‚̍‚‚˘—\Œă’†ŠÔ‹y‚Ń—\Œă•s—ǏǗá‚ɑ΂ľ‚ẮCBEP —Ă–@‚Ě‘ă‘Ö–@‚Ć‚ľ‚ÄVIP —Ă–@4 ƒR[ƒX‚Ş“K‰ž‚ľ“ž‚é‚ƍl‚Ś‚ç‚ę‚éBˆę”Ę‚É”äŠr“I‚—îŽŇi40-50 ÎˆČăjCt‹@”\•s—Ç—áCƒwƒr[ƒXƒ‚[ƒJ[‚Ȃǂł́Cd“Ä‚ČƒuƒŒƒIƒ}ƒCƒVƒ“”xáŠQ‚Ě”­ÇƒŠƒXƒN‚ލ‚‚­‚Č‚é‚Ć‚ł‚ę‚Ä‚˘‚éB

•\@BEP —Ă–@
ƒVƒXƒvƒ‰ƒ`ƒ“ 20 mg/m2 “_“HĂ’i‘ć1-5 “új
ƒGƒgƒ|ƒVƒh 100 mg/m2 “_“HĂ’i‘ć1-5 “új
ƒuƒŒƒIƒ}ƒCƒVƒ“ 30 mg/body “_“HĂ’i‘ć2C9C16 “ú*j
ˆČă‚đ3 T–ˆ

*ƒuƒŒƒIƒ}ƒCƒVƒ“‚Ě“Š—^“ú‚đ‘ć1C8C15 “ú‚Ć‚ˇ‚éę‡‚ŕ‚ ‚éB

y•śŒŁz

1j Williams SD, Birch R, Einhorn LH, et al. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987G316F1435-40.iⅡj

2j IGCCCGFInternational Germ cell consensus classificationFa prognostic factor-based staging system for metastatic germ cell cancer. J. Clin. Oncol., 1997G15F594-603.iⅣaj

3j de Wit R, Roberts JT, Wilkinson PM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5- day schedule in good-prognosis germ cell cancerFA randomized study of the European organization for research and treatment of cancer genitourinary tract cancer cooperative group and the medical research council. J Clin Oncol. 2001G19F1629-40.iⅡj

4j Loehrer PJ, Johnson D, Elson P, et al. Importance of bleomycin in favorable-prognosis disseminated germ cell tumorsFAn eastern cooperative oncology group trial. J Clin Oncol. 1995G13F470-6.iⅡj

5j Culine S, Kerbrat P, Kramar A, et al. Refining the optimal chemotherapy regimen for good-risk metastatic nonseminomatous germ-cell tumorsFa randomized trial of the Genito-Urinary Group of the French Federation of Cancer CentersiGETUG T93BPj. Ann Oncol. 2007G18F917-24.iⅡj

6j Einhorn LH, Foster RS. Bleomycin, etoposide, and cisplatin for three cycles compared with etoposide and cisplatin for four cycles in good-risk germ cell tumorsFis there a preferred regimen?. J Clin Oncol. 2006G24F2597-8.iⅥj

7j Simpson AB, Paul J, Graham J, et al. Fatal bleomycin pulmonary toxicity in the west of Scotland 1991-95Fa review of patients with germ cell tumours. Br J Cancer. 1998G78F1061-66.iⅣbj

8j Motzer RJ, Nichols CJ, Margolin KA, et al. Phase Ⅲ randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol. 2007G25F247-56.iⅡj

9j Nichols CR, Catalano PJ, Crawford ED, et al. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumorsFan Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. 1998G16F1287-93.iⅡj

10j Hinton S, Catalano PJ, Einhorn LH, et al. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumorsFfinal analysis of an intergroup trial. Cancer. 2003G97F1869-75.iⅡj


CQ 14

œ¸‘ƒŽîᇓą“ü‰ťŠw—Ă–@‚ō‚“x‚Č•›ě—p‚đ”F‚ß‚˝ę‡CŽŸƒR[ƒX‚Ĺ‚Ě“Š—^—Ę‚đˆŰŽ‚ˇ‚ׂŤ‚ŠH


„§ƒOƒŒ[ƒh

A
BEP —Ă–@‚Í3 TƒTƒCƒNƒ‹‚ʼn”\‚ČŒŔ‚čŠů’č‚Ě“Š—^—Ę‚đˆŰŽ‚ľ‚čs‚¤•K—v‚Ş‚ ‚éB‚ľ‚Š‚ľCƒuƒŒƒIƒ}ƒCƒVƒ“‚É‚ć‚é”xáŠQ‚đ”F‚ß‚˝ę‡‚́CˆČŒă‚ĚƒuƒŒƒIƒ}ƒVƒCƒ“‚ĚŽg—p‚𒆎~‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚éB‚Ü‚˝C‘OŽĄ—Ă‚Ĺœ‘—}§‚É‚ć‚éd“Ä‚Č‡•šÇ‚đ”F‚ß‚˝ę‡‚́CŽŸƒR[ƒX‚Ĺ‚ĚŒ¸—Ę‚Şl—ś‚ł‚ę‚é‚ŞC‚ą‚ę‚ç‚̍‡•šÇ‚đ‰ń”đ‚ˇ‚é‚˝‚߂ɁCD’†‹…Œ¸­‚⌌Ź”ÂŒ¸­‚ɑ΂ˇ‚éŽxŽ—Ă–@‚đ“KŘ‚ɍs‚¤‚ą‚Ć‚Şd—v‚Ĺ‚ ‚éB
y‰đ ŕz

•W€“ą“ü‰ťŠw—Ă–@‚Ĺ‚ ‚éBEPiƒuƒŒƒIƒ}ƒVƒCƒ“CƒGƒgƒ|ƒVƒhCƒVƒXƒvƒ‰ƒ`ƒ“j—Ă–@‚É‚¨‚˘‚ẮCƒuƒŒƒIƒ}ƒCƒVƒ“‚É‚ć‚éŠÔŽżŤ”x‰Š‚â”xüˆŰÇ‚Ş—Ő°“I‚É‹^‚í‚ę‚˝ę‡‚ÍˆČŒă‚ĚƒuƒŒƒIƒ}ƒVƒCƒ“‚Ě“Š—^‚𒆎~‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚é1-3jBŽŸƒR[ƒXˆČŒă‚Ě“ą“ü—Ă–@‚ɂ‚˘‚ẮCIGCCC —\Œă—ǍDŒQ‚Ĺ‚ÍEPiƒGƒgƒ|ƒVƒhCƒVƒXƒvƒ‰ƒ`ƒ“j—Ă–@4j‚ށCIGCCC —\Œă’†ŠÔC•s—ÇŒQ‚Ĺ‚ÍVIPiƒGƒgƒ|ƒVƒhCƒCƒzƒXƒtƒ@ƒ~ƒhCƒVƒXƒvƒ‰ƒ`ƒ“j—Ă–@5j‚Ş‘ă‘ÖŽĄ—Ă‚Ć‚ľ‚Ä‘I‘đ‰Â”\‚Ĺ‚ ‚éB

œ‘—}§‚ÉŠÖ‚ľ‚ẮC‘OŽĄ—Ă‚É‚¨‚Ż‚é”’ŒŒ‹…iD’†‹…j”‚⌌Ź””‚ĚNadir ’l‚đ–ÚˆŔ‚Ć‚ľ‚ÄŽŸƒR[ƒX‚Ě“Š—^—Ę‚đŒ¸—Ę‚ˇ‚é•K—v‚Í‚Č‚˘1jB‚˝‚ž‚ľCˆę•”‚Ě—Ő°ŽŽŒą‚Ĺ‚Íœ‘—}§‚ÉŠÖ˜A‚ˇ‚鍇•šÇiŒŒŹ”ÂŒ¸­‚É‚ć‚éoŒŒ‚Ȃǁj‚đ”F‚ß‚˝ę‡‚ɁCŽŸƒR[ƒX‚ĹƒGƒgƒ|ƒVƒh‚đ20-25“Œ¸—Ę‚ˇ‚é‚Ć‹K’č‚ł‚ę‚Ä‚˘‚é1-3jBŠCŠO‚Ĺ‚ÍBEP —Ă–@‚É‚¨‚Ż‚éG-CSF ‚Ě—\–h“Š—^‚đ„§‚ˇ‚éˆÓŒŠ6j‚Ɣےč“I‚ČˆÓŒŠ7j‚Ş‚ ‚éB‚˝‚ž‚ľCŒăŽŇ‚É‚¨‚˘‚Ä‚ŕćs‚ˇ‚鉝Šw—Ă–@‚ŏdÇ‚ČŠ´őÇ‚đ‡•š‚ľ‚˝ę‡‚ɂ́CŽŸƒR[ƒXˆČ~‚ĚG-CSF —\–h“Š—^‚ސ„§‚ł‚ę‚Ä‚˘‚éBˆę•űC–{–M‚ł͐¸‘ƒŽîᇉťŠw—Ă–@‚É‚¨‚Ż‚éG-CSF ‚Ě—\–h“Š—^‚Ş•ŰŒŻ‚ŏł”F‚ł‚ę‚Ä‚˘‚éB‚˘‚¸‚ę‚É‚ľ‚Ä‚ŕCD’†‹…Œ¸­‚ɑ΂ˇ‚銴ő‘΍ô‚⌌Ź”ÂŒ¸­‚ĚŠÇ—‚Č‚Ç‚ĚŽxŽ—Ă–@‚đ“KŘ‚ɍs‚¤‚ą‚Ć‚ŞC‹­“x‚đˆŰŽ‚ľ‚˝BEP —Ă–@‚đ‹s‚ˇ‚邤‚Ś‚ŏd—v‚Ĺ‚ ‚éB

t‹@”\áŠQ‚ÉŠÖ‚ľ‚Ă̓VƒXƒvƒ‰ƒ`ƒ“‚Ě“Š—^Šî€‚Ć‚ľ‚āCŒŒ´ƒNƒŒƒAƒ`ƒjƒ“’l3 mg/dL ˆČă‚âƒNƒŒƒAƒ`ƒjƒ“ƒNƒŒƒAƒ‰ƒ“ƒX40 mL/min –˘–ž‚Ěę‡‚É’†’f‚ľ‚ĉń•œŒă‚ɍĊJ‚ˇ‚é‚Ć‹K’č‚ľ‚˝—Տ°ŽŽŒą2, 3j‚Ş‚ ‚é‚ŞC“ˆę‚ł‚ę‚˝ƒGƒrƒfƒ“ƒX‚Í‚Č‚˘BƒuƒŒƒIƒ}ƒCƒVƒ“‚ÉŠÖ‚ľ‚Ä‚ŕCŒŒ´ƒNƒŒƒAƒ`ƒjƒ“’l2 mg/dL ˆČă‚âƒNƒŒƒAƒ`ƒjƒ“ƒNƒŒƒAƒ‰ƒ“ƒX40 mL/min –˘–ž‚Č‚Ç‚Ěę‡‚É’†Ž~‚ˇ‚é‚Č‚Ç‚ĚˆÓŒŠ2, 8j‚Ş‚ ‚čC“ˆę‚ł‚ę‚Ä‚˘‚Č‚˘Bt‹@”\’ቺŽž‚̍RŠŕÜ“Š—^—Ę‚ĚŒ¸—Ę‚ÉŠÖ‚ľ‚Ä‚ÍBEP —Ă–@‚Ĺ‚ĚƒGƒrƒfƒ“ƒX‚Ĺ‚Í‚Č‚˘‚ށCƒNƒŒƒAƒ`ƒjƒ“ƒNƒŒƒAƒ‰ƒ“ƒX’l‚ɉž‚ś‚˝ŠeŽíRŠŕÜ‚ĚŒ¸—Ę‚ÉŠÖ‚ˇ‚éƒKƒCƒhƒ‰ƒCƒ“‚Ş•Ą”C’ńĽ9, 10j‚ł‚ę‚Ä‚˘‚éB

ĹŒă‚ɁCBEP —Ă–@‚Í3 TƒTƒCƒNƒ‹‚ōs‚¤‚ą‚Ć‚Şd—v‚Ĺ‚ ‚éB‰ź‚É4 TƒTƒCƒNƒ‹‚ōs‚Á‚˝ę‡C‚ť‚Ě—LŒřŤiŽĄ–ü—Śj‚đ•ŰŘ‚ˇ‚éƒf[ƒ^‚Í‘śÝ‚ľ‚Č‚˘B‚Ü‚˝Cdose intensity ‚މş‚Ş‚é‚Ć—\Œă‚ĚˆŤ‰ť‚đľ‚­‚Ć‚˘‚¤Cƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ĚŒ‹‰Ę‚ރI[ƒXƒgƒ‰ƒŠƒA‚ĚƒOƒ‹[ƒv‚Š‚ç•ń‚ł‚ę‚Ä‚˘‚é11jB‰˘B‚ĚƒKƒCƒhƒ‰ƒCƒ“7j‚ł́CŽŸƒR[ƒXŠJŽnŽžŠú‚̉„’ˇ‚ÉŠÖ‚ľ‚āCŠJŽn—\’č“ú‚É”­”M‚đ”F‚ß‚éę‡CD’†‹…”500/mm3CŒŒŹ””10 –œ/mm3–˘–ž‚Ěę‡‚ɍl—ś‚ˇ‚é‚ŞC‰„’ˇ‚Í3 “úˆČ“ŕ‚É‚Ć‚Ç‚ß‚é‚ׂŤ‚Ć‚ł‚ę‚Ä‚˘‚éBˆČă‚̂悤‚ɁCBEP —Ă–@‚Ĺ‚Í“Š—^—Ę‹y‚Ń“Š—^ŠÔŠu‚đ‰Â‹y“I‚ÉˆŰŽ‚ľ‚Č‚Ş‚çCŽĄ—Ă‚đs‚¤‚ą‚Ć‚Şd—v‚Ĺ‚ ‚éB‚ł‚ç‚É–ňÜ‚ĚˆŔˆŐ‚ČŒ¸—Ę‚âC“Š—^ŠÔŠu‚̉„’ˇ‚ÍŽĄ–ü—Ś‚ť‚Ě‚ŕ‚Ě‚đ‘š‚Č‚¤‰Â”\Ť‚Ş‚ ‚é‚ą‚Ć‚đ”FŽŻ‚ˇ‚é•K—v‚Ş‚ ‚éB‚ť‚Ě‚˝‚߂ɂ́C•›ě—p‚Ě”­Œťƒpƒ^[ƒ“‚â•›ě—p‚Ě’ö“x‚Ě•]‰żC‚Č‚ç‚Ń‚É•›ě—p‘΍ô‚ɏKn‚ľ‚Ä‚˘‚é•K—v‚Ş‚ ‚čC\•Ş‚ČŽĄ—ĂŒoŒą‚đ—L‚ˇ‚éŽ{Ý‚Ĺ‚ĚŽĄ—Ă‚Ş–]‚Ü‚ľ‚˘B

y•śŒŁz

1j Williams SD, Birch R, Einhorn LH, et al. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987G316F1435-40.iⅡj

2j de Wit R, Roberts JT, Wilkinson PM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5- day schedule in good-prognosis germ cell cancerFA randomized study of the European organization for research and treatment of cancer genitourinary tract cancer cooperative group and the medical research council. J Clin Oncol. 2001G19F1629-40.iⅡj

3j Nichols CR, Catalano PJ, Crawford ED et al. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumorsFan Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. 1998G16F1287-93.iⅡj

4j Culine S, Kerbrat P, Kramar A, et al. Refining the optimal chemotherapy regimen for good-risk metastatic nonseminomatous germ-cell tumorsFa randomized trial of the Genito-Urinary Group of the French Federation of Cancer CentersiGETUG T93BPj. Ann Oncol. 2007G18F917-24.iⅡj

5j Hinton S, Catalano PJ, Einhorn LH, et al. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumorsFfinal analysis of an intergroup trial. Cancer. 2003G97F1869-75.iⅡj

6j Schmoll HJ, Osanto S, Kawai K, et al. Advanced seminoma and nonseminomaFSIU/ICUD Consensus Meeting on Germ Cell TumorsiGCTj, Shanghai 2009. Urology. 2011G78i4 SuppljFS456-68.iⅠj

7j Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancerFa report of the second meeting of the European Germ Cell Cancer Consensus GroupiEGCCCGjFpart Ⅱ. Eur Urol. 2008G53F497-513.iⅠj

8j Einhorn LH, Foster RS. Bleomycin, etoposide, and cisplatin for three cycles compared with etoposide and cisplatin for four cycles in good-risk germ cell tumorsFis there a preferred regimen?. J Clin Oncol. 2006G24F2597-8.iⅥj

9j Kintzel PE, Dorr RT. Anticancer drug renal toxicity and eliminationFdosing guidelines for altered renal function. Cancer Treat Rev. 1995G21F33-64.iⅠj

10j Lichtman SM, Wildiers H, Launay-Vacher V, et al. International Society of Geriatric OncologyiSIOGjrecommendations for the adjustment of dosing in elderly cancer patients with renal insufficiency. Eur J Cancer. 2007G43F14-34.iⅠj

11j Toner GC, Stockler MR, Boyer MJ, et al. Comparison of two standard chemotherapy regimens for good-prognosis germ-cell tumoursFa randomised trial. Australian and New Zealand Germ Cell Trial Group. Lancet. 2001G10G357i9258jF739-45.iⅡj


CQ 15

œisŤ¸‘ƒŽîᇂɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŽc‘śŽîᇂ́C‚ˇ‚ׂĊO‰Č“I‚ɐ؏œ‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

A
isŤ¸‘ƒ”ńƒZƒ~ƒm[ƒ}‚ĚŒă• –ŒƒŠƒ“ƒpß“]ˆÚ‚ɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŽc‘śŽîᇐ؏œ‚́CŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚Ä‚˘‚é‚ą‚Ć‚đ‘O’ń‚Ć‚ľ‚Đ„§‚ł‚ę‚éB

„§ƒOƒŒ[ƒh

B
Œă• –ŒƒŠƒ“ƒpßˆČŠO‚ÉŽc‘śŽîᇂޑśÝ‚ˇ‚éę‡C‚ť‚ę‚ç‚Ě•a—‘gD‘œ‚ĆŒă• –ŒƒŠƒ“ƒpß‚Ě•a—‘gD‘œ‚Ć‚Í‚ľ‚΂ľ‚Έę’v‚ľ‚Č‚˘‚ą‚Ć‚Ş‚ ‚é‚̂ŁC‚ť‚ę‚ç‚Ě‘gD‚ŕŘœ‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚éBˆę•űCƒZƒ~ƒm[ƒ}‚Ěę‡‚ɂ́CŠďŒ`Žîiteratomaj‚ŞŽc‘śŽîᇂɊ܂܂ę‚éŠm—Ś‚͋ɂ߂ĒႢ‚˝‚߁C90“ˆČă‚̏kŹ‚đ”F‚ß‚˝Ç—á‚âŽc‘śŽîᇂŞ3 cm ˆČ‰ş‚ĚÇ—á‚Ĺ‚ÍŒo‰ßŠĎŽ@‚ŕ‰Â”\‚Ĺ‚ ‚éB
y‰đ ŕz

isŤ¸‘ƒŽîᇂɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŒă• –ŒƒŠƒ“ƒpßŽc‘śŽîᇂɑ΂ˇ‚éŽčp‚đl—ś‚ˇ‚éę‡Cˆę”Ę‚ÉŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚Ä‚˘‚鎖‚Ş‘O’ń‚Ć‚Č‚éiCQ21 ŽQĆjB–{Žčp‚̏d—vŤ‚́CŒ´”­‘ƒ‚ރZƒ~ƒm[ƒ}‚Ć”ńƒZƒ~ƒm[ƒ}‚Ĺ‚â‚âˆŮ‚Č‚éBˆę”ʂɁCƒZƒ~ƒm[ƒ}‚Ĺ‚ÍŽc‘śŽîᇂɊďŒ`Žî‚ŞŠÜ‚Ü‚ę‚Ä‚˘‚é‚ą‚Ć‚Í‚Ů‚Ć‚ń‚Ç‚Č‚­C‚Ü‚˝‘ĺŒŒŠÇ‚Ć‚Ě–ü’…‚Ş‹É‚ß‚Ä‹­ŒĹ‚Ĺ‚ ‚čCŘœ‚É‚¨‚Ż‚鍇•šÇ‚Ş‘‰Á‚ˇ‚é‚ƍl‚Ś‚ç‚ę‚é1jBisŤƒZƒ~ƒm[ƒ}‚ɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŒă• –ŒƒŠƒ“ƒpßŠs´piRPLNDjŽž‚Ě•a—‘gDŠw“IŒŸő‚É‚¨‚˘‚āCŽc‘śŠŕ‚đ”F‚ß‚éŠm—Ś‚́CŽc‘śŽîᇂŞ3 cm ˆČă‚Ěę‡‚É‚Í12-30“C3 cm ‚ć‚čkŹ‚ľ‚˝ę‡‚É‚Í10“–˘–ž‚Ĺ‚ ‚é‚Ć‚Ě•ń‚Ş‚ ‚é2, 3jB‚ľ‚˝‚Ş‚Á‚āCƒZƒ~ƒm[ƒ}‚Ĺ‚Í3 cm ˆČ‰ş‚ĚŽc‘śŽîᇂł͌o‰ßŠĎŽ@‚ŕ‰Â”\‚Ĺ‚ ‚é‚ƍl‚Ś‚ç‚ę‚éB‚Ü‚˝CƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚ẮCFDG-PET ‚މťŠw—Ă–@Œă‚ĚŽc‘śŠŕ‚̐f’f‚É—L—p‚Ĺ‚ ‚é‚Ć‚ˇ‚é•ń‚ŕ‚ ‚č4jC‚ą‚ę‚ç‚ĚŒŸ¸Œ‹‰Ę‚ŕl—ś‚É“ü‚ę‚Ä”ť’f‚ˇ‚é‚ׂŤ‚Ĺ‚ ‚éiCQ16 ŽQĆjB‚ą‚ę‚ɑ΂ľ‚āC”ńƒZƒ~ƒm[ƒ}‚ĚŒă• –ŒƒŠƒ“ƒpß“]ˆÚ‚ɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŽc‘śŽîᇂđŘœ‚ľ‚˝ę‡C‚ť‚Ě•a—‘gD‚͈ę”Ę“I‚ɁC‰óŽ€EüˆŰ‰ť‘gDCŠďŒ`ŽîiteratomajCŽc‘śŠŕ‚Ş‚ť‚ę‚ź‚ę40-50“C35-40“C10-15“‚É”F‚ß‚ç‚ę‚é‚Ş5-10jCŒťŽž“_‚Ĺ‚Í‚ą‚ę‚ç‚Ě‘gD‘œ‚đŽčp‘O‚É—\‘Ş‚ˇ‚éƒpƒ‰ƒ[ƒ^‚âƒmƒ‚ƒOƒ‰ƒ€‚Í‚Č‚˘11jB

Fox ‚ç‚Ě•ń‚ł́C‰ťŠw—Ă–@ŒăipostchemotherapyPCj‚ÉRPLND ‚đŽó‚Ż‚˝580 l’†CĹ‰‚̉ťŠw—Ă–@Œă‚ÉRPLND ‚đŽó‚Ż‚˝ŠłŽŇŒQ‚Í‹~Ď‰ťŠw—Ă–@Œă‚ÉRPLND ‚đŽó‚Ż‚˝Ç—á‚ć‚č—\Œă—ǍD‚Ĺ‚ ‚čCŠŕ×–E—zŤ‚Ĺ‚ ‚Á‚˝133 l‚ɂ‚˘‚ẲđÍ‚ŁCŠŽ‘S“Eœ‚ł‚ę‚˝Ç—á‚Ě•ű‚Ş•sŠŽ‘S“EœÇ—á‚ć‚č—\Œă—ǍD‚Ĺ‚ ‚é‚ą‚Ć‚đq‚ׂâ‚é12jB

PC-RPLND ‚̏d—vŤ‚́CŽc‘śŠŕ×–E‚ĚŠŽ‘S“Eœ‚É‚ ‚é‚ą‚Ć‚Í‚˘‚¤‚Ü‚Ĺ‚ŕ‚Č‚˘‚ށCŠďŒ`Žî‚ĚŽŠ‘RŽj‚Ć‚ľ‚āCgrowing teratoma syndrome13j‚âmalignant transformation14-16j‚đl—ś‚ľ‚˝ę‡‚É‚ŕ‚ť‚ĚŠŽ‘S“Eœ‚͏d—v‚Ĺ‚ ‚éB‚ą‚ę‚ç‚ĚƒP[ƒX‚͉ťŠw—Ă–@‚â•úŽËü—Ă–@‚É’ďRŤ‚Ĺ‚ ‚é‚ą‚Ć‚Ş‘˝‚­CŠO‰Č“IŘœ‚ŞŠî–{‚Ĺ‚ ‚éBŠs´”͈͂ɂ‚˘‚ẮCL”ÄŠs´‚ލs‚í‚ę‚Ä‚Ť‚˝‚Ş17-19jC5 cm –˘–ž‚ɏkŹ‚ľ‚˝ę‡‚âCŒ´”­‘ƒ‚Ć“Ż‘¤‚ĚƒŠƒ“ƒpß‚ÉŒŔ‹Ç‚ľ‚˝ę‡‚ɂ́CŽË¸_Œo‚̉ˇ‘ś‚đl—ś‚ľ‚Ämodified unilateral template resection ‚ŞŽŽ‚Ý‚ç‚ęC—ǍD‚ČŒ‹‰Ę‚Ş•ń‚ł‚ę‚Ä‚˘‚é20-22jB‚ť‚ę‚ç‚Ě•ń‚É‚ć‚é‚ƁCmodified template ‚đ—p‚˘‚˝ŽË¸_Œo‰ˇ‘śŽčp‚ł́C85“’ö“x‚ŏ‡sŤŽË¸‚މ”\‚Ĺ‚ ‚é‚ŞC—ź‘¤‚̍L”ÄŠs´‚Ĺ‚Í25“–˘–ž‚Ć•ń‚ł‚ę‚Ä‚˘‚éB

ĹŒă‚ɁC‰đ–UŠw‚ ‚邢‚Í•a—Šw“I‚Č—‰đ‚ĚŒüă‚âŽüpŠúŠÇ—‚̐i•ŕ‚É‚ć‚éC‰ťŠw—Ă–@Œă‚ĚŽc‘śŽîᇓEœp‚É‚¨‚Ż‚鍇•šÇ‚Ş’á‰ş‚ľC‚Š‚ÂŽčppŽŽ‚ސô—ű‚ł‚ę‚Ä‚Ť‚˝‚ą‚Ć‚ŕC–{Žčp‚ސ„§‚ł‚ę‚éˆęˆö‚Ć‚Č‚Á‚Ä‚˘‚é23, 24jB‚ľ‚Š‚ľC‘ĺŒŒŠÇ‚âd—v‘ŸŠí‚Ć‚Ě–ü’…剝—Ł‚Č‚Ç‚Ě‘€ě‚Ş—v‹‚ł‚ę‚é‚ą‚Ć‚Ş‘˝‚­C‚ť‚ĚŽŔŽ{‚É‚ ‚˝‚Á‚Ă͏\•Ş‚Čŕ–ž‚đs‚˘CŠłŽŇ‚¨‚ć‚щƑ°‚Ě—‰đ‚Ć“ŻˆÓ‚đ“ž‚é•K—v‚Ş‚ ‚éB

y•śŒŁz

1j Mosharafa AA, Foster RS, Leibovich BC, et al. Is post-chemotherapy resection of seminomatous elements associated with higher acute morbidity?. J Urol. 2003G169F2126-2128.iⅣbj

2j Herr HW, Sheinfeld J, Puc HS, et al. Surgery for a post-chemotherapy residual mass in seminoma. J Urol. 1997G157F860-2.iⅣbj

3j Heidenreich A, Thuüer D, Polyakov S. Postchemotherapy retroperitoneal lymph node dissection in advanced germ cell tumours of the testis. Eur Urol. 2008G53F260-74.iⅠj

4j De Santis M, Becherer A, Bokemeyer C, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminomaFan update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004G22F 1034-9.iⅣaj

5j Toner GC, Panicek DM, Heelan RT, et al. Adjunctive surgery after chemotherapy for nonseminomatous germ cell tumorsFrecommendations for patient selection. J Clin Oncol. 1990G8F1683-94.iⅣbj

6j Stenning SP, Parkinson MC, Fisher C, et al. Postchemotherapy residual masses in germ cell tumor patientsFcontent, clioncal features, and prognosis. Medical Research Council Testicular Working Party. Cancer. 1998G83i7jF1409-29.iⅣbj

7j Donohue JP, Leviovitch I, Foster RS, et al. Integration of surgery and systemic therapyFresults and principles of integration. Semin Urol Oncol 1998G16F65-71.iⅣbj

8j Steyerberg EW, Keizer HJ, Sleijfer DT, et al. Retroperitoneal metastases in testicular cancerFrole of CT measurements of residual masses in decision making for resection after chemotherapy. Radiology. 2000G215F437-44.iⅣbj

9j Hendry WF, Norman AR, Dearnaley DP, et al. Metastatic nonseminomatous germ cell tumors of the testisFresults of elective and salvage surgery for patients with residual retroperitoneal masses. Cancer. 2002G94F1668-76.iⅣbj

10j Albers P, Weissbach L, Krege S, et al. Prediction of necrosis after chemotherapy of advanced germ cell tumorsFresults of a prospective multicenter trial of the German Testicular Cancer Study Group. J Urol. 2004G171F1835-8.iⅣbj

11j Vergouwe Y, Steyerberg EW, Foster RS, et al. Predicting retroperitoneal histology in postchemotherapy testicular germ cell cancerFa model update and multicentre validation with more than 1000 patients. Eur Urol. 2007G51F424-32.iⅣbj

12j Fox EP, Weathers TD, Williams SD, et al. Outcome analysis for patients with persistent nonseminomatous germ cell tumor in postchemotherapy retroperitoneal lymph node dissections. J Clin Oncol. 1993G11F1294-9.iⅣbj

13j Logothesis CJ, Samuels ML, Trindade A, et al. The growing teratoma syndrome. Cancer. 1982G50F1629-35.iⅤj

14j Ahmed T, Bosl GJ, Hajdu SI. Teratoma with malignant transformation in germ cell tumors in men. Cancer. 1985G56F860-3.iⅣbj

15j Motzer RJ, Amsterdam A, Prieto V, et al. Teratoma with malignant transformationFdiverse malignant histologies arising in men with germ cell tumors. J Urol. 1998G159F133-8.iⅣbj

16j Donadio AC, Motzer RJ, Bajorin DF, et al. Chemotherapy for teratoma with malignant transformation. J Clin Oncol. 2003G21F4285-91.iⅣbj

17j Fosså SD, Ous S, Lien HH, et al. Post-chemotherapy lymph node histology in radiologically normal patients with metastatic nonseminomatous testicular cancer. J Urol. 1989G141F557-9.iⅣbj

18j Wood DP Jr, Herr HW, Heller G, et al. Distribution of retroperitoneal metastases after chemotherapy in patients with nonseminomatous germ cell tumors. J Urol. 1992G148F1812-6.iⅣbj

19j Rabbani F, Goldenberg SL, Gleave ME, et al. Retroperitoneal lymphadenectomy for post-chemotherapy residual massesFis a modified dissection and resection of residual masses sufficient?. Br J Urol. 1998G81F295-300.iⅣbj

20j Ehrlich Y, Yossepowitch O, Kedar D, et al. Distribution of nodal metastases after chemotherapy in nonseminomatous testis cancerFa possible indication for limited dissection. BJU Int. 2006G97F1221-4.iⅣbj

21j Beck SD, Foster RS, Bihrle R, et al. Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor?. Cancer. 2007G110F1235-40.iⅣbj

22j Heidenreich A, Pfister D, Witthuhn R, et al. Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancerFradical or modified template resection. Eur Urol. 2009G55F217-24.iⅣbj

23j Baniel J, Foster RS, Rowland RG, et al. Complications of post-chemotherapy retroperitoneal lymph node dissection. J Urol. 1995G153F976-80.iⅣbj

24j Heidenreich A, Albers P, Hartmann M, et al. Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage 1 nonseminomatous germ cell tumors of the testisFexperience of the German Testicular Cancer Study Group. J Urol. 2003G169F1710-14.iⅣbj


Column3

‰ťŠw—Ă–@Œă‚ĚŒă• –ŒƒŠƒ“ƒpßŠf´‚É‚¨‚Ż‚é
_Œo‰ˇ‘ś‚ɂ‚˘‚Ä

‰ťŠw—Ă–@Œă‚ĚŒă• –ŒƒŠƒ“ƒpßŠf´‚́C“ďˆŐ“x‚̍‚‚˘C‚NP‚ĚŽčp‚É‚Č‚é‚ą‚Ć‚Ş‘˝‚˘B‚Ü‚˝C‹tsŤŽË¸‚Ć‚˘‚¤C’jŤ‚É‚Ć‚Á‚ÄQOL ‚đ‘ĺ‚Ť‚­‘š‚Č‚¤ƒŠƒXƒN‚Ş‚ ‚čCfull template ‚Šmodified template ‚ŠC_Œo‚đ‰ˇ‘ś‚ˇ‚é‚Š‚ľ‚Č‚˘‚Š‚ޏí‚É‹c˜_‚Ć‚Č‚Á‚Ä‚Ť‚˝B

‰˘•Ä‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́CŠî–{“I‚É‚ÍŠJ• Žčp/full template ‚ōs‚˘C‰ťŠw—Ă–@ŠJŽnŽž‚ĚŽîᇌa‚ޏŹ‚ł‚˘ę‡‚Ímodified template ‚ŕl—ś‚ľ‚¤‚é‚Ć‚ł‚ę‚Ä‚˘‚éB‚Ü‚˝C_Œo‰ˇ‘ś‚ÉŠÖ‚ľ‚ẮC—źƒKƒCƒhƒ‰ƒCƒ“‚Ć‚ŕ‚ɉ”\‚Ȃ牡‘ś‚ˇ‚é‚ׂŤ‚Ć‹LÚ‚ł‚ę‚Ä‚˘‚éB

Žá”NC‘s”N’jŤ‚É”­ś‚ˇ‚éŽîᇂƂ˘‚¤ŤŠi‚đl‚Ś‚é‚ƁC‰Â”\‚ČŒŔ‚č_Œo‰ˇ‘ś‚đŽŽ‚Ý‚é•K—v‚Ş‚ ‚é‚ƍl‚Ś‚ç‚ę‚éB

‚˝‚ž‚ľC‰ťŠw—Ă–@ŠJŽnŽž‚ĚŽîᇂ̑傫‚łEL‚Ş‚č‚đŠÓ‚Ý‚¸C‰ˇ‘ś‚Ě‚˝‚ß‚Émodified template ‚đ‘I‘đ‚ˇ‚é‚ą‚Ć‚Í”đ‚Ż‚Č‚Ż‚ę‚΂Ȃç‚Č‚˘B

ˆČă‚Š‚çCŒ´‘Ľ“I‚É‚ÍŠJ• ‚É‚ć‚éfull template RPLND ‚đs‚˘C‰Â”\‚ČŒŔ‚č_Œo‰ˇ‘ś‚đŽŽ‚Ý‚éB‚˛‚­ŒŔ‚ç‚ę‚˝Ç—á‚Ĺ‚Ímodified template ‚ŕ‘I‘đ‚ľ‚¤‚éC‚ƍl‚Ś‚Ä‚¨‚­‚Ě‚Ş—Ç‚˘‚ĆŽv‚í‚ę‚éB

y•śŒŁz

1j Guidelines on Testicular Cancer, European Association of Urology.

2j NCCN Clinical Practice Guidelines in Oncology, Testicular Cancer.


CQ 16

œisŤ¸‘ƒŽîᇂɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŽc‘śŠŕ‚ĚŒŸő‚É‚¨‚˘‚āCFDG-PET ‚͐„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

B
isŤ¸‘ƒŽîᇂɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŽc‘śŠŕ‚ĚŒŸo‚ÉŠÖ‚ˇ‚épositron emission tomographyiPETj‚Ě—LŒřŤ‚ɂ‚˘‚āCƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚ẮCŠ´“xC“ÁˆŮŤC—zŤ”˝‰ž“K’†—ŚC‰AŤ”˝‰ž“K’†—Ś‚Ě‚˘‚¸‚ę‚É‚¨‚˘‚Ä‚ŕ—D‚ę‚˝Žc‘śŠŕŒŸo”\‚đ—L‚ľ‚Ä‚¨‚čC‰ťŠw—Ă–@Œă‚ĚŽc‘śŠŕ‚Ě—L–ł‚Ě”ť’č‚Ě‚˝‚ß‚É—p‚˘‚é‚ą‚Ƃ͐„§‚ł‚ę‚éB

„§ƒOƒŒ[ƒh

C2
”ńƒZƒ~ƒm[ƒ}‚Ěę‡‚́CŠďŒ`Žî‚ĹFDGi2-fluoro-deoxy-D-glucosej‚ŞŽć‚荾‚Ü‚ę—zŤ‚Ć‚Č‚éę‡‚Ş‚ ‚é‚˝‚߁C„§‚Ĺ‚Ť‚Č‚˘B
y‰đ ŕz

isŤ”ńƒZƒ~ƒm[ƒ}‚É‚¨‚Ż‚鉝Šw—Ă–@Œă‚ĚŽc‘śŽîᇂɊւľ‚ẮCŠďŒ`Žî‚É‚¨‚˘‚ÄFDGi2-fluoro-deoxy-D-glucosej‚ĚŽć‚荾‚Ý‚Ş‹­‚­CFDG-PET —zŤ‚É‚Č‚é‚ą‚Ć‚âC‰óŽ€‚ɊׂÁ‚˝á­‰ť‘gD’†‚̉ŠÇ‚É‚ć‚Á‚āC‚˘‚Š‚É‚ŕŠŕ×–E‚ŞŽc‘ś‚ˇ‚é‚悤‚É‚Ý‚Ś‚éBDe Wit ‚ç‚Í109 l‚̉ťŠw—Ă–@‚đŽó‚Ż‚˝isŤ”ńƒZƒ~ƒm[ƒ}ŠłŽŇ‚É‚¨‚Ż‚鉝Šw—Ă–@Œă‚ĚFDG-PET ‚ĚŠ´“xC“ÁˆŮ“x‚Í‚ť‚ę‚ź‚ę72“C47“‚ŁC‚Ü‚˝C—zŤ”˝‰ž“K’†—Śipositive predictive valueFPPVj‚ƉAŤ”˝‰ž“K’†—Śinegative predictive valueFNPVj‚Í‚ť‚ę‚ź‚ę54“C67“‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é1jB‚Ü‚˝CBuchler ‚ç‚ÍPET ‚މAŤ‚Ć‚Č‚Á‚˝93 —á‚̉ťŠw—Ă–@Œă‚Ě”ńƒZƒ~ƒm[ƒ}Ç—á‚Ě’ˇŠúŠĎŽ@‚É‚¨‚˘‚āCNPV ‚Í81.7“‚Ĺ‚ ‚čCprimary ‚ĚŽîᇑgD‚Éteratoma ‚âteratocarcinoma ‚ŞŠÜ‚Ü‚ę‚Ä‚˘‚˝‚ŕ‚́C‚ŕ‚Ć‚ŕ‚ĆŽîᇃ}[ƒJ[‚ލ‚’l‚Ĺ‚ ‚Á‚˝‚ŕ‚́C‰ťŠw—Ă–@Œă‚ĚŽc‘śŽîá‡‚Ş‘ĺ‚Ť‚˘‚ŕ‚Ě‚Ĺ‚ÍPET failure ‚Ć‚Č‚č‚₡‚˘‚Ć•ń‚ľ‚Ä‚˘‚é2jB‚ť‚Ě‘ź‚˘‚­‚‚Š‚Ě•ń‚É‚¨‚˘‚Ä‚ŕCFDG-PET ‚ÍCT ‚ć‚č‚ੴ“x‚Ş’á‚­CŽŔŰ‚ÉŽčp•s—v‚ČŠłŽŇ‚Ě‘I‘đ‚É‚Í—p‚˘‚ç‚ę‚Č‚˘‚Əq‚ׂç‚ę‚Ä‚˘‚é3-6jB‚ľ‚˝‚Ş‚Á‚āCisŤ”ńƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚ẮC‰ťŠw—Ă–@Œă‚ĚŽc‘śŽîᇓEœŽčp‚Ě—v”Ű‚đŒˆ‚ß‚é‚˝‚ß‚ĚŒŸ¸‚Ć‚ľ‚ÄFDG-PET ‚͐„§‚Ĺ‚Ť‚Č‚˘BĹ‹ß‚ł́CisŤ”ńƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚āC‰ťŠw—Ă–@‚É‚ć‚Á‚Ä‰ć‘œăCR ‚ ‚邢‚Í1 cm –˘–ž‚Ü‚Ĺ‚ĚkŹ‚Ş“ž‚ç‚ę‚˝ę‡‚ɂ́CŽčp‚đ‚š‚¸‚ÉŒo‰ßŠĎŽ@‚މ”\‚Ĺ‚ ‚é‚Ć‚ˇ‚é•ń‚ŕ‚ ‚é7, 8jB

ˆę•űCisŤƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚ẮC‰ťŠw—Ă–@Œă‚ĚŽc‘śŽîᇒ†‚ÉŠďŒ`Žî‚Ş‘śÝ‚ˇ‚é‚ą‚Ć‚Í‹É‚ß‚Ä‚Ü‚ę‚Ĺ‚ ‚é‚˝‚߁CFDG-PET ‚Ě—L—pŤ‚Í”ńƒZƒ~ƒm[ƒ}‚Ěę‡‚ĆˆŮ‚Č‚éBDe Santis ‚ç‚́C‰ťŠw—Ă–@Œă‚ĚƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚ÄFDG-PET ŒŸ¸‚Ş—zŤ‚Ĺ‚ ‚é‚ą‚Ƃ́CŽc‘śŽîᇒ†‚ÉŠŕ×–E‚Ş‘śÝ‚ˇ‚é‰Â”\Ť‚đ‹­‚­ŽŚ´‚ˇ‚é‚Ć•ń‚ľ‚Ä‚˘‚éB‚ť‚ę‚É‚ć‚é‚ƁCFDG-PET ŒŸ¸‚É‚¨‚Ż‚éCŠ´“xC“ÁˆŮ“xCPPVCNPV ‚Í‚ť‚ę‚ź‚ęC80“C100“C100“C96“‚Ĺ‚ ‚Á‚˝B‚ť‚ę‚ɑ΂ľ‚āCCT ŒŸ¸‚Ĺ‚ĚŽc‘śŽîᇌa3 cm ‚𔝒čŠî€‚Ć‚ľ‚āCŽc‘śŠŕ‚Ě—L–ł‚đ—\‘Ş‚ľ‚˝ę‡CŠ´“xC“ÁˆŮ“xCPPVCNPV ‚Í‚ť‚ę‚ź‚ęC70“C74“C37“C92“‚Ĺ‚ ‚čCFDG-PET ‚É‚ć‚éf’f‚Ě•ű‚Ş—D‚ę‚Ä‚˘‚˝9, 10jB‚ť‚ĚŒăC“ŻƒOƒ‹[ƒv‚Í177 l‚ĚPET Ž{sÇ—á‚ɂ‚˘‚Ä‚Ěvalidation study ‚ĚŒ‹‰Ę‚ŕ•ń‚ľ‚Ä‚˘‚é‚ŞC‚ť‚ę‚É‚ć‚é‚ĆŠ´“xC“ÁˆŮ“xCPPVCNPV ‚ť‚ę‚ź‚ę82“C90“C95“C69“‚Ĺ‚ ‚Á‚˝11jB‚ł‚ç‚ɏŹ‹K–Í‚Čstudy ‚Ĺ‚Í‚ ‚é‚ŞCPutra ‚ç‚âHinz ‚ç‚ŕ“Ż—l‚ĚŒ‹‰Ę‚đŽŚ‚ľCFDG-PET ‚Ě—L—pŤ‚đ•ń‚ľ‚Ä‚˘‚é12, 13jB‚ľ‚Š‚ľC‚ť‚Ěˆę•ű‚ŁCGanjoo ‚ç‚́C‹~Ď‰ťŠw—Ă–@‚đŽó‚Ż‚˝10 l‚ĚƒZƒ~ƒm[ƒ}ŠłŽŇ‚ɑ΂ľ‚ÄFDG-PET ‚đŽ{s‚ľC‘SˆőPET negative ‚Ć‚˘‚¤Œ‹‰Ę‚É‚ŕ‚Š‚Š‚í‚炸C5 —á‚ĹŽîᇂލđ‘ĺ‚ľ‚˝‚ą‚Ć‚ć‚čC‰ťŠw—Ă–@Œă‚Ě‘ĺ‚Ť‚ČƒZƒ~ƒm[ƒ}‚ĚŽc‘śŽîᇂɊւľ‚ẮCFDG-PET ‚Ě—L—pŤ‚É‚Í‹^–â‚ŞŽc‚é‚Ć•ń‚ľ‚Ä‚˘‚é14, 15jB

¸‘ƒŽîᇂɑ΂ˇ‚éPET ŒŸ¸‚́C­‚Č‚­‚Ć‚ŕƒZƒ~ƒm[ƒ}‚ÉŠÖ‚ľ‚Ă͉ťŠw—Ă–@Œă‚ĚŽc‘śŠŕ×–E‚Ě—L–ł‚đf’f‚ˇ‚é‚É‚Í—L—pŤ‚ލ‚‚˘‚ĆŽv‚í‚ę‚éBˆę•űC”ńƒZƒ~ƒm[ƒ}‚Ĺ‚ÍŠ´“xC“ÁˆŮ“x‚Ć‚ŕ‚ÉŒˆ‚ľ‚č‚‚˘‚Ć‚Í‚˘‚Ś‚¸C‚ť‚Ě—L—pŤ‚͒Ⴂ‚ĆŽv‚í‚ę‚éB

‚Č‚¨ŒťÝCˆŤŤŽîᇂ̕aŠúf’f‚¨‚ć‚ŃÄ”­E“]ˆÚŒŸő–Ú“I‚ĚFDG-PET ‚Í•ŰŒŻf—Ă‚Ě”ÍˆÍ“ŕ‚ĹŽ{s‰Â”\‚Ĺ‚ ‚éB

y•śŒŁz

1j De Wit M, Hartmann M, Brenner W, et aml. 18Fn-FDG-PET in germ cell tumors following chemotherapyFResults of the German multicenter trial. ASCO Annual Meeting Proceedings Part I. Vol 24, No.@18SiJune 20 Supplementj. 2006G4521.iⅣbj

2j Buchler T, Simonova K, Fencl P, et al. Clinical outcomes of patients with nonseminomatous germ cell tumours and negative postchemotherapy positron emission tomography. Cancer Invest. 2012G30i6jF487-92.iⅣbj

3j Spermon, JR, De Geus-Oei LF, Kiemeney LA, et al. The role oif 18jfluoro-2-deoxyglucose positron emission tomography in initial staging and re-staging aftor ohemotherapy for testicular germ cell tumours. BJU Int. 2002G89i6jF549-56.iⅣbj

4j Sanchez D, Zudaire JJ, Fernandez JM, et al. FDG-PET in the evaluation of nonseminomatous germ cell tumors at relapse. BJU Int 2002G89i9jF912-6.iⅣbj

5j Kollmannsberger C, Oechsle K, Dohmen BM, et al. Prospaective comparison of FDG-PET with conventional assessment by computed tomography scans and serum tumor markers for the evaluation of residual masses in patients with nonseminomatous germ cell carcinoma. Cancer. 2002G94i9jF2353-62.iⅣaj

6j Stephens AW, Gonin R, Hutchins GD, et al. Positron emission tomography evaluation of residual radiographic abnormalities in postchemotherapy germ cell tumor patients. J Clin Oncol. 1996G14i5jF1637-41.iⅣaj

7j Ehrlich Y, Brames MJ, Beck SD, et al. Long-term follow-up of Cisplatin combination chemotherapy in patients with disseminated nonseminomatous germ cell tumorsFis a postchemotherapy retroperitoneal lymph node dissection needed after complete remission?. J Clin Oncol. 2010G28i4jF531-6.iⅣaj

8j Kollmannsberger C, Daneshmand S, So A, et al. Management of disseminated nonseminomatous germ cell tumors with risk-based chemotherapy followed by response-guided postchemotherapy surgery. J Clin Oncol. 2010G28i4jF537-42.iⅣaj

9j Oechsle K, Hartmann M, Brenner W, et al.m18FnFluorodeoxyglucose positron emission tomography in nonseminomatous germ cell tumors after chemotherapyFThe German multicenter positron emission tomography study group. J Clin Oncol. 2008G26i36jF5930-5.iⅣbj

10j De Santis M, Becherer A, Bokemeyer C, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminomaFan update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004G22i6jF1034-9.iⅣaj

11j Bachner M, Loriot Y, Gross-Goupil M, et al. 2-18fluoro-deoxy-D-glucose positron emission tomographyiFDG-PETjfor postchemotherapy seminoma residual lesionsFa retrospective validation of the SEMPET trial. Ann Oncol. 2012G23i1jF59-64.iⅣbj

12j John Putra L, Lawrentshuk N, Ballok Z, et al. 18F-fluorodeoxyglucose positron emission tomography in evaluation of germ cell tumor after chemotherapy. Urology. 2004G64i6jF1202-7.iⅣbj

13j Hinz S, Schrader M, Kempkensteffen C, et al. The role of positron emission tomography in the evaluation of residual masses after chemotherapy for advanced stage seminoma. J Urol. 2008G179i3jF936-40.iⅣaj

14j Ganjoo KN, Chan RJ, Sharma M, et al. Positron emission tomography scans in the evaluation of postchemotherapy residual masses in patients with seminoma. J Clin Oncol. 1999G17i11jF3457-60.iⅢj

15j Albers P, Bender H, Yilmaz H, et al. Positron emission tomography in the clinical staging of patients with Stage Ⅰ and Ⅱ testicular germ cell tumors. Urology. 1999G53i4jF808-11.iⅣaj


CQ 17

œisŤ¸‘ƒŽîᇂɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŽc‘śŽîᇂđŘœ‚ľC•a—Šw“I‚ÉŽc‘śŠŕ‚đ”F‚ß‚˝ę‡C’ljÁŽĄ—Â͐„§‚ł‚ę‚é‚ŠH


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B
isŤ¸‘ƒŽîᇂɂ¨‚Ż‚鉝Šw—Ă–@Œă‚ĚŽc‘śŽîᇐ؏œ‚đs‚Á‚˝Œ‹‰ĘC•a—‘gDf’fŒ‹‰Ę‚Ş‰óŽ€Eፍ­‰ť‘gD‚Ĺ‚ ‚ę‚΁C’ljÁ‰ťŠw—Ă–@‚Í•K—v‚Ĺ‚Č‚˘Bˆę•űC•a—‘gDŒŸő‚É‚¨‚˘‚ÄŽc‘śŠŕ‚đ”F‚ß‚˝ę‡‚ɂ́C’ljÁ‰ťŠw—Ă–@‚ސ„§‚ł‚ę‚éB
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isŤ¸‘ƒŽîᇂɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŽc‘śŽîᇐ؏œ‚đŽ{s‚ľ‚˝ŰC35“’ö“x‚ÉŠďŒ`Žî‚ށC‚Ü‚˝15“’ö“x‚ÉŠŕ×–E‚ĚŽc‘ś‚Ş‚Ý‚ç‚ę‚éiCQ16 ŽQĆjB‰óŽ€Eፍ­‰ť‘gD‚ł͒ljÁŽĄ—Ă–ł‚ľ‚Ĺ—ÇD‚Č—\Œă‚ŞŠú‘Ň‚Ĺ‚Ť‚é1-9jBˆę•űCteratoma with malignant area ‚âŠŕ×–E‚Ş”F‚ß‚ç‚ę‚˝ę‡‚ɂ́C’ljÁ‰ťŠw—Ă–@‚͐„§‚ł‚ę‚éB

Fox ‚ç‚͉ťŠw—Ă–@Œă‚ĚŒă• –ŒƒŠƒ“ƒpßŠs´p‚đŽó‚Ż‚˝580 —á‚Ě”ńƒZƒ~ƒm[ƒ}‚Ě‚¤‚żCŽc‘śŠŕ‚đ”F‚ß‚˝133 —á‚ɂ‚˘‚ÄŒă‚ëŒü‚ŤŒŸ“˘‚đs‚˘C•W€“I‰ťŠw—Ă–@‚đ2 ƒR[ƒX’ljÁ‚ľ‚˝Ç—á‚Ć–łŽĄ—Ă‚ĹŒo‰ßŠĎŽ@‚ľ‚˝Ç—á‚đ”äŠr‚ľ‚˝ę‡C–ž‚ç‚Š‚ɉťŠw—Ă–@‚đ’ljÁ‚ľ‚˝•ű‚Ş—\Œă—ǍD‚Ĺ‚ ‚é‚Ć•ń‚ľ‚Ä‚˘‚é10jBKaranikolas ‚ç‚ŕ“Ż—l‚ɁC’ljÁ‰ťŠw—Ă–@‚đŽó‚Ż‚˝ŠłŽŇŒQ‚Ĺ—LˆÓ‚ɗǍD‚Ȑś‘ś—Ś‚Ş“ž‚ç‚ę‚˝‚Ć•ń‚ľ‚Ä‚˘‚é11jBˆę•űCFizazi ‚ç‚́C‰ťŠw—Ă–@Œă‚ĚŽc‘śŽîᇐ؏œ‘gD’†‚ÉŠŕ×–E‚đ”F‚ß‚˝238 —á‚ɂ‚˘‚ĒljÁ‰ťŠw—Ă–@‚Ě—L—pŤ‚đŒŸ“˘‚ľ‚Ä‚¨‚čC‚ť‚ę‚É‚ć‚é‚ĆIGCCC ‚É‚¨‚Ż‚éintermediate prognosis group ‚̂ݒljÁ‰ťŠw—Ă–@‚Ě—L—pŤ‚Ş”F‚ß‚ç‚ęCgood prognosis group ‚âpoor prognosis group ‚ĚÇ—á‚Ĺ‚Í—L—pŤ‚ŞŘ–ž‚Ĺ‚Ť‚Č‚Š‚Á‚˝‚Ć‚ľ‚Ä‚˘‚é12jB

‚ą‚ę‚ç‚Ě•ń‚Í‚ˇ‚ׂČă•űŽ‹“IŒ¤‹†‚Ĺ‚ ‚é‚ŞCŒťŽž“_‚ł́C‰ťŠw—Ă–@Œă‚̐؏œŽc‘śŽîᇑgD“ŕ‚ÉŠŕ×–E‚đ”F‚ß‚˝ę‡‚ɂ́C’ljÁ‰ťŠw—Ă–@‚đs‚Á‚˝•ű‚ޗǍD‚Č—\Œă‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚ĆŽv‚í‚ęC„§‚ł‚ę‚éB

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1j Rabbani F, Goldenberg SL, Gleave ME, et al. Retroperitoneal lymphadenectomy for post-chemotherapy residual massesFis a modified dissection and resection of residual masses sufficient?. Br J Urol. 1998G81i2jF295-300.iⅣbj

2j Stenning SP, Parkinson MC, Fisher C, et al. Postchemotherapy residual masses in germ cell tumor patientsFcontent, clioncal features, and prognosis. Medical Research Council Testicular Working Party. Cancer. 1998G83i7jF1409-29.iⅣbj

3j Donohue JP, Leviovitch I, Foster RS, et al. Integration of surgery and systemic therapyFresults and principles of integration. Semin Urol Oncol. 1998G16i2jF65-71.iⅣbj

4j Napier MP, Naraghi A, Christmas TJ, et al. Long-term follow-up of residual masses after chemotherapy in patients with non-seminomatous germ cell tumours. Br J Cancer. 2000G83i10jF1274-80.iⅣbj

5j Hendry WF, Norman AR, Dearnaley DP, et al. Metastatic nonseminomatous germ cell tumors of the testisFresults of elective and salvage surgery for patients with residual retroperitoneal masses. Cancer. 2002G94i6jF1668-76.iⅣbj

6j Oldenburg J, Alfsen GC, Lien HH, et al. Postchemotehrapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses. J Clin Oncol. 2003G21i17jF3310-17.iⅣbj

7j Albers P, Weissbach L, Krege S, et al. Prediction of necrosis after chemotherapy of advanced germ cell tumorsFresults of a prospective multicnter trial of the German Testicular Cancer Study Group. J Urol. 2004G171i5jF1835-8.iⅣbj

8j Muramaki M, Hara I, Miyake H, et al. Clinical outcome of retroperitoneal lymph node dissection after induction chemotherapy for metastatic non-seminomatous germ cell tumors. Int J Urol. 2004G11i9jF763-7.iⅣbj

9j Nonomura N, Nishimura K, Takaha N, et al. Nerve-sparing retroperitoneal lymph node dissection for advanced testicular cancer after chemotherapy. Int J Urol. 2002G9i10jF539-44.iⅣbj

10j Fox EP, Weathers TD, Williams SD, et al. Outcome analysis for patients with persistent nonseminomatous germ cell tumor in postchemotherapy retroperitoneal lymph node dissections. J Clin Oncol. 1993G11i3jF1294-9.iⅣbj

11j Karanikolas N, Serio A. Viable germ cell tumoriGCTjidentified at post-chemotherapy retroperitoneal lymph node dissectioniPCRPLNDjFthe significance of risk assignment and adjuvant chemotherapy. J Urol. 2006G175isuppl 4jF191.iⅣbj

12j Fizazi K, Tjulandin S, Salvioni R, et al. Viable malignant cells after primary chemotherapy for disseminated nonseminomatous germ cell tumorsFprognostic factors and role of postsurgery chemotherapy--results from an international study group. J Clin Oncol. 2001G19i10jF2647-57.iⅣbj


CQ 18

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1990 ”N‘ă‰“Ş‚É‚¨‚˘‚āCƒVƒXƒvƒ‰ƒ`ƒ“’ďRŤ‚̐¸‘ƒŽîᇊłŽŇ‚É ‘΂ˇ‚é‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚ÄŽŠ‰Ćœ‘ˆÚA‚đ•š—p‚ľ‚˝‘ĺ—ʉťŠw—Ă–@iHigh dose chemotherapyFHDCTj‚ŞŽŽ‚Ý‚ç‚ę‚Ä‚Ť‚˝B“Š—^–ňÜ‚Ć‚ľ‚āCƒVƒXƒvƒ‰ƒ`ƒ“‚ć‚č‚ŕ“Ż‚śƒvƒ‰ƒ`ƒiťÜ‚Ĺ“Š—^‹K§ˆöŽq‚ލœ‘—}§‚Ĺ‚ ‚éƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“C‚¨‚ć‚Ńƒgƒ|ƒCƒ\ƒƒ‰[ƒ[‘jŠQ–ň‚Ĺ‚ ‚éƒGƒgƒ|ƒVƒh‚Ě2 Ü‚ލL‚­—p‚˘‚ç‚ę‚Ä‚Ť‚˝ihigh dose CEjB‚ą‚Ě2 Ü‚ɃAƒ‹ƒLƒ‹‰ťÜ‚Ĺ‚ ‚éƒVƒNƒƒzƒXƒtƒ@ƒ~ƒh‚ŕ‚ľ‚­‚̓CƒzƒXƒtƒ@ƒ~ƒh‚đ‰Á‚Ś‚˝ƒŒƒWƒƒ“‚ŕ‚ć‚­Žg—p‚ł‚ę‚Ä‚Ť‚˝ihigh dose CECChigh dose ICEjB‚ľ‚Š‚ľC‚ą‚ę‚珉Šú‚ĚHDCT ‚ÉŠÖ‚ˇ‚é•ń‚ł́C‘OŽĄ—Ă‚Şintensive ‚É‚ł‚ę‚Ä‚Ť‚˝ƒP[ƒX‚Ş‘˝‚­C‘Sgó‘Ô‚¨‚ć‚эœ‘‹@”\‚Ş”ć•ž‚ľ‚˝ó‘Ô‚Ĺ‚Í’ˇŠúŠ°‰đ—Ś‚Ş13`35“CŽĄ—ĂŠÖ˜AŽ€‚Ş3-13“‚Ć–ž‘Ť‚ˇ‚ׂŤ‚ŕ‚Ě‚Ć‚Í‚˘‚Ś‚Č‚Š‚Á‚˝1-3jB

œ‘Žx‰‡—Ă–@‚Ć‚ľ‚Ä––˝ŒŒŠ˛×–EˆÚAiPeripheral blood stem cell transplantationFPBSCTj‚ŞŠm—§‚ł‚ęCŽŠ‰Ćœ‘ˆÚA‚É”ä‚אNP‚ޏ­‚Č‚˘‚ą‚Ć‚â”’ŒŒ‹…‚̉ń•œ‚Ş‘Ź‚â‚Š‚Ĺ‚ ‚é‚ą‚Ć‚ŞŽŚ‚ł‚ę‚é‚悤‚É‚Č‚č4jC¸‘ƒŽîᇊłŽŇ‚ɑ΂ˇ‚éHDCT ‚ĚŽx‰‡—Ă–@‚Ć‚ľ‚Ä‚ŕPBSCT ‚ŞŽ{s‚ł‚ę‚é‚悤‚É‚Č‚Á‚Ä‚Ť‚˝B‚ą‚ę‚çPBSCT •š—pHDCT ‚̐ŹŃ‚đ‚Ü‚Ć‚ß‚é‚ƁC’ˇŠúŠ°‰đ—Ś‚Í34-65“CŽĄ—ĂŠÖ˜AŽ€‚Í0-3.3“‚Ć‚Č‚Á‚Ä‚˘‚é5-8jBĹ‹ßEinhorn ‚ç‚ÍIndiana University ‚É‚¨‚˘‚ÄHDCT ‚đŽ{s‚ľ‚˝184 —á‚Ě“]ˆÚŤ¸‘ƒŽîᇊłŽŇ‚Ě‚¤‚ż116 —ái63“j‚Ş’ˇŠúŠŽ‘SŠ°‰đ‚đ“ž‚˝‚Ć”­•\‚ľ‚Ä‚˘‚é‚ŞC‚ą‚ę‚ŕŒă‚ëŒü‚ŤƒVƒ“ƒOƒ‹ƒA[ƒ€‚Ĺ‚Ě•ń‚Ĺ‚ ‚é‚˝‚ß—L—pŤ‚đŒ‹˜_‚Ă‚Ż‚é‚ą‚Ć‚Í‚Ĺ‚Ť‚Č‚˘9jB

HDCT ‚Ş’Ęí—Ę‚Ě‹~Ď‰ťŠw—Ă–@‚É”ä‚ׂĖ{“–‚É—D‚ę‚Ä‚˘‚é‚Ě‚Š”Ű‚Š‚ĚŒŸŘ‚́C‘ć3 ‘Š—Տ°ŽŽŒą‚É‚¨‚˘‚ÄŒŸŘ‚ł‚ę‚Č‚Ż‚ę‚΂Ȃç‚Č‚˘BĄ‚Ü‚Ĺ‚Ě‚Ć‚ą‚ëC‚ť‚̂悤‚Č—Ő°ŽŽŒą‚Ě•ń‚Í2 ‚”F‚ß‚ç‚ę‚éB1 ‚‚̓ˆ[ƒƒbƒp‚𒆐S‚Ć‚ľ‚˝‘˝Ž{Ý‹¤“ŻŒ¤‹†‚ĹÄ”­‚đ—ˆ‚ľ‚˝¸‘ƒŽîᇊłŽŇ280 –ź‚đVIP —Ă–@4 ƒR[ƒX‚ƁCVIP —Ă–@3 ƒR[ƒX{high dose CECiƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“CƒGƒgƒ|ƒVƒhCƒVƒNƒƒzƒXƒtƒ@ƒ~ƒhj1 ƒR[ƒX‚Ě2 ŒQ‚ɐU‚č•Ş‚Ż‚˝‚ŕ‚Ě‚Ĺ‚ ‚éBŒ‹‰Ę‚́C3 ”NŽžŠł“ÁˆŮ“Iś‘ś—Śi35“ vs. 42“j‚¨‚ć‚Ń‘Sś‘ś—Śi53“ vs. 53“j‚Ć‚ŕ‚É—LˆÓˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝B–{—Տ°ŽŽŒą‚É‚¨‚˘‚āCHDCT ‚Í1 ƒR[ƒX‚Ě‚Ý‚Ĺ‚ ‚é‚ą‚Ć‚Ş–â‘č“_‚Ć‚ľ‚ÄŽw“E‚ł‚ę‚Ä‚˘‚é10jB

‚ŕ‚¤1 ‚‚́CƒhƒCƒc‚ĚƒOƒ‹[ƒv‚É‚ć‚é‘ć3 ‘Š—Տ°ŽŽŒą‚ĹƒVƒXƒvƒ‰ƒ`ƒ“‚𒆐S‚Ć‚ľ‚˝‰ťŠw—Ă–@‚đŽ{s‚ľ‚˝Œă‚ɁCÄ”­‚ ‚邢‚ÍŽĄ—Ă’ďRŤ¸‘ƒŽîᇊłŽŇ230 –ź‚đHDCT •Ą”‰ńŒQiVIP —Ă–@1 ƒR[ƒX‚Ɉř‚Ť‘ą‚˘‚Ähigh dose CE ‚đ3 ƒR[ƒXŽ{sj‚ƁCHDCT ’P‰ńŒQiVIP —Ă–@3 ƒR[ƒX‚Ɉř‚Ť‘ą‚˘‚Ähigh dose CEC ‚đ1 ƒR[ƒXŽ{sj‚Ć‚É–łěˆ×‚ÉŠ„‚č•t‚Ż‚˝‚ŕ‚Ě‚Ĺ‚ ‚éBŽĺ—v•]‰ż€–Ú‚Ĺ‚ ‚é1 ”N‚Ĺ‚ĚƒCƒxƒ“ƒgƒtƒŠ[ś‘ś—ŚiŽĄ—Ă–@‚Ě•ĎXCd“Ä‚Č—LŠQŽ–ŰC•a‹C‚̐isC——R‚đ–â‚í‚Č‚˘Ž€–S‚Ě‚ˇ‚ׂĂđŠÜ‚ށj‚́CHDCT •Ą”‰ńŒQ‚Ĺ40“CHDCT ’P‰ńŒQ‚Ĺ37“‚Ć—LˆÓˇ‚đ”F‚ß‚Č‚Š‚Á‚˝11jB‘o•ű‚Ě‘ć3 ‘Š—Տ°ŽŽŒą‚ĚŒ‹‰Ę‚ć‚čC‹~Ď‰ťŠw—Ă–@‚É‚¨‚Ż‚éHDCT ‚Ě—L—pŤ‚ÍŘ–ž‚ł‚ę‚Č‚Š‚Á‚˝B

ˆę•űCpoor risk ‚̐¸‘ƒŽîᇊłŽŇ‚ɑ΂ľC“ą“ü‰ťŠw—Ă–@‚Ć‚ľ‚ÄHDCT ‚đ“ą“ü‚ľ‚悤‚Ć‚ˇ‚鎎‚Ý‚ŕ‚Č‚ł‚ę‚Ä‚Ť‚˝B‚ą‚ę‚ç‚ĚŽĄ—ÐŹŃ‚ɂ‚˘‚ẮC’ˇŠúŠ°‰đ—Ś‚Ş43-73“CŽĄ—ĂŠÖ˜AŽ€‚Í0-4.5“‚Ć•ń‚ł‚ę‚Ä‚˘‚é12-14jB

“ą“ü—Ă–@‚Ć‚ľ‚Ä‚ĚHDCT ‚Ě—L—pŤ‚ÉŠÖ‚ˇ‚é‘ć3 ‘Š—Տ°ŽŽŒą‚́CĄ‚Ü‚Ĺ‚Ě‚Ć‚ą‚ë3 ‚‚̕ń‚Ş‚ ‚éB2007 ”N‚É—\Œă•s—ǐ¸‘ƒŽîᇊłŽŇiIGCCC ‚Ĺintemediate ‚ŕ‚ľ‚­‚Ípoor prognosisj‚ɑ΂ľC4 ƒR[ƒX‚ĚBEP —Ă–@in111jŽ{ÝŒQ‚Ć2 ƒR[ƒX‚ĚBEP —Ă–@‚Ɉř‚Ť‘ą‚˘‚Ä2 ƒR[ƒX‚Ěhigh dose CECin108j‚đŽ{s‚ˇ‚é2 ŒQ‚ɐU‚č•Ş‚Ż‚˝‘ć3 ‘Š—Տ°ŽŽŒą‚ĚŒ‹‰Ę‚Ş”­•\‚ł‚ę‚˝15jB‘w•Ę‰đÍ‚ĚŒ‹‰Ę‚ł́CŒŒ´ƒ}[ƒJ[‚̉ş‚Ş‚č‚Ş•s—Ç‚Ĺ‚ ‚Á‚˝Ç—á‚ɂ‚˘‚Ä‚ÍHDCT ‚Ě—L—pŤ‚Ş”F‚ß‚ç‚ę‚˝‚ŕ‚̂́C‘S‘Ě‚Ć‚ľ‚Ä‚ĚŒ‹‰Ę‚Í1 ”N‚Ĺ‚ĚŠŽ‘SŠ°‰đ—Ś‚ŞBEP ’P“ĆŒQ‚Í48“CBEP{HDCT —Ă–@ŒQ‚Í52“‚ŁC“ŒvŠw“I‚Č—LˆÓˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝ip0.53jB

ƒtƒ‰ƒ“ƒX‚ĚƒOƒ‹[ƒv‚́CŒŒ´ƒ}[ƒJ[‚Ě’l‚ć‚čisŤ‚Ć’č‹`‚ł‚ę‚˝¸‘ƒŽîᇊłŽŇ115 —á‚đCA ŒQFPVB{ƒGƒgƒ|ƒVƒhiƒVƒXƒvƒ‰ƒ`ƒ“‚Ě‚Ý”{—Ę“Š—^j‚đ4 ƒR[ƒXŽ{s‚ƁCB ŒQF‘Oq‚ĚPVB{ƒGƒgƒ|ƒVƒh2 ƒR[ƒXŽ{sŒă‚Éhigh dose CECiƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“‚Ĺ‚Í‚Č‚­”{—Ę‚ĚƒVƒXƒvƒ‰ƒ`ƒ“‚đŽg—pj‚đ2 ƒR[ƒXŽ{s‚ˇ‚é2 ŒQ‚ÉŠ„‚č•t‚Ż‚˝BŽĺ—v•]‰ż€–Ú‚Í‘Sś‘ś—Ś‚Ĺ—źŽŇ‚ĚŠÔ‚É—LˆÓˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝ip0.167jBƒTƒuƒOƒ‹[ƒv‰đÍ‚ĚŒ‹‰ĘCIGCCC ‚Ěintermediate ŒQ‚Ĺ‚Ě5 ”Nś‘ś—Ś‚ÍA ŒQ‚Ĺ88“CB ŒQ‚Ĺ82“‚Ć—LˆÓˇ‚đ”F‚ß‚Č‚Š‚Á‚˝‚ށCpoor risk ŒQ‚Ĺ‚ÍA ŒQ‚Ĺ69“CB ŒQ‚Ĺ44“‚ƁCHDCT ‚đŽ{s‚ľ‚˝ŒQ‚Ě•ű‚Ş—\Œă•s—Ç‚Ĺ‚ ‚Á‚˝ip0.045jB–{—Տ°Œ¤‹†‚ɑ΂ľ‚ẮC’ʏí—ʉťŠw—Ă–@‚Ć‚ľ‚Ä•W€‚Ĺ‚ ‚éBEP —Ă–@‚ŞŽg—p‚ł‚ę‚Ä‚¨‚炸C‚Ç‚ż‚ç‚ĚŒQ‚É‚¨‚˘‚Ä‚ŕ”{—Ę‚ĚƒVƒXƒvƒ‰ƒ`ƒ“‚ŞŽg—p‚ł‚ę‚Ä‚˘‚é‚ȂǁC‚˘‚­‚‚Š‚Ě–â‘č“_‚ŞŽw“E‚ł‚ę‚Ä‚˘‚é16jB

‚ł‚ç‚ɁCƒˆ[ƒƒbƒp‚ĚƒOƒ‹[ƒv‚ŞIGCCC ‚Ěpoor risk ¸‘ƒŽîᇊłŽŇ131 —á‚đ’ʏí—ĘŒQiBEP —Ă–@‚đ4 ƒR[ƒXj‚ƁCHDCT ŒQiVIP1 ƒR[ƒX‚Ɉř‚Ť‘ą‚˘‚Ähigh dose VIPFƒVƒXƒvƒ‰ƒ`ƒ“‚Ě‚Ý’Ęí—Ę‚đ3 ƒR[ƒXj‚ÉŠ„‚č•t‚Ż‚˝BŽĺ—v•]‰ż€–Ú‚Í2 ”NŒă‚ĚFailure free survivaliŽĄ—Ă‚ĚŽ¸”sC•a‹C‚̐isC——R‚đ–â‚í‚Č‚˘Ž€–Sj‚Ĺ’Ęí—ĘŒQ‚Í44.8“CHDCT ŒQ‚Í58.2“‚ƁCHDCT ŒQ‚Ě•ű‚ޗǍD‚Ĺ‚ ‚Á‚˝‚ށC“ŒvŠw“I—LˆÓˇ‚Í‚Č‚Š‚Á‚˝ip0.060j17jB

‚ą‚ę‚ç3 ‚‚̑ć3 ‘Š—Տ°ŽŽŒą‚ĚŒ‹‰Ę‚ć‚čC“ą“ü‰ťŠw—Ă–@‚Ć‚ľ‚Ä‚ĚHDCT ‚Ě—L—pŤ‚Í–ž‚ç‚Š‚Ĺ‚Č‚­Cpoor risk ‚̐¸‘ƒŽîᇊłŽŇ‚ɑ΂ˇ‚éŒťŽž“_‚Ĺ‚Ě•W€“IŽĄ—Ă‚ÍBEP —Ă–@4 ƒR[ƒX‚Ć‚Č‚Á‚Ä‚˘‚éB

‚Ü‚Ć‚ß‚é‚ƁC‹~Ď‰ťŠw—Ă–@‚¨‚ć‚Ń“ą“ü‰ťŠw—Ă–@‘o•ű‚É‚¨‚˘‚āCHDCT ‚Ě’Ęí—ʉťŠw—Ă–@‚ɑ΂ˇ‚é—DˆĘŤ‚ÍŘ–ž‚ł‚ę‚Ä‚˘‚Č‚˘‚˝‚߁C“úí—Տ°‚Ć‚ľ‚㋁[ƒ`ƒ“‚ÉHDCT ‚đŽ{s‚ˇ‚é‚ą‚Ƃ͐„§‚ł‚ę‚Č‚˘B

y•śŒŁz

1j Siegert W, Beyer J, Strohscheer I, et al. High-dose treatment with carboplatin, etoposide, and ifosfamide followed by autologous stem-cell transplantation in relapsed or refractory germ cell cancerFa phase Ⅰ/Ⅱ study. The German Testicular Cancer Cooperative Study Group. J Clin Oncol. 1994G12i6jF1223-31.iⅢj

2j Nichols CR, Andersen J, Lazarus HM, et al. High-dose carboplatin and etoposide with autologous bone marrow transplantation in refractory germ cell cancerFan Eastern Cooperative Oncology Group protocol. J Clin Oncol. 1992G10i4jF558-63.iⅢj

3j Motzer RJ, Mazumdar M, Bosl GJ, et al. High-dose carboplatin, etoposide, and cyclophosphamide for patients with refractory germ cell tumorsFtreatment results and prognostic factors for survival and toxicity. J Clin Oncol. 1996G14i4jF1098-105.iⅢj

4j Henon PR, Liang H, Beck-Wirth G, et al. Comparison of hematopoietic and immune recovery after autologous bone marrow or blood stem cell transplants. Bone Marrow Transplant. 1992G9i4jF285-91.iⅢj

5j Rodenhuis S, de Wit R, de Mulder PH, et al. A multi-center prospective phase Ⅱ study of high-dose chemotherapy in germ-cell cancer patients relapsing from complete remission. Ann Oncol. 1999G10i12jF1467-73.iⅢj

6j Rick O, Beyer J, Kingreen D, et al. High-dose chemotherapy in germ cell tumoursFa large single centre experience. Eur J Cancer. 1998G34i12jF1883-8.iⅢj

7j Margolin BK, Doroshow JH, Ahn C, et al. Treatment of germ cell cancer with two cycles of high-dose ifosfamide, carboplatin, and etoposide with autologous stem-cell support. J Clin Oncol. 1996G14i10jF2631-7.iⅢj

8j Bhatia S, Abonour R, Porcu P, et al. High-dose chemotherapy as initial salvage chemotherapy in patients with relapsed testicular cancer. J Clin Oncol. 2000G18i19jF3346-51.iⅢj

9j Einhorn LH, Williams SD, Chamness A, et al. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007G357i4jF340-8.iⅢj

10j Pico JL, Rosti G, Kramar A, et al. A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours. Ann Oncol. 2005G16i7jF1152-9.iⅡj

11j Lorch A, Kollmannsberger C, Hartmann JT, et al. Single versus sequential high-dose chemotherapy in patients with relapsed or refractory germ cell tumorsFa prospective randomized multicenter trial of the German Testicular Cancer Study Group. J Clin Oncol. 2007G25i19jF2778-84.iⅡj

12j Motzer RJ, Mazumdar M, Bajorin DF, et al. High-dose carboplatin, etoposide, and cyclophosphamide with autologous bone marrow transplantation in first-line therapy for patients with poor-risk germ cell tumors. J Clin Oncol. 1997G15i7jF2546-52.iⅢj

13j Decatris MP, Wilkinson PM, Welch RS, et al. High-dose chemotherapy and autologous haematopoietic support in poor risk non-seminomatous germ-cell tumoursFan effective first-line therapy with minimal toxicity. Ann Oncol. 2000G11i4jF427-34.iⅢj

14j Schmoll HJ, Kollmannsberger C, Metzner B, et al. Long-term results of first-line sequential high-dose etoposide, ifosfamide, and cisplatin chemotherapy plus autologous stem cell support for patients with advanced metastatic germ cell cancerFan extended phase Ⅰ/Ⅱ study of the German Testicular Cancer Study Group. J Clin Oncol. 2003G21i22jF4083-91.iⅢj

15j Motzer RJ, Nichols CJ, Margolin KA, et al. Phase Ⅲ randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol. 2007G25i3jF247-56.iⅡj

16j Droz JP, Kramar A, Biron P, et al. Failure of high-dose cyclophosphamide and etoposide combined with double-dose cisplatin and bone marrow support in patients with high-volume metastatic nonseminomatous germ-cell tumoursFmature results of a randomised trial. Eur Urol. 2007G51i3jF739-46Gdiscussion 47-8.iⅡj

17j Daugaard G, Skoneczna I, Aass N, et al. A randomized phase Ⅲ study comparing standard dose BEP with sequential high-dose cisplatin, etoposide, and ifosfamideiVIPjplus stem-cell support in males with poor-prognosis germ-cell cancer. An intergroup study of EORTC, GTCSG, and Grupo GerminaliEORTC 30974j. Ann Oncol. 2011G22i5jF1054-61.iⅡj


CQ 19

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ˆę•űCŽc‚č‚Ě20-30“‚ĚŠłŽŇ‚ÉŠÖ‚ľ‚ẮCBEP —Ă–@‚ž‚Ż‚Ĺ‚ÍŠŽ‘SŠ°‰đ‚ÉŽ‚żž‚Ţ‚ą‚Ć‚Ş‚Ĺ‚Ť‚Č‚˘‚˝‚߁C‹~Ď‰ťŠw—Ă–@‚Ş•K—v‚Ć‚Č‚éB‹~Ď‰ťŠw—Ă–@‚É‚¨‚Ż‚ékeydrug ‚Ě1 ‚‚Ƃľ‚āCƒCƒzƒXƒtƒ@ƒ~ƒh‚Ş‚ ‚čCVIPiƒGƒgƒ|ƒVƒhCƒCƒzƒXƒtƒ@ƒ~ƒhCƒVƒXƒvƒ‰ƒ`ƒ“j—Ă–@‚âVeIPiƒrƒ“ƒuƒ‰ƒXƒ`ƒ“CƒCƒzƒXƒtƒ@ƒ~ƒhCƒVƒXƒvƒ‰ƒ`ƒ“j—Ă–@‚Ş‹~Ď‰ťŠw—Ă–@‚Ě‘ă•\“I‚Č‚ŕ‚Ě‚Ć‚ľ‚čL‚­Ž{s‚ł‚ę‚Ä‚Ť‚˝B

Motzer ‚ç‚É‚ć‚ę‚΁C‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚Ä‚ĚVIP —Ă–@‚Ě‘tŒř—Ś‚Í25“‚ŁC’ˇŠúŠ°‰đ‚đ“ž‚˝‚Ě‚Í15“‚Ĺ‚ ‚Á‚˝1jB‚Ü‚˝CƒGƒgƒ|ƒVƒh‚Ě‘ă‚í‚č‚Ƀrƒ“ƒuƒ‰ƒXƒ`ƒ“‚đ—p‚˘‚éVeIP —Ă–@‚ம‚Ý‚ç‚ęC’ˇŠúŠ°‰đ—Ś‚Í23.7“‚Ć•ń‚ł‚ę‚Ä‚˘‚é2jBFarhat ‚ç‚ÍVIP —Ă–@‚¨‚ć‚ŃVeIP —Ă–@‘o•ű‚đŒđ‚Ś‚˝ŽĄ—ÐŹŃ‚đ”­•\‚ľ‚Ä‚˘‚é‚ŞC‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚Ä‚Ě’ˇŠúŠ°‰đ—Ś‚Í30“‚Ĺ‚ ‚Á‚˝B‚˝‚ž‚ľC‚ą‚Ě•ń‚Ĺ‚Í34 —á’†11 —á‚É‚¨‚˘‚āC’ljÁŽĄ—Ă‚Ć‚ľ‚Ä’´‘ĺ—ʉťŠw—Ă–@‚ŞŽ{s‚ł‚ę‚Ä‚˘‚é3jB

—v–ń‚ˇ‚é‚ƁC‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚Ä‚ĚVIP —Ă–@‚ ‚邢‚ÍVeIP —Ă–@‚Ě’ˇŠúŠ°‰đ—Ś‚Í25“‘OŒă‚Ć‚˘‚Á‚˝‚Ć‚ą‚ë‚Ĺ‚ ‚čC—LŠQŽ–Ű‚Ş”äŠr“I‹­‚˘‚ą‚Ć‚Ş–â‘č‚Ĺ‚ ‚Á‚˝B‚Ü‚˝C’´‘ĺ—ʉťŠw—Ă–@‚Ş‹~Ď—Ă–@‚Ć‚ľ‚čs‚í‚ę‚Ä‚Ť‚˝‚ށC’ˇŠú‚ĚŠŕ‚Č‚ľś‘śiNEDj‚Ş–ń30“’ö“x‚ŁCŽĄ—ĂŠÖ˜AŽ€‚Ş3-13“‚Ĺ‚ ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é‚ą‚Ć‚Š‚çC]—ˆ‚̍RŠŕÜ‚ĆŒđˇ‘ĎŤ‚đ—L‚ľ‚Č‚˘Cě—p‹@˜‚ĚˆŮ‚Č‚éRŠŕÜ‚Ş‹~Ď‰ťŠw—Ă–@‚É—p‚˘‚ç‚ę‚é‚悤‚É‚Č‚Á‚˝‚Ć‚˘‚¤‚ą‚Ć‚É‚Č‚éB

ƒpƒNƒŠƒ^ƒLƒZƒ‹‚̍ě—p‹@˜‚́C”÷ŹŠÇ‚ĚˆŔ’艝E‰ßčŒ`ŹE’Ed‡—}§‚ŁC’PÜ‚Ĺ‚Í–ń20“‘OŒă‚Ě—LŒřŤ‚Ş•ń‚ł‚ę‚Ä‚˘‚é4jB‚ą‚Ě‚˝‚߁CVIP —Ă–@CVeIP —Ă–@‚É‘ă‚í‚鎥—Ă‚Ć‚ľ‚āCƒpƒNƒŠƒ^ƒLƒZƒ‹‚đŠÜ‚Ţ‘˝Ü•š—p—Ă–@‚ŞŒŸ“˘‚ł‚ę‚˝B

Motzer ‚ç5j‚͏‰‰ńÄ”­—á‚ɑ΂ľCTIPiƒpƒNƒŠƒ^ƒLƒZƒ‹CƒCƒzƒXƒtƒ@ƒ~ƒhCƒVƒXƒvƒ‰ƒ`ƒ“j—Ă–@‚đs‚˘CŠŽ‘SŠ°‰điCRj‚Ş77“‚Ć”ńí‚ɂ悢ŹŃ‚đ•ń‚ľC‚Ü‚˝Kondagunta ‚ç6j‚ŕ“Ż‚śƒRƒz[ƒg‚ɑ΂ľ‚ÄCR 70“C63“‚Édurable CR ‚đ“ž‚˝‚Ć•ń‚ľ‚˝‚ށC”äŠr“I—\Œă—ǍD‚Ć‚ł‚ę‚éCR Œă‚ĚÄ”­—á‚݂̂ɑ΂ľ‚ÄTIP —Ă–@‚đs‚Á‚Ä‚¨‚čC‰đŽß‚É‚Í’ˆÓ‚đ—v‚ˇ‚éB‚ť‚ĚŒăMead ‚ç‚́CBEP failure ‚ĚÇ—á‚ɑ΂ľC2nd line —Ă–@‚Ć‚ľ‚čs‚˘C‘tŒř—Ś60“C’ˇŠúNED ‚đ38“‚É“ž‚˝‚Ć•ń‚ľ‚˝7jB–{–M‚É‚¨‚˘‚ẮCKawai ‚ç8j‚ŞTIP —Ă–@‚Ě—LŒřŤ‚đ•ń‚ľC‚Ü‚˝CNonomura ‚ç9j‚́CƒVƒXƒvƒ‰ƒ`ƒ“‚đƒlƒ_ƒvƒ‰ƒ`ƒ“‚É•ĎX‚ľ‚˝TIN —Ă–@‚Ě—LŒřŤ‚đŽŚ‚ľ‚Ä‚˘‚éB‚ą‚ę‚ç‚Ě•ń‚́C]—ˆ‚Ě‹~Ď‰ťŠw—Ă–@‚É”ä‚ׁC“Ż“™ˆČă‚ĚŒř‰Ę‚đ”F‚߁C‚Ü‚˝C—LŠQŽ–Ű‚ŕ_ŒoŠw“IˆŮí‚Ş‚â‚â‹­‚­”F‚ß‚ç‚ę‚éˆČŠOCd“Ä‚Č‚ŕ‚Ě‚Í‚Č‚Š‚Á‚˝B

•\@TIP —Ă–@
–ňÜ “Š—^—Ę day 1 day 2 day 3 day 4 day 5 day 6
ƒpƒNƒŠƒ^ƒLƒZƒ‹** 175`250 mg/m2
i–{–M•ŰŒŻ“K—p—Ę‚Ĺ‚Í
Ĺ‘ĺ210 mg/m2j
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ƒCƒzƒXƒtƒ@ƒ~ƒh 1.2 g/m2
‚Ü‚˝‚Í
1.5 g/m2
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ƒVƒXƒvƒ‰ƒ`ƒ“ 20 mg/m2   Ť Ť Ť Ť Ť
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1 ƒR[ƒXF21 “ú

 * ƒƒXƒi‚Ě“Š—^‚́CƒCƒzƒXƒtƒ@ƒ~ƒh“Š—^—Ę‚Ě20“‘Š“–—Ę‚đCƒCƒzƒXƒtƒ@ƒ~ƒh“Š—^I—š’źŒăE4 ŽžŠÔŒăE8 ŽžŠÔŒă‚ɍs‚¤B

** ƒpƒNƒŠƒ^ƒLƒZƒ‹‚É‚ć‚éd“Ä‚Č•›ě—p—\–h‚Ě‚˝‚߁C‘O“Š–ň‚Ć‚ľ‚ăXƒeƒƒCƒhCƒqƒXƒ^ƒ~ƒ“H1 blockerCƒqƒXƒ^ƒ~ƒ“H2 blocker ‚đŽg—p‚ˇ‚éB

y•śŒŁz

1j Motzer RJ, Cooper K, Geller NL, et al. The role of ifosfamide plus cisplatin-based chemotherapy as salvage therapy for patients with refractory germ cell tumors. Cancer. 1990G66F2476-81.iⅣbj

2j Loehrer PJ Sr, Gonin R, Nichols CR, et al. Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor. J Clin Oncol. 1998G16F2500-4.iⅣbj

3j Farhat F, Culine S, Theodore C, et al. Cisplatin and ifosfamide with either vinblastine or etoposide as salvage therapy for refractory or relapsing germ cell tumor patientsFthe Institut Gustave Roussy experience. Cancer. 1996G77F1193-7.iⅣbj

4j Motzer RJ, Bajorin DF, Schwartz LH, et al. Phase Ⅱ trial of paclitaxel shows antitumor activity in patients with previously treated germ cell tumors. J Clin Oncol. 1994G12F2277-83.iⅣbj

5j Motzer RJ, Sheinfeld J, Mazumdar M, et al. Paclitaxel, ifosfamide, and cisplatin second-line therapy for patients with relapsed testicular germ cell cancer. J Clin Oncol. 2000G18F2413-8.iⅣbj

6j Kondagunta GV, Bacik J, Donadio A, et al. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. 2005G23F6549-55.iⅣbj

7j Mead GM, Cullen MH, Huddart R, et al. A phase Ⅱ trial of TIPipaclitaxel, ifosfamide and cisplatinjgiven as second-lineipost-BEPjsalvage chemotherapy for patients with metastatic germ cell cancerFA Medical Research Council trial. Br J Cancer. 2005G93F178-84.iⅣbj

8j Kawai K, Miyazaki J, Tsukamoto S, et al. Paclitaxel, ifosfamide and cisplatin regimen is feasible for Japanese patients with advanced germ cell cancer. Jpn J Clin Oncol. 2003G33F127-31.iⅣbj

9j Nonomura N, Miki T, Okuyama A, et al. Paclitaxel, ifosfamide, and nedaplatiniTINjsalvage chemotherapy for patients with advanced germ cell tumors. Int J Urol. 2007G14F527-31.iⅣbj


CQ 20

œ‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚āCƒQƒ€ƒVƒ^ƒrƒ“‚âƒCƒŠƒmƒeƒJƒ“‚đŠÜ‚ŢƒŒƒWƒƒ“‚͐„§‚ł‚ę‚é‚ŠH


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C1
ƒZƒ~ƒm[ƒ}C”ńƒZƒ~ƒm[ƒ}‚Ć‚ŕ‚ɁC‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚Ä‚ĚƒQƒ€ƒVƒ^ƒrƒ“‚âƒCƒŠƒmƒeƒJƒ“‚đŠÜ‚ŢƒŒƒWƒƒ“‚́CŽĺ‚É3rd line ˆČ~‚Ě‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚Ä—p‚˘‚ç‚ę‚é‚ŞCŠm—§‚ł‚ę‚˝ƒŒƒWƒƒ“‚Ş‚Č‚­Œř‰Ę‚ŕŒŔ’č“I‚Ĺ‚ ‚éB
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1997 ”N‚ÉIGCCC ‚ŞěŹ‚ł‚ęCƒŠƒXƒN‚˛‚Ć‚É“ą“ü‰ťŠw—Ă–@‚đs‚¤‚ą‚Ć‚Ĺ‚Ů‚ÚƒRƒ“ƒZƒ“ƒTƒX‚Ş“ž‚ç‚ę‚Ä‚˘‚éB‚Ü‚˝CƒpƒNƒŠƒ^ƒLƒZƒ‹‚đŠÜ‚ŢTIP —Ă–@‚Ě—LŒřŤ‚ŞŠm—§‚ł‚ę‚‚‚ ‚éŒťÝC1st lineC2nd line —Ă–@‚Ĺ‘tŒř‚ľ‚Č‚Š‚Á‚˝ŠłŽŇŒQ‚ɑ΂ˇ‚鎥—Ă–@‚ĚŠm—§‚Ş•K—v‚Ĺ‚ ‚čCƒQƒ€ƒVƒ^ƒrƒ“‚Ş—p‚˘‚ç‚ę‚é‚悤‚É‚Č‚Á‚˝B

ƒQƒ€ƒVƒ^ƒrƒ“’PÜ‚ł́C‘tŒř—Ś15-19“‚Ć•ń‚ł‚ęC‚ť‚Ě—LŒřŤ‚ŞŽŚ´‚ł‚ę‚˝1, 2jB‘˝Ü•š—p—Ă–@‚Ĺ‚ÍƒpƒNƒŠƒ^ƒLƒZƒ‹{ƒQƒ€ƒVƒ^ƒrƒ“iTG —Ă–@j3, 4jCƒQƒ€ƒVƒ^ƒrƒ“{ƒIƒLƒTƒŠƒvƒ‰ƒ`ƒ“iGO —Ă–@C‚Ü‚˝‚ÍGEMOX —Ă–@j5, 6jCƒpƒNƒŠƒ^ƒLƒZƒ‹{ƒQƒ€ƒVƒ^ƒrƒ“{ƒVƒXƒvƒ‰ƒ`ƒ“iTGP —Ă–@j7, 8jCƒpƒNƒŠƒ^ƒLƒZƒ‹{ƒQƒ€ƒVƒ^ƒrƒ“{ƒIƒLƒTƒŠƒvƒ‰ƒ`ƒ“iTGO —Ă–@j9j‚âƒpƒNƒŠƒ^ƒLƒZƒ‹{ƒQƒ€ƒVƒ^ƒrƒ“{ƒlƒ_ƒvƒ‰ƒ`ƒ“iTGN —Ă–@j10j‚Ć‚˘‚Á‚˝‘g‚ݍ‡‚í‚š‚ŞŒŸ“˘‚ł‚ę‚˝B

2 Ü•š—p‚Ĺ‚ ‚éTG —Ă–@‚âGOi‚Ü‚˝‚ÍGEMOXj—Ă–@‚ł́C‘tŒř—Ś–ń20-40“C’ˇŠúŠŕ‚Č‚ľś‘ś‚Ş10“–˘–ž‚Ĺ‚ ‚čC‚ť‚ĚŒř‰Ę‚Íbest supportive care ‚Ć‚ľ‚Ä‚ĚˆÓ–Ą‡‚˘‚Ş‘ĺ‚Ť‚˘BTGP ‚âTGOCTGN ‚Č‚Ç‚Ě3 Ü•š—p—Ă–@‚ł́C‘tŒř—Ś30-50“’ö“x‚ŁC’ˇŠúNED ‚Ş10-20“‚Ć‚Č‚čC2 Ü•š—p—Ă–@‚ć‚č‚ť‚Ě—LŒřŤ‚ލ‚‚˘‰Â”\Ť‚Ş‚ ‚éB

‘ź‚Ě–ňÜ‚Ć‚ľ‚ẮCƒCƒŠƒmƒeƒJƒ“‚đ—p‚˘‚˝ŽĄ—Ă–@‚ށC­”‚Ĺ‚Í‚ ‚é‚Ş•ń‚ł‚ę‚Ä‚˘‚éBMiki ‚ç‚́CƒCƒŠƒmƒeƒJƒ“‚Ćƒlƒ_ƒvƒ‰ƒ`ƒ“‚Ě2 Ü•š—p—Ă–@‚đs‚˘C‘tŒř—Ś50“CCR —Ś11“‚Ć•ń‚ľ11jCPectasides ‚ç‚́CƒIƒLƒTƒŠƒvƒ‰ƒ`ƒ“‚Ć‚Ě•š—p—Ă–@‚đ3rd line ‚ōs‚˘C‘tŒř—Ś40“‚Ć•ń‚ľ‚Ä‚˘‚é12jB‚Ü‚˝CƒpƒNƒŠƒ^ƒLƒZƒ‹CƒCƒŠƒmƒeƒJƒ“CƒIƒLƒTƒŠƒvƒ‰ƒ`ƒ“‚Ě3 Ü•š—p—Ă–@‚ŞShamash ‚ç‚Š‚ç•ń‚ł‚ęC‘tŒř—Ś71“C’ˇŠúNED 29“‚É“ž‚ç‚ę‚˝‚Ć•ń‚ł‚ę13jCƒCƒŠƒmƒeƒJƒ“‚ŕ—L–]‚Č–ňÜ‚Ě1 ‚Â‚Ćl‚Ś‚ç‚ę‚éB

‚ľ‚Š‚ľCƒQƒ€ƒVƒ^ƒrƒ“CƒCƒŠƒmƒeƒJƒ“‚đŠÜ‚Ţ‹~Ď‰ťŠw—Ă–@‚́Cˆę•”‚ĚŠłŽŇ‚É—LŒř‚Ĺ‚ ‚é‰Â”\Ť‚ލl‚Ś‚ç‚ę‚é‚ŞCÇ—ᐔ‚ŕ­‚Č‚­C3rd line ˆČ~‚Ě‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚Ä‚ĚƒQƒ€ƒVƒ^ƒrƒ“‚âƒCƒŠƒmƒeƒJƒ“‚ĚŒř‰Ę‚ÍŒŔ’č“I‚Ĺ‚ ‚čC•W€ŽĄ—Ă‚Ć‚ľ‚Đ„§‚ˇ‚é‚É‚˝‚鍪‹’‚É–R‚ľ‚­CĄŒă‚ĚŒŸ“˘‚Ş‰Ű‘č‚Ĺ‚ ‚éB

y•śŒŁz

1j Bokemeyer C, Gerl A, Schoffski P, et al. Gemcitabinein patients with relapsed or cisplatin-refractory testicular cancer. J Clin Oncol. 1999G17F512-6.iⅣbj

2j Einhorn LH, Stender MJ, Williams SD. Phase Ⅱ trial of gemcitabine in refractory germ cell tumors. J Clin Oncol. 1999G17F509-11.iⅣbj

3j Einhorn LH, Brames MJ, Juliar B, et al. Phase Ⅱ study of paclitaxel plus gemcitabine salvage chemotherapy for germ cell tumors after progression following high-dose chemotherapy with tandem transplant. J Clin Oncol. 2007G25F513-6.iⅣbj

4j Hinton S, Catalano P, Einhorn LH, et al. Phase Ⅱ study of paclitaxel plus gemcitabine in refractory germ cell tumorsiE9897jFa trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2002G20F1859-63.iⅣbj

5j Kollmannsberger C, Beyer J, Liersch R, et al. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancerFa study of the German Testicular Cancer Study Group. J Clin Oncol. 2004G22F108-14.iⅣbj

6j Pectasides D, Pectasides M, Farmakis D, et al. Gemcitabine and oxaliplatiniGEMOXjin patientswith cisplatin-refractory germ cell tumorsFa phase Ⅱ study. Ann Oncol. 2004G15F493-7.iⅣbj

7j Mardiak J, Salek T, Sycova-Mila Z, et al. Gemcitabine plus cisplatine and paclitaxeliGCPjin second-line treatment of germ cell tumorsiGCTjFa phase Ⅱ study. Neoplasma. 2005G52F243-7.iⅣbj

8j Nicolai N, Necchi A, Gianni L, et al. Long-term results of a combination of paclitaxel, cisplatin and gemcitabine for salvage therapy in male germ-cell tumours. BJU Int. 2009G104F340-6.iⅣbj

9j Oechsle K, Kollmannsberger C, Honecker F, et al. Long-term survival after treatment with gemcitabine and oxaliplatin with and without paclitaxel plus secondary surgery in patients with cisplatin-refractory and/or multiply relapsed germ cell tumors. Eur Urol. 2011G60F850-5.iⅣbj

10j Shiraishi T, Nakamura T, Mikami K, et al. Salvage chemotherapy with paclitaxel and gemcitabine plus nedaplatiniTGNjas part ofmultidisciplinary therapy in patients with heavily pretreated cisplatin-refractory germ cell tumors. Int J Clin Oncol. 2009G14F436-41.iⅣbj

11j Miki T, Mizutani Y, Nonomura N, et al. Irinotecan plus cisplatin has substantial antitumor effect as salvage chemotherapy against germ cell tumors. Cancer. 2002G95F1879-85.iⅣbj

12j Pectasides D, Pectasides M, Farmakis D, et al. Oxaliplatin and irinotecan plus granulocyte-colony stimulating factor as third-line treatment in relapsed or cisplatin-refractory germ-cell tumor patientsFa phase Ⅱ study. Eur Urol. 2004G46F216-21.iⅣbj

13j Shamash J, Powles T, Mutsvangwa K, et al. A phase Ⅱ study using a topoisomerase I- based approach in patients with multiply relapsed germ-cell tumours. Ann Oncol. 2007G18F925-30.iⅣbj


CQ 21

œÄ”­EŽĄ—Ă’ďRŤŽîᇂɂ¨‚˘‚āC‹~Ď‰ťŠw—Ă–@Œă‚ĚŽc‘śŽîᇓEœi‹~ĎŠO‰Č—Ă–@j‚͐„§‚ł‚ę‚é‚ŠH


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Ä”­EŽĄ—Ă’ďRŤŽîᇂł ‚Á‚Ä‚ŕCŽíX‚Ě‹~Ď‰ťŠw—Ă–@‚É‚ć‚čŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚˝ę‡‚́C‘Ź‚â‚Š‚ÉŽc‘śŽîᇓEœ‚đs‚¤‚ą‚Ć‚Ş„§‚ł‚ę‚éB

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ˆę”ʂɁC“]ˆÚ‚đ—L‚ˇ‚鐸‘ƒŽîᇁi“Á‚É”ńƒZƒ~ƒm[ƒ}Ç—áj‚ł́CƒVƒXƒvƒ‰ƒ`ƒ“‚đŠÜ‚މťŠw—Ă–@‚đŽŔŽ{‚ľ‚˝Œă‚ɁCŽc‘ś•a•Ď‚đŘœ‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚Ä‚˘‚éB‚ť‚Ěę‡Cd—v‚Č‚ą‚Ć‚ÍŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚Ä‚˘‚é‚ą‚Ć‚Ĺ‚ ‚éB‚ą‚̂悤‚ČƒAƒvƒ[ƒ`‚ĹŽĄ—Ă‚É—Ő‚Ţ‚ą‚ƂŁC¸‘ƒŽîᇂĚ90-95“‚ĚÇ—á‚ŞŽĄ–ü‰Â”\‚Ć‚Č‚Á‚˝B

‚ľ‚Š‚ľCÄ”­EŽĄ—Ă’ďRŤŽîᇂ̏ꍇ‚Íó‹ľ‚Ş‘ĺ‚Ť‚­ˆŮ‚Č‚éB•W€“I‚Č‹~Ď‰ťŠw—Ă–@‚ĚŽŔŽ{Œă‚É“]ˆÚ‘ƒŘœp‚ލs‚í‚ę‚˝ŠłŽŇ‚Ě55“‚ĹŽc‘śŠŕ‚đ”F‚ß‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é1jB‹~Ď‰ťŠw—Ă–@‚Ć‚ľ‚ÄŽŔŽ{‚ł‚ę‚˝‘ĺ—ʉťŠw—Ă–@Œă‚É“]ˆÚ‘ƒŘœp‚ŞŽ{s‚ł‚ę‚˝ę‡‚ł́CŽc‘śŠŕ‚đ35“‚ĚŠłŽŇ‚ɁCŠďŒ`Žî‚âፍ­‰óŽ€‘gD‚đ65“‚ĚŠłŽŇ‚É”F‚߁CŽc‘śŠŕ‚̔䗌‚Ş’á‰ş‚ľ‚Ä‚˘‚é2jB‚ł‚ç‚ɁC‹~Ď‰ťŠw—Ă–@Œă‚Ě“]ˆÚ‘ƒŘœ‘gD‚ĹŽc‘śŠŕ‚đ”F‚ß‚˝ŠłŽŇ‚́C‰ťŠw—Ă–@‚đ’ljÁ‚ľ‚Ä‚ŕ—\Œă•s—Ç‚Ĺ‚ ‚é1jBˆę•űCŠďŒ`Žî‚âፍ­‰óŽ€‘gD‚ł́CŠŽ‘SŘœ‚É‚ć‚莥–ü‚ŞŠú‘Ň‚Ĺ‚Ť‚é3jB‚ą‚̂悤‚Č“_‚Š‚çC—\Œă‚̉ü‘P‚đ–ÚŽw‚ˇ‚ɂ́C“ą“ü‰ťŠw—Ă–@Œă‚Ć“Ż—l‚ɁC‹­—Í‚Č‹~Ď‰ťŠw—Ă–@‚đs‚˘Žîᇃ}[ƒJ[‚ސłí‰ť‚ˇ‚ę‚΁C‘Ź‚â‚Š‚ÉŽc‘ś•a•Ď‚ĚŠŽ‘SŘœ‚đs‚¤‚ׂŤ‚Ĺ‚ ‚é4jB

ˆę•űC‹~Ď‰ťŠw—Ă–@‚đs‚Á‚Ä‚ŕŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚Č‚˘ę‡‚́CŽc‘ś•a•ĎŘœ‚Ě“K‰ž‚Í‚Č‚˘‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚éB‚˝‚ž‚ľC•a•Ď‚ŞŒŔ‹Ç‚ľŘœ‰Â”\‚Ĺ‚ ‚éę‡‚́CŽc‘ś•a•ĎŘœidesperation surgeryj‚ŞŽŔŽ{‚ł‚ę‚é‚ą‚Ć‚Ş‚ ‚é5, 6jB“Á‚ÉŒă• –ŒƒŠƒ“ƒpß‚É•a•Ď‚ŞŒŔ‹Ç‚ľ‚Ä‚˘‚éę‡‚Ş‚ť‚Ě“K‰ž‚Ć‚ł‚ę‚é1, 7jB‚Ü‚˝CŽîᇃ}[ƒJ[‚ĹAFP ‚’l‚Ěę‡‚́ChCG ‚’l‚Ěę‡‚ĆˆŮ‚Č‚čC­‚Č‚­‚Ć‚ŕă¸ŒXŒü‚Ş‚Č‚˘ę‡‚ÉŒŔ‚čCŽc‘ś•a•ĎŘœ‚đl—ś‚ľ‚Ä‚ŕ‚悢‚Ć‚ł‚ę‚é8jB‚ą‚ę‚ç‚Ě“_‚ŁCdesperation surgery ‚Ě“K‰ž‚́CŒŔ‹ÇŤ‚ĚŒă• –Œ•a•Ď‚đ—L‚ˇ‚éÇ—á‚ŠCŘœ‰Â”\‚Č•a•Ď‚đ—L‚ˇ‚éAFP ‚’l—á‚Ě‚˘‚¸‚ę‚Š‚É‚Č‚éB‚ą‚ę‚ç‚ĚÇ—á‚Ě‚¤‚żCdesperation surgery ‚É‚¨‚˘‚ÄŠŽ‘SŘœ‚ŞŽŔŽ{‚ł‚ęCŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚˝Ç—á‚Őś‘śŠúŠÔ‚Ş’ˇ‚˘‚ą‚Ć‚Ş–{–M‚Ě‹¤“ŻŒ¤‹†‚Ĺ•ń‚ł‚ę‚Ä‚˘‚é8jB‚ľ‚Š‚ľCÄ”­EŽĄ—Ă’ďRŤŽîᇂɂ¨‚Ż‚é‹~Ď‰ťŠw—Ă–@Œă‚ĚŽc‘śŽîᇓEœi‹~ĎŠO‰Č—Ă–@j‚ÉŠÖ‚ˇ‚錤‹†‚́C‚ˇ‚ׂČă‚ëŒü‚ŤŒ¤‹†‚Š‚çŽŔŽ{‚ł‚ę‚˝‚ŕ‚̂ŁCƒGƒrƒfƒ“ƒXƒŒƒxƒ‹‚ލ‚‚˘‚ŕ‚Ě‚Í‚Č‚­CĄŒă‚Ě‚ł‚ç‚Č‚é—Տ°Œ¤‹†‚ŞŠú‘Ň‚ł‚ę‚éB

y•śŒŁz

1j Fox EP, Weathers TD, Williams SD, et al. Outcome analysis for patients with persistent nonteratomatous germ cell tumor in postchemotherapy retroperitoneal lymph node dissection. J Clin Oncol. 1993G11F1294-9.iⅣbj

2j Sammler C, Bayer J, Bokemeyer C, et al. Risk factors in germ cell tumour patients with relapse or progressive disease after first-line chemotherapyFevaluation of a prognostic score for survival after high-dose chemotherapy. Eur J Cancer. 2008G44i2jF237-43.iⅣbj

3j Rick O, Bokemeyer C, Christian J, et al. Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer. J Clin Oncol. 2004G22F3713-9.iⅣbj

4j Eggener SE, Carver BS, Loeb S, et al. Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymph node dissection after multiple chemotherapy regimens for metastatic testicular germ cell tumors. Cancer. 2007G109F528-35.iⅣbj

5j Ravi R, Ong J, Oliver RT, et al. Surgery as salvage therapy in chemotherapy-resistant nonseminomatous germ cell tumours. Br J Urol. 1998G81F884-8.iⅣbj

6j Albers, P, Ganz A, Hanning WD, et al. Salvage surgery of chemorefractory germ cell tumors with elevated tumor markers. J Urol. 2000G164F381-4.iⅣbj

7j Murphy BR, Breeden ES, Donohue JP, et al. Surgical salvage of chemorefractory germ cell tumors. J Clin Oncol. 1993G11F324-9.iⅣbj

8j Habuchi T, Kamoto T, Hara I, et al. Factors that influence the results of salvage surgery in patients with chemorefractory germ cell carcinomas with elevated tumor markers. Cancer. 2003G98F1635-42.iⅣbj


CQ 22

œ‰ťŠw—Ă–@‚đŠÜ‚ޏWŠw“IŽĄ—ĂŒă”ÓŠúÄ”­—á‚ɑ΂ľ‚āC‚ǂ̂悤‚ČŽĄ—Ă‚Ş„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

B
”ÓŠúÄ”­‚É‚¨‚˘‚Ä‚ŕCŽîᇃ}[ƒJ[‚̏㏸‚Ş‚Ý‚ç‚ęC‚Š‚“]ˆÚ‘ƒ‚ŞŒŔ‹Ç‚ľ‚Ä‚˘‚Č‚˘ę‡‚́C‘Sg‰ťŠw—Ă–@‚ĚŽŔŽ{‚ސ„§‚ł‚ę‚éB

„§ƒOƒŒ[ƒh

C1
Ä”­•a•Ď‚ŞŒŔ‹Ç‚ľ‚Ä‚˘‚éę‡‚́C•a•Ď‚ɑ΂ˇ‚éŠO‰Č“IŘœ‚ŕ„§‚ł‚ę‚éB
y‰đ ŕz

‰”­Žîᇂɑ΂ľŽčpE‰ťŠw—Ă–@‚Č‚Ç‚ĹŠŽ‘S‘tŒř‚Ć‚Č‚Á‚˝ŒăC2 ”N‚đ’´‚Ś‚čĔ­‚ľ‚˝ę‡C”ÓŠúÄ”­‚Ć’č‹`‚ł‚ę‚éB‰˘•Ä‚Ě•ń‚đ‰đÍ‚ľ‚˝Œ‹‰ĘC¸‘ƒŽîᇑS‘Ě‚Ĺ2.6“C”ńƒZƒ~ƒm[ƒ}‚Ĺ‚Í3.2“CƒZƒ~ƒm[ƒ}‚Ĺ‚Í1.4“‚ɔӊúÄ”­‚Ş”­ś‚ľ‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é1, 2jBÄ”­‚́C52“‚ĚÇ—á‚ŞŒă• –ŒC15“‚Ş”xC12“‚ޏcŠuC8“‚ŞŒz•”C4“‚ލœ”Ő•”‚É”F‚ß‚ç‚ę‚˝‚ށCƒZƒ~ƒm[ƒ}‚Ć”ńƒZƒ~ƒm[ƒ}‚Ĺ‚ť‚Ě•p“x‚ɍˇ‚Ş‚Č‚Š‚Á‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é2jB”ÓŠúÄ”­Žîᇂ̕a—‘gD‚́CŽîᇂ̐ŤŠi‚Š‚çl‚Ś‚ç‚ę‚é‚悤‚ɁCŠďŒ`Žî‚Ş–ń”ź”‚đč‚ß‚é‚Ć‚ł‚ę‚éB‚Ü‚˝C–ń20“‚Í‘BŠŕ‚≥–ä‹Ř“÷Žî‚Č‚Ç”ńăó×–EŤ‚ĚˆŤŤŽîᇂł ‚é‚Ć‚ł‚ęC”ÓŠúÄ”­‚ĚŽĄ—Ă‚đ•ĄŽG‚É‚ľ‚Ä‚˘‚é3jB

”ÓŠúÄ”­—á‚ɑ΂ˇ‚鎥—Âɂ‚˘‚āCŒťŽž“_‚Ĺ‚Í–žŠm‚ČŽĄ—Ă•űj‚Í‚Č‚˘B‚˝‚žC•a—‘gDŠŒŠ‚Š‚ç–ž‚ç‚Š‚Ȃ悤‚ɁCŠďŒ`Žî‚â”ńăó×–EŤŽîᇂޑ˝‚­č‚ß‚é‚ą‚ƁCŽc‚č‚ĚŽîá‡‚ŕ‰‰ńŽĄ—Ă‚É‘Ĺ‚żŸ‚Á‚Đś‚ŤŽc‚Á‚˝‚ŕ‚Ě‚Ĺ‚ ‚é‚ą‚Ć‚Š‚çC‰ťŠw—Ă–@‚É’ďRŤ‚Ş‚ ‚éB‚Ü‚˝•ŞŽqś•¨Šw“IŒ¤‹†‚Š‚ç”ÓŠúÄ”­ŽîᇂłÍmicrosatellite instability ‚ĆBRAF ˆâ“`Žq‚Ě•ĎˆŮ‚đ”F‚߁C‰ťŠw—Ă–@‚ɑ΂ˇ‚é’ďRŤ‚ÉŠÖ‚í‚Á‚Ä‚˘‚é‚Ć‚ĚŽw“E‚ŕ‚ ‚é4jB

ŽĄ—Ă•űjŒˆ’č‚Ě‚˝‚߁Cˆę”Ę“I‚Č“]ˆÚŤ¸‘ƒŽîᇂƓŻ—l‚ɁC‚Ü‚¸Žîᇃ}[ƒJ[‚̏㏸‚Ě—L–ł‚Ć•a•Ď•”ˆĘ‚đŠm”F‚ˇ‚éB‚ŕ‚ľŽîᇃ}[ƒJ[‚Şă¸‚ľC“]ˆÚ‘ƒŘœ‚ލs‚Ś‚Č‚˘‚Č‚ç‚ΑSg‰ťŠw—Ă–@‚đs‚¤B‚ť‚̍ہC“]ˆÚ‘ƒ‚̐śŒŸ‚đs‚˘C•a—ŠŒŠ‚đ“ž‚é‚ą‚Ć‚Ş–]‚Ü‚ľ‚˘2jB‰ťŠw—Ă–@‚ɂ‚˘‚Ă͏‰‰ń‰ťŠw—Ă–@‚Ć“Ż—l‚Ě‚ŕ‚Ě‚đ—p‚˘‚Ä‚ŕ—LŒřŤ‚Í’á‚­CˆŮ‚Č‚é‚ŕ‚Ě‚Ş•K—v‚Ĺ‚ ‚éBRonnen ‚ç‚́C‚ą‚ę‚çÇ—á‚ɑ΂ľƒpƒNƒŠƒ^ƒLƒZƒ‹CƒCƒzƒXƒtƒ@ƒ~ƒhCƒVƒXƒvƒ‰ƒ`ƒ“‚Ě3 Ü•š—p—Ă–@iTIP —Ă–@j‚đŽ{s‚ľC”äŠr“I—ǍD‚ČŽĄ—ÐŹŃ‚đ•ń‚ľ‚Ä‚˘‚é5jB

ˆę•űCÄ”­•a‘ƒ‚ŞŒŔ‹Ç‚ľ‚ÄŠŽ‘SŘœ‚މ”\‚Ć”ť’f‚ł‚ę‚éę‡‚́CŽîᇃ}[ƒJ[‚̏㏸‚ÉŠÖ‚í‚č‚Č‚­C‚Ü‚¸“]ˆÚ‘ƒ‚đŘœ‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚é1, 2, 6, 7jB‚ť‚Ě——R‚́C•a•Ď‚ŞŒŔ‹Ç‚ľ‚˝ŠďŒ`Žî‚Ěę‡CˆÚ“]‘ƒ‚̐؏œ‚É‚ć‚莥–ü‚ŞŠú‘Ň‚ł‚ę‚é‚˝‚ß‚Ĺ‚ ‚éBŽŔŰCMichael ‚ç‚́C“]ˆÚ‘ƒŘœ’P“Ć‚Ĺ‚ŕ–ń7 Š„‚ĚÇ—á‚ŞŠŽ‘SŠ°‰đ‚ľ‚¤‚é‚Ć•ń‚ľ‚Ä‚˘‚é3jB‚Ü‚˝CŠďŒ`ŽîˆČŠO‚Ĺ‚ ‚Á‚Ä‚ŕC•a—‘gD‚đ’m‚é‚ą‚Ć‚Ş‚Ĺ‚ŤCˆČŒă‚ĚŽĄ—Ă•űjŒˆ’č‚É‘ĺ‚Ť‚­Šń—^‚ˇ‚é‚ą‚Ć‚ŕC“]ˆÚ‘ƒŘœ‚ĚˆÓ‹`‚É‹“‚°‚ç‚ę‚éB

‚ą‚̂悤‚ɁC‹ß”N‚ĚŒ¤‹†‚Š‚琸‘ƒŽîᇂ̔ӊúÄ”­‚ĚŽŔ‘Ô‚Ş–ž‚ç‚Š‚É‚Č‚Á‚Ä‚Ť‚˝BĄŒă‚ł‚ç‚Č‚é—Տ°Œ¤‹†‚ĚĎ‚Ýd‚Ë‚Š‚çC‚ą‚ę‚çÇ—á‚ɑ΂ˇ‚鎥—Ă–@‚ĚŠm—§‚Ş–]‚Ü‚ę‚éB

y•śŒŁz

1j Gerl A, Clemm C, Schmeller N, et al. Late relapse of germ cell tumors after cisplatin-based chemotherapy. Ann Oncol. 1997G8F41-7.iⅣbj

2j Oldenburg J, Martin JM, Fosså SD. Late relapse of germ cell malignanciesFIncidence, management, and prognosis. J Clin Oncol. 2006G24F5503-11.iⅣbj

3j Michael H, Lucia J, Foster RS, et al. The pathology of late recurrence of testicular germ cell tumors. Am J Surg Pathol. 2000G24F257-73.iⅣbj

4j Mayer F, Wermann H, Albers P, et al. Histopathological and molecular features of late relapses in non-seminomas. BJU Int 2011G107F936-43.iⅣbj

5j Ronnen EA, Kondagunta GV, Bacik J, et al. Incidence of late-relapse germ cell tumor and outcome to salvage chemotherapy. J Clin Oncol. 2005G23F6999-7004.iⅣbj

6j Muramaki M, Hara I, Miyake H, et al. Clinical study of six cases showing late relapse of germ cell tumors. Int J Urol. 2005G12F855-8.iⅤj

7j Geldart TR, Gale J, McKendrick J, et al. Late relapse of metastatic testicular nonseminomatous germ cell cancerFsurgery is needed for cure. BJU Int. 2006G98F353-8.iⅣbj


CQ 23

œ”]“]ˆÚÇ—á‚ł́C‚ǂ̂悤‚ČŽĄ—Ă‚Ş„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

B
ƒRƒ“ƒgƒ[ƒ‹‚ˇ‚ׂŤd“ĂȐ_ŒoÇó‚Ş‚Č‚˘‚Š‚Ź‚葁‹}‚ɉťŠw—Ă–@‚đŠJŽn‚ˇ‚ׂŤ‚Ĺ‚ ‚éB
y‰đ ŕz

IGCCCGiInternational Germ Cell Cancer Collaborative Groupj‚Ě•ń‚Ĺ‚Í1jC“]ˆÚŤ¸‘ƒŽîᇏǗá‚Ě1.2“‚Ş”]“]ˆÚ‚𔺂Á‚Ä‚˘‚é‚Ć‚ł‚ę‚Ä‚¨‚čC‘˝”‚̐¸‘ƒŽîᇏǗá‚ĚŽĄ—Ă‚đs‚Á‚Ä‚˘‚éŽ{Ý‚Ĺ‚ŕ”]“]ˆÚÇ—á‚ĚŒoŒą”‚ÍŒŔ‚ç‚ę‚Ä‚˘‚éB‚ľ‚˝‚Ş‚Á‚āCŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ł‚ę‚˝Ç—áWĎŒ^ƒŒƒ|[ƒg‚đŽQl‚É‚š‚´‚é‚đ‚Ś‚Č‚˘B

Lester ‚ç‚Í22 —á‚Ě”]“]ˆÚÇ—á‚đ•ń‚ľC‚ť‚Ě‚¤‚ż‰”­Žž‚Š‚ç”]“]ˆÚ‚Ş‚ ‚éÇ—áC“ą“ü—Ă–@iPVB —Ă–@j‚ĹCR ‚đ“ž‚ç‚ę‚˝Œă‚Ě”]‚Ě‚Ý‚Ö‚Ě“]ˆÚÇ—á‚͉ťŠw—Ă–@C•úŽËü—Ă–@i‘S”]ĆŽËjCŽčp—Ă–@‚đ‘g‚ݍ‡‚í‚š‚ÄŞŽĄ‚đ–ÚŽw‚ľ‚āCĎ‹É“I‚ČŽĄ—Ă‚đ‚ˇ‚×‚Ť‚Ć‚ľ‚˝2jB

Bokemeyer ‚ç‚Í44 —á‚Ě”]“]ˆÚÇ—á‚ɑ΂ľC①ƒVƒXƒvƒ‰ƒ`ƒ“‚đŠÜ‚މťŠw—Ă–@’P“ƁC②•úŽËü—Ă–@i‘S”]ĆŽË30-45 Gy/20-25 frj’P“ƁC③Žčp—Ă–@’P“ƁC④‰ťŠw—Ă–@{•úŽËü—Ă–@C⑤‰ťŠw—Ă–@{•úŽËü—Ă–@{Žčp—Ă–@‚đs‚Á‚˝BŽĄ—Ă•ű–@‚ž‚Ż‚Š‚猊‚˝ŹŃ‚́C⑤‚ŞĹ‚ŕ—ǍD‚Ĺ’†‰›’l144 ƒJŒŽ‚̐ś‘śŠúŠÔ‚Ş“ž‚ç‚ę‚˝‚ށC②E③‚Í—\Œă•s—Ç‚Ĺ‚ ‚Á‚˝B’P•Ď—ʉđÍ‚É‚ć‚錟“˘‚Ĺ‚Í‰fŽž‚Š‚ç‚Ě”]“]ˆÚC’P”­‚Ě”]“]ˆÚ‘ƒC‰ťŠw—Ă–@‚Ć•úŽËü—Ă–@‚Ě•š—p‚Ě3 €–Ú‚Ş—LˆÓ‚É—\Œă—ǍDˆöŽq‚Ć‚Č‚Á‚˝3jB

‚Ü‚˝CFosså ‚ç‚Í‘˝Ž{Ý‚Ĺ‚Ě139 —á‚Ě”]“]ˆÚÇ—á‚ĚŽĄ—ÐŹŃ‚đ•ń‚ľ‚Ä‚˘‚é4jB139 —á‚đ‰”­Žž‚ ‚邢‚͉ťŠw—Ă–@ŠJŽnŒă4 TˆČ“ŕ‚É”]“]ˆÚ‚Ɛf’f‚ł‚ę‚˝ŒQiƒOƒ‹[ƒv1jC“ą“ü‰ťŠw—Ă–@ŠŽ‹Œă‚É”]“]ˆÚ‚ޏoŒť‚ľ‚˝ŒQiƒOƒ‹[ƒv2j‚Ě2 ŒQ‚É•Ş—Ţ‚ľCŒŸ“˘‚đs‚Á‚˝B5 ”NŽžŠł“ÁˆŮ“Iś‘ś—Ś‚̓Oƒ‹[ƒv1 ‚Ĺ45“CƒOƒ‹[ƒv2 ‚Ĺ12“‚Ĺ‚ ‚čCƒOƒ‹[ƒv1 ‚ł͉ťŠw—Ă–@‚ŞŠî–{ŽĄ—ÂŁC•úŽËü—Ă–@‚͐ś‘ś—ŚŒüă‚ÉŠń—^‚ˇ‚銄‡‚͍‚‚­‚Č‚˘‚ą‚ƁCƒOƒ‹[ƒv2 ‚ł͉ťŠw—Ă–@‚ĚƒƒŠƒbƒg‚͏­‚Č‚­C•úŽËü—Ă–@iÇ—á‚É‚ć‚čŽčp—Ă–@•š—pj‚ޏd—v‚ČŽĄ—Ă‚Ĺ‚ ‚é‚Əq‚ׂâ‚éB

Kollmannsberger ‚ç‚͏‰”­Žž‚Š‚ç”]“]ˆÚ‚Ě‚ ‚é22 l‚ɑ΂ľ‚Ähigh dose VIP —Ă–@}•úŽËü—Ă–@i‘S”]ĆŽËj‚đs‚˘C12 li55“j‚ĹCR ‚Ş“ž‚ç‚ę‚˝‚Ć‚ˇ‚é—ǍD‚ȐŹŃ‚đ•ń‚ľ‚˝5jB‚ľ‚Š‚ľŒťŽž“_‚ł́Cpoor prognosis Ç—á‚ɑ΂ˇ‚é•W€ƒŒƒWƒƒ“‚ÍBEP —Ă–@‚ސ„§‚ł‚ę‚Ä‚¨‚čC‚ą‚Ě•ń‚̉đŽß‚ɂ͐Td‚đ—v‚ˇ‚éB

‹ß”NCƒKƒ“ƒ}ƒiƒCƒt‚Č‚Ç‚Ě’čˆĘŽčp“IĆŽËistereotactic radiosurgeryFSRSj‚Ş‹}‘Ź‚É•‹y‚ľ‚Ä‚Ť‚Ä‚˘‚é‚ŞCSRS ‚Ə]—ˆ‚ĚŽčp—Ă–@C‘S”]ĆŽË‚Ć‚Ě”äŠr/•š—pŒř‰Ę‚Ȃǂ𐸑ƒŽîᇌ´”­—á‚ÉŒŔ’č‚ľ‚ÄŒŸ“˘‚ľ‚˝˜_•ś‚ÍŒťó‚Ĺ‚Í‘śÝ‚ľ‚Č‚˘B‘S”]ĆŽË‚͔ӊú—LŠQŽ–Ű‚Ć‚ľ‚Ä‹L–Á—͏áŠQ‚Č‚Ç”F’m‹@”\’ቺ‚ޏoŒť‚ˇ‚éę‡‚ŕ‚ ‚čCQOL ‚Ş’˜‚ľ‚­‘š‚Č‚í‚ę‚é‰Â”\Ť‚ŕ”O“Ş‚É’u‚­•K—v‚Ş‚ ‚éB’ˇŠú—\Œă‚ŞŠú‘Ň‚Ĺ‚Ť‚éÇ—á‚ɑ΂ľ‚ẮC1 ‰ńĆŽË—Ę‚đŒ¸‚ç‚ľ”ÓŠú—LŠQŽ–Ű‚đŒyŒ¸‚ˇ‚鎥—ĂŒv‰ć‚ŕl—ś‚ˇ‚ׂŤ‚Ĺ‚ ‚낤BSRS ‚Í’áNP‚Čmodality ‚Ĺ‚Í‚ ‚é‚ŞC“]ˆÚ‘ƒ‚ĚŒÂ”C‘ĺ‚Ť‚łCŠłŽŇ‚Ě‘Sgó‘ԁCŠú‘Ň‚ł‚ę‚鐜‘śŠúŠÔ‚Č‚Ç‚đ\•Ş‚ɍl—ś‚ľ‚˝‚¤‚Ś‚Ĺ“K‰ž‚đŒˆ’č‚ˇ‚ׂŤ‚Ĺ‚ ‚éB

y•śŒŁz

1j International Germ-Cell Cancer Collaborative Group. International Germ-Cell Consensus ClassificationFA prognostic factor-based staging system for metastatic germ-cell tumors. J Clin Oncol. 1997G15F594-603.iⅤj

2j Lester SG, Morphis‡U JG, Hornback NB, et al. Brain metastases and Testicular TumorsFNeed for Aggressive Therapy. J Clin Oncol. 1984G2F1397-1403.iⅣaj

3j Bokemeyer C, Nowak P, Haupt A, et al. Treatment of brain metastases in patients with testicular cancer. J Clin Oncol. 1997G15i4jF1449-54.iⅣaj

4j Fosså SD, Bokemeyer C, Gerl A, et al. Treatment outcome of patients with brain metastases from malignant germ cell tumors. Cancer. 1999G85i4jF988-97.iⅣaj

5j Kollmannsberger C, Nichols C, Bamberg M, et al. First-line high-dose chemotherapy}radiation therapy in patients with metastatic germ-cell cancer and brain metastases. Ann Oncol. 2000G11i5jF553-9.iⅣaj


CQ 24

œStage ⅠƒZƒ~ƒm[ƒ}‚ɑ΂ľ‚Ăǂ̂悤‚ČŒo‰ßŠĎŽ@iƒT[ƒxƒCƒ‰ƒ“ƒXj‚ސ„§‚ł‚ę‚é‚ŠH


„§ƒOƒŒ[ƒh

B
‚ˆĘ¸‘ƒ“EœpŒă‚É3 ‚‚̑I‘đŽˆiŒo‰ßŠĎŽ@C•úŽËü—Ă–@CƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“—Ă–@j‚Ě‚˘‚¸‚ę‚đ‘I‚ń‚Ĺ‚ŕCÄ”­‚Ě‘ĺ•”•Ş‚Í2 ”NˆČ“ŕ‚É‹N‚ą‚čCpŒă3 ”NˆČ“ŕ‚Í“Á‚É–Č–§‚ČƒtƒHƒ[‚Ş•K—v‚Ĺ‚ ‚éB‚ľ‚Š‚ľC–łŽ‹‚Ĺ‚Ť‚Č‚˘Šm—Ś‚Ĺ5 ”NˆČ~‚É‚ŕÄ”­‚ľ‚Ä‚­‚é‚˝‚߁C­‚Č‚­‚Ć‚ŕ”N1 ‰ń‚ĚƒtƒHƒ[ƒAƒbƒv‚đCpŒă10 ”N‚đ–ڏˆ‚É‘ą‚Ż‚é•K—v‚Ş‚ ‚éB
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①Œo‰ßŠĎŽ@‚Ş‘I‘đ‚ł‚ę‚˝ę‡‚Ě—ŻˆÓŽ–€

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‚ľ‚Š‚ľCŠĎŽ@ŠúŠÔ‚މ„‚Ń‚ę‚ΔӊúÄ”­‚Í‚ł‚ç‚É’ˇŠú‚É‹y‚ԉ”\Ť‚Ş‚ ‚é5jB–T‘ĺ“Ž–Ź—Ěˆć‚Ě‚Ý‚Ě20-30 Gy ‚Ě•â••úŽËü—Ă–@‚ލs‚í‚ę‚˝ę‡CĆŽË—Ěˆć‚Ĺ‚ĚÄ”­‚Í”ńí‚É‚Ü‚ęi5/487F1“j‚Ć‚Č‚čCÄ”­•”ˆĘ‚͏cŠu‚⍽œăâ|ƒŠƒ“ƒpß‚Ş‘˝‚˘8jB‚ą‚Ě‚˝‚߁C—á‚Ś‚ΖT‘ĺ“Ž–Ź—Ěˆć‚Ě•â••úŽËü—Ă–@‚đs‚Á‚˝ę‡C• •”CT ‚Í•s—v‚ŁCœ”Ő“ŕ‚Ě‚Ý‚ĚCT ƒXƒLƒƒƒ“‚đ„§‚ľ‚Ä‚˘‚é•ń‚ŕ‚ ‚é12jBĆŽË–ě‚ÉŠÖ‚ˇ‚éTE10 Œ¤‹†‚Ěƒf[ƒ^‚ł́C242 —á‚Ědogleg Œ^ĆŽË‚Ĺ‚Íœ”Ő“ŕÄ”­‚ÍŠĎŽ@‚ł‚ę‚Č‚Š‚Á‚˝‚ށi0“jC236 —á‚Ě–T‘ĺ“Ž–Ź—Ěˆć‚Ě‚Ý‚ĚĆŽË‚Ĺ‚Í4 —ái1.7“j‚É”F‚ß‚Ä‚˘‚é11, 13jB‚ľ‚Š‚ľC–T‘ĺ“Ž–Ź—ĚˆćEdogleg Œ^‚Ě—źĆŽË•ű–@‚É‚¨‚˘‚Ä‚ŕC• •”ƒŠƒ“ƒpß‚âĆŽË–ě‚É‚ŕÄ”­‚Í‹N‚ą‚é8, 11jB‚ľ‚˝‚Ş‚Á‚āCŒo‰ßŠĎŽ@‚ĚCT ‚É‚¨‚˘‚Ă͍œ”Ő•”‚ž‚Ż‚ĚƒXƒLƒƒƒ“‚ž‚Ż‚Ĺ‚Č‚­C• •”œ”Ő•”‚ĚƒXƒLƒƒƒ“‚đs‚¤‚Ě‚Ş‘Ă“–‚ƍl‚Ś‚ç‚ę‚é14, 15jB‚Č‚¨‘Α¤¸‘ƒ‚ĚŽîᇔ­ś‚ɂ‚˘‚ẮC•úŽËü—Ă–@i20-30 GyC–T‘ĺ“Ž–Ź—Ěˆć‚Ě‚ÝĆŽËj‚Ĺ‚Í904 —á’†15 —ái1.7“FŠĎŽ@ŠúŠÔ’†‰›’l6.5 ”Nj‚É”F‚ß‚ç‚ę‚Ä‚˘‚é‚ŞCŒă‚Ů‚Çq‚ׂé•â•ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“—Ă–@iAUC7j‚đs‚¤‚ƁC573 —á’†2 —ái0.3“j‚Ć—LˆÓ‚ɒቺ‚ľ‚Ä‚˘‚é10, 11jB

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1j von der Maase H, Specht L, Jacobsen GK, et al. Surveillance following orchidectomy for stage Ⅰ seminoma of the testis. Eur J Cancer. 1993G29AF1931-4.iⅣaj

2j Choo R, Thomas G, Woo T, et al. Long-term outcome of postorchiectomy surveillance for Stage Ⅰ testicular seminoma. Int J Radiat Oncol Biol Phys. 2005G61F736-40.iⅣaj

3j Cummins S, Yau T, Huddart R, et al. Surveillance in stage Ⅰ seminoma patientsFa long-term assessment. Eur Urol. 2010G57F673-8.iⅣaj

4j Warde P, Specht L, Horwich A, et al. Prognostic factors for relapse in stage Ⅰ seminoma managed by surveillanceFa pooled analysis. J Clin Oncol. 2002G20F4448-52.iⅣaj

5j Chung P, Parker C, Panzarella T, et al. Surveillance in stage Ⅰ testicular seminoma-risk of late relapse. Can J Urol. 2002G9F1637-40.iⅣaj

6j Tolan S, Vesprini D, Jewett MA, et al. No role for routine chest radiography in stage Ⅰ seminoma surveillance. Eur Urol. 57F474-9.iⅣaj

7j Horwich A, Alsanjari N, AfHern R, et al. Surveillance following orchidectomy for stage Ⅰ testicular seminoma. Br J Cancer. 1992G65F775-8.iⅣaj

8j Santoni R, Barbera F, Bertoni F, et al. Stage Ⅰ seminoma of the testisFa bi-institutional retrospective analysis of patients treated with radiation therapy only. BJU Int. 2003G92F47-52Gdiscussion 52.iⅣaj

9j Jones WG, Fosså SD, Mead GM, et al. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage Ⅰ Testicular SeminomaFa report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942iISRCTN18525328j. J Clin Oncol. 2005G23F1200-8.iⅡj

10j Oliver RT, Mead GM, Rustin GJ, et al. Randomized trial of carboplatin versus radiotherapy for stage Ⅰ seminomaFmature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 studyiISRCTN27163214j. J Clin Oncol. 2011G29F957-62.iⅡj

11j Mead GM, Fosså SD, Oliver RT, et al. Randomized trials in 2466 patients with stage Ⅰ seminomaFpatterns of relapse and follow-up. J Natl Cancer Inst 2011G103F241-9.iⅡj

12j Skliarenko J, Vesprini D, Warde P. Stage Ⅰ seminomaFwhat should a practicing uro-oncologist do in 2009?. Int J Urol. 2009G16F544-51.

13j Fosså SD, Horwich A, Russell JM, et al. Optimal planning target volume for stage Ⅰ testicular seminomaFA Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group. J Clin Oncol. 1999G17F1146.iⅡj

14j Albers P, Albrecht W, Algaba F, et al. EAU guidelines on testicular cancerF2011 update. Eur Urol. 60F304-19.

15j Oldenburg J, Fosså SD, Nuver J, et al. Testicular seminoma and non-seminomaFESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013GSupple 6F125-32.

16j National Comprehensive Cancer NetworkiNCCNj. org. NCCN Clinical practice guidelines in oncologyFtesticular cancer. Ver.@1. 2014.

17j Travis LB, Fosså SD, Schonfeld SJ, et al. Second cancers among 40,576 testicular cancer patientsFfocus on long-term survivors. J Natl Cancer Inst. 2005G97F1354-65.iⅣaj

18j Zagars GK, Ballo MT, Lee AK, Strom SS. Mortality after cure of testicular seminoma. J Clin Oncol. 2004G22F640-7.iⅣaj

19j Fosså SD, Chen J, Schonfeld SJ, et al. Risk of contralateral testicular cancerFa population-based study of 29,515 U.@S. men. J Natl Cancer Inst. 2005G97F1056-66.iⅣaj


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*uChoueiri TK, Stephenson AJ, Gilligan T, et al. Management of clinical stage Ⅰ nonseminomatous germ cell testicular cancer. Urol Clin North Am. 2007G34F137-48v, uNCCN Guidelines Version 1.2012 Testicular Cancer. 2012v‚ć‚čˆř—p

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RPLND ‚ĹŠO‰Č“I‚ÉŠŽ‘S‚Č“Eœ‚ލs‚í‚ęC‚Š‚•a—Šw“I‚É“]ˆÚ‚Ě‚Č‚˘‚ą‚Ć‚ŞŘ–ž‚ł‚ę‚˝ŠłŽŇ‚É‚ÍŒo‰ßŠĎŽ@‚Ş‘I‘đ‚ł‚ę‚éB‚ą‚Ěę‡CŒă• –ŒÄ”­‚Í‹É‚ß‚Ä’á‚­i3“–˘–žj6, 15jCÄ”­‚Ě•p“x‚ލ‚‚˘‚Ě‚Í”xCcŠuC‘lŒa•”‚̏‡‚ŁCÄ”­‚Ě90“ˆČă‚ÍRPLND ‚Š‚ç2 ”NˆČ“ŕ‚ɐś‚ś‚éi•˝‹Ď8 ƒJŒŽj‚ށCÄ”­‚̏ꏩ‚ĆŽžŠú‚ÉŠÖ˜AŤ‚Í‚Č‚˘8, 15jB‚Ů‚Ć‚ń‚Ç‚ĚÄ”­‚Í‹š•”X üŒŸ¸‚ĆŽîᇃ}[ƒJ[‚ĹŒŸo‚ł‚ę‚é8jB‚ľ‚˝‚Ş‚Á‚āCRPLND Œă‚ĚƒtƒHƒ[ƒAƒbƒvƒXƒPƒWƒ…[ƒ‹‚͉ťŠw—Ă–@Œă‚Ć“Ż—l‚ɁCŒo‰ßŠĎŽ@’P“ĆŽž‚Ěƒ‚ƒjƒ^ƒŠƒ“ƒOŠÔŠu‚đ‚â‚≄’ˇ‚ľ‚˝‚ŕ‚Ě‚Ş‘Ă“–‚Ĺ‚ ‚낤B‚˝‚ž‚ľCŒă• –ŒƒŠƒ“ƒpß‚ÉŽć‚čŽc‚ľ‚Ě‹^‚˘‚Ş‚Č‚Ż‚ę‚΁Cƒ‹[ƒ`ƒ“‚Ě• Eœ”Ő•”CT ŒŸ¸‚Í•K—v‚Č‚˘B•˝‹Ď“IƒtƒHƒ[ƒAƒbƒvƒXƒPƒWƒ…[ƒ‹‚đ•\3 ‚ÉŽŚ‚ˇB

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1j Jones RH, Vasey PA. Part ‡TFtesticular cancer--management of early disease. Lancet Oncol. 2003G4F730-7.iⅣaj

2j Divrik RT, Akdoğan B, Ozen H, et al. Outcomes of surveillance protocol of clinical stage Ⅰ nonseminomatous germ cell tumors-is shift to risk adapted policy justified? J Urol. 2006G176F1424-29Gdiscussion 1429-30.iⅣbj

3j Gels ME, Hoekstra HJ, Sleijfer DT, et al. Detection of recurrence in patients with clinical stage Ⅰ nonseminomatous testicular germ cell tumors and consequences for further follow-upFa single-center 10-year experience. J Clin Oncol. 1995G13F1188-94.iⅣaj

4j Colls BM, Harvey VJ, Skelton L, et al. Late results of surveillance of clinical stage Ⅰ non-seminoma germ cell testicular tumoursF17 yearsfexperience in a national study in New Zealand. BJU Int. 1999G83F76-82.iⅣaj

5j Read G, Stenning SP, Cullen MH, et al. Medical Research Council prospective study of surveillance for stage Ⅰ testicular teratoma. Medical Research Council Testicular Tumors Working Party. J Clin Oncol. 1992G10F1762-8.iⅣaj

6j Choueiri TK, Stephenson AJ, Gilligan T, et al. Management of clinical stage Ⅰ nonseminomatous germ cell testicular cancer. Urol Clin North Am. 2007G34F137-48.iⅠj

7j Oliver RT, Ong J, Shamash J, et al. Long-term follow-up of Anglian Germ Cell Cancer Group surveillance versus patients with Stage 1 nonseminoma treated with adjuvant chemotherapy. Urology. 2004G63F556-61.iⅣaj

8j Sharir S, Foster RS, Donohue JP, et al. What is the appropriate follow-up after treatment? Semin Urol Oncol. 1996G14F45-53.iⅣaj

9j Segal R. Surveillance programs for stage Ⅰ nonseminomatous germ cell tumors of the testis. Urol Oncol. 2006G24F68-74.iⅣaj

10j Rustin GJ, Mead GM, Stenning SP, et al. Randomized trial of two or five computed tomography scans in the surveillance of patients with stage Ⅰ nonseminomatous germ cell tumors of the testisFMedical Research Council Trial TE08, ISRCTN56475197--the National Cancer Research Institute Testis Cancer Clinical Studies Group. J Clin Oncol. 2007G25F1310-5.iⅡj

11j Pont J, Albrecht W, Postner G, et al. Adjuvant chemotherapy for high-risk clinical stage Ⅰ nonseminomatous testicular germ cell cancerFlong-term results of a prospective trial. J Clin Oncol. 1996G14F441-8.iⅣaj

12j Studer UE, Fey MF, Calderoni A, et al. Adjuvant chemotherapy after orchiectomy in high-risk patients with clinical stage Ⅰ non-seminomatous testicular cancer. Eur Urol. 1993G23F444-9.iⅣaj

13j Albers P, Siener R, Krege S, et al. Randomized phase Ⅲ trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage Ⅰ Nonseminomatous testicular germ cell tumorsFAUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. 2008G26F2966-72.iⅡj

14j Cullen MH, Stenning SP, Parkinson MC, et al. Short-course adjuvant chemotherapy in high-risk stage Ⅰ nonseminomatous germ cell tumors of the testisFa Medical Research Council report. J Clin Oncol. 1996G14F1106-13.iⅣaj

15j McLeod DG, Weiss RB, Stablein DM, et al. Staging relationships and outcome in early stage testicular cancerFa report from the Testicular Cancer Intergroup Study. J Urol. 1991G145F1178-83Gdiscussion 1182-3.iⅣaj

16j Williams SD, Stablein DM, Einhorn LH, et al. Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage Ⅱ testicular cancer. N Engl J Med. 1987G317F1433-8.iⅡj


CQ 26

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–uSchmoll HJ, Jordan K, Huddart R, et al. ESMO Guidelines Working Group. Testicular seminomaFESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010G21 Suppl 5Fv140-6.vCuNCCN Guidelines Version 1.2012 Testicular Cancer.2012.v‚ć‚čˆř—p

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y•śŒŁz

1j Albers P. Resection of retroperitoneal residual tumor after chemotherapy for testicular cancer indication and surgical techniques. Crit Rev Oncol Hematol. 2004G50F79-85.iⅣaj

2j Warde P, Huddart R, Bolton D, et al. Management of localized seminoma, stageⅠ-ⅡFSIU/ICUD Consensus Meeting on Germ Cell TumorsiGCTj, Shanghai 2009. Urology. 2011G78i4 SuppljFS435-43.

3j De Santis M, Becherer A, Bokemeyer C, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminomaFan update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004G22F 1034-9.iⅣaj

4j Becherer A, De Santis M, Karanikas G, et al. FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol. 2005G54F284-8.iⅣaj

5j Spiess PE, Kassouf W, Brown GA, et al. Surgical management of growing teratoma syn-dromeFthe M.@D. Anderson cancer center experience. J Urol. 2007G177F1330-4.iⅣaj

6j Spiess PE, Pisters LL, Liu P, et al. Malignant transformation of testicular teratomaFa chemoresistant phenotype. Urol Oncol. 2008G26F595-9.iⅣaj

7j Steyerberg EW, Keizer HJ, Fosså SD, et al. Prediction of residual retroperitoneal mass histology after chemotherapy for metastatic nonseminomatous germ cell tumourFmultivariate analysis of individual patient data from six study groups. J Clin Oncol. 1995G13F1177-87.iⅣaj

8j Sheinfeld J. The role of adjunctive postchemotherapy surgery for nonseminomatous germ-cell tumorsFcurrent concepts and controversies. Semin Urol Oncol. 2002G20F262-71.iⅣaj

9j Hendry WF, AfHern RP, Hetherington JW, et al. Para-aortic lymphadenectomy after chemotherapy for metastatic non-seminomatous germ cell tumoursFprognostic value and therapeutic benefit. Br J Urol. 1993G71F208-13.iⅣaj

10j Hendry WF, Norman AR, Dearnaley DP, et al. Metastatic nonseminomatous germ cell tumors of the testisFresults of elective and salvage surgery for patients with residual retroperitoneal masses. Cancer. 2002G94F1668-76.iⅣbj

11j Steyerberg EW, Kaiser HJ, Habbema JD. Prediction models for the histology of residual masses after chemotherapy for metastatic testicular cancer. ReHiT Study Group. Int J Cancer. 1999G83F856-9.iⅣaj

12j Carver BS, Shayegan B, Serio A, et al. Long-term clinical outcome after postchemotherapy retroperitoneal lymph node dissection in men with residual teratoma. J Clin Oncol. 2007G25F1033-7.iⅣaj

13j Fizazi K, Tjulandin S, Salvioni R, et al. Viable malignant cells after primary chemotherapy for disseminated nonseminomatous germ cell tumorsFprognostic factors and role of postsurgery chemotherapy--results from an international study group. J Clin Oncol. 2001G19F2647-57.iⅣbj

14j Fizazi K, Oldenburg J, Dunant A, et al. Assessing prognosis and optimizing treatment in patients with postchemotherapy viable nonseminomatous germ-cell tumorsiNSGCTjFresults of the sCR2 international study. Ann Oncol. 2008G19F259-64.iⅣaj

15j Fosså SD, Ous S, Lien HH, et al. Post-chemotherapy lymph node histology in radiologically normal patients with metastatic nonseminomatous testicular cancer. J Urol. 1989G141F557-9.iⅣbj

16j Kuczyk M, Machtens S, Stief C, et al. Management of the post-chemotherapy residual mass in patients with advanced stage non-seminomatous germ cell tumorsiNSGCTj. Int J Cancer. 1999G83F852-5.iⅣaj

17j Toner GC, Panicek DM, Heelan RT, et al. Adjunctive surgery after chemotherapy for nonseminomatous germ cell tumorsFrecommendations for patient selection. J Clin Oncol 1990G8F1683-94.iⅣaj

18j Katz MH, McKiernan JM. Management of non-retroperitoneal residual germ cell tumor masses. Urol Clin North Am. 2007G34F235-43.iⅣaj

19j Kollmannsberger C, Daneshmand S, So A, et al. Management of disseminated nonseminomatous germ cell tumors with risk-based chemotherapy followed by response-guided postchemotherapy surgery. J Clin Oncol. 2010G28F537-42.iⅣaj

20j Ehrlich Y, Brames MJ, Beck SD, et al. Long-term follow-up of Cisplatin combination chemotherapy in patients with disseminated nonseminomatous germ cell tumorsFis a postchemotherapy retroperitoneal lymph node dissection needed after complete remission? J Clin Oncol. 2010G28F531-6.iⅣaj

21j Classen J, Schmidberger H, Meisner C, et al. Radiotherapy for stages ⅡA/B testicular seminomaFfinal report of a prospective multicenter clinical trial. J Clin Oncol 2003G21F1101-6.iⅢj

22j Chung PW, Gospodarowicz MK, Panzarella T, et al. Stage Ⅱ testicular seminomaFpatterns of recurrence and outcome of treatment. Eur Urol. 2004G45F754-9.iⅣaj

23j Sharir S, Foster RS, Donohue JP, et al. What is the appropriate follow-up after treatment?. Semin Urol Oncol. 1996G14F45-53.iⅣaj


CQ 27

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cŠuŒ´”­‚Ěăó×–EŽîᇂ́CŤ‘BŠOŒ´”­‚Ě50-70“‚đč‚߁CŽĺ‚Č•a•Ď‚Ě‘śÝ•”ˆĘ‚Í‘OcŠu‚Ĺ‚ ‚é9jBcŠuŒ´”­‚Ěăó×–EŽîá‡322 —á‚ĚŒŸ“˘‚ł́CŹnŠďŒ`Žî27“C–˘nŠďŒ`ŽîEˆŤŤŹ•Ş‚đ—L‚ˇ‚éŠďŒ`Žî16“CƒZƒ~ƒm[ƒ}37“C”ńƒZƒ~ƒm[ƒ}iŠďŒ`Ží‚̐Ź•Ş‚đŽ‚˝‚Č‚˘j16“C‚¨‚ć‚эŹ‡Œ^4“‚Ĺ‚ ‚Á‚˝10jB‰“Šu“]ˆÚ‚́CƒZƒ~ƒm[ƒ}‚ł́CŒz•”‚â• o“ŕƒŠƒ“ƒpß‚Č‚Ç‚É”F‚ß‚ç‚ęC”ńƒZƒ~ƒm[ƒ}‚ł́C”xCŠĚ‘ŸCŒz•”‚â• o“ŕƒŠƒ“ƒpß‚Č‚Ç‚É”F‚ß‚ç‚ę‚é9jBcŠuŒ´”­‚Ě”ńƒZƒ~ƒm[ƒ}‚ł́C‘˘ŒŒŠíˆŤŤŽîᇁi‹}Ť”’ŒŒ•a‚Ȃǁj‚ލ‡•š‚ˇ‚é‚ą‚Ć‚ŕ‚ ‚é11jBcŠuŒ´”­ăó×–EŽîᇂ̎ŠŠoÇó‚́CŒÄ‹z˘“ďC‹š’ɁCŠPC”­”M‚Č‚Ç‚Ĺ‚ ‚é9jBŒă• –ŒŒ´”­‚Ěăó×–EŽîᇂ́CŤ‘BŠOŒ´”­‚Ě30-40“‚đč‚߁C‹‘ĺ‚ČŽîᎂŔ­ŒŠ‚ł‚ę‚é‚ą‚Ć‚Ş‘˝‚˘BŽŠŠoÇó‚́C• ’ɁC”w•”’ɁC‘̏dŒ¸­C”­”MCG’m‰Â”\‚Č• •”ŽîᎁC‰A囊…Žî‚Č‚Ç‚Ĺ‚ ‚é9jBcŠuC‚¨‚ć‚ŃŒă• –ŒŒ´”­‚Ć‚ŕ‚ɁC—Ť‰ť“ű–[‚đ—ˆ‚ˇ‚ą‚Ć‚ŕ‚ ‚éB

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¸‘ƒ‚ÉŽîᎂđ”F‚ß‚Č‚˘ę‡‚Ĺ‚ŕChCGC‚ ‚邢‚ÍAFP ‚Ě’˜–ž‚ȏ㏸‚đ”F‚ß‚˝ę‡‚́Căó×–EŽîᇂދ^‚í‚ę‚é‚˝‚߁CĎ‹É“I‚ÉŽîᇐśŒŸiCT ƒKƒCƒh‰şśŒŸC“ŞŠW“ŕ‚Ěę‡‚́C’čˆĘ”]ŽîᇐśŒŸj‚đs‚¤B•a—‘gD‚̐f’f‚ɂ́C–Ɖu‘gDőF‚Ş•K—v‚Ć‚Č‚é‚ą‚Ć‚Ş‘˝‚­CAFPChCG ‚̐őF‚â‘Ů”ŐƒAƒ‹ƒJƒŠƒtƒHƒXƒtƒ@ƒ^[ƒ[‚âOCT4ioctamer-binding transcription factor 4j‚̐őF‚ސf’f‚É—L—p‚Ć‚ł‚ę‚Ä‚˘‚é12jB‚Ü‚˝CŽîᇃ}[ƒJ[‚â‘gDf‚ĹŠm’č‚Ş˘“ď‚Čę‡Cchromosome 12p ‚ĚˆŮí‚Ş—L—p‚Čę‡‚Ş‚ ‚é13jBŤ‘BŠOăó×–EŽîᇂ́C¸×ŠÇ“ŕˆŤŤăó×–Eiintratubular malignant germ cellsFITMGCj‚đ•š”­‚ľ‚Ä‚˘‚éę‡‚Ş‚ ‚čC‰ťŠw—Ă–@‘O‚É•Đ‘¤or —ź‘¤¸‘ƒ‚̐śŒŸ‚đs‚Á‚˝ŒŸ“˘‚ł́iŒă• –ŒŒ´”­53 —áC‚¨‚ć‚яcŠuŒ´”­15 —ájC21 —ái31“F‚¤‚żŒă• –ŒŒ´”­18 —áj‚ÉITMGC ‚đ”F‚ß‚˝14jB‘唟‚ĚÇ—á‚ŞCƒVƒXƒvƒ‰ƒ`ƒ“‚𒆐S‚Ć‚ľ‚˝‰ťŠw—Ă–@‚đŽó‚Ż‚é‚˝‚߁C‚Ů‚Ć‚ń‚Ç‚ĚITMGC ‚ŞŽĄ—Ă‚ł‚ę‚Ä‚˘‚é‚ƍl‚Ś‚ç‚ęCŤ‘BŠOŒ´”­‚Ěăó×–EŽîᇂɑ΂ˇ‚郋[ƒ`ƒ“‚̐¸‘ƒśŒŸ‚͐„§‚ł‚ę‚Ä‚˘‚Č‚˘15jB

Ť‘BŠOăó×–EŽîᇂł́CŽĄ—ÏI—šŒă‚ĚˆŮŽžŤ¸‘ƒŽîᇂ̔­ś‚É’ˆÓ‚ˇ‚é•K—v‚Ş‚ ‚éBŽĄ—ĂŒă‚̐Ť‘BŠOăó×–EŽîá‡635 —ái53“‚͏cŠuŒ´”­j‚ĚŒă‚ëŒü‚ŤŒ¤‹†‚ł́Cf’f‚Š‚ç‚Ě’†‰›’l5 ”N‚ĚŽž“_‚ŁC16 —ái4.1“C11 —á‚ŞƒZƒ~ƒm[ƒ}j‚ɐ¸‘ƒŽîᇂ𔭏ǂľ‚˝BˆŮŽžŤ¸‘ƒŽîᇂĚ10 ”NŠÔ—ÝŒv”­ÇƒŠƒXƒN‚́C10.3“‚Ĺ‚ ‚Á‚˝B10 ”NŠÔ—ÝŒv”­ÇƒŠƒXƒN‚́C”ńƒZƒ~ƒm[ƒ}CƒZƒ~ƒm[ƒ}CŒă• –ŒŒ´”­C‚¨‚ć‚яcŠuŒ´”­‚ŁC‚ť‚ę‚ź‚ęC14.3“C1.4“C14.2“C‚¨‚ć‚Ń6.2“‚Ĺ‚ ‚čC”ńƒZƒ~ƒm[ƒ}C‚¨‚ć‚ŃŒă• –ŒŒ´”­‚Ĺ”­ÇƒŠƒXƒN‚ލ‚‚Š‚Á‚˝15jB

y•śŒŁz

1j Stang A, Trabert B, Wentzensen N, et al. Gonadal and extragonadal germ cell tumors in the United States, 1973-2007. Int J Androl. 2012G35F616-25.iⅣaj

2j Trama A, Mallone S, Nicolai N, et al. Burden of testicular, paratesticular and extragonadal germ cell tumors in Europe. Eur J Cancer. 2012G48F159-69.iⅣaj

3j McCarthy BJ, Shibui S, Kayama T, et al. Primary CNS germ cell tumors in Japan and the United StatesFan analysis of 4 tumor registries. Neuro Oncol. 2012G14F1194-200.iⅣaj

4j Horton Z, Schlatter M, Schultz S. Pediatric germ cell tumors. Surg Oncol. 2007G16F205-13.

5j Kleinhans B, Kalem T, Hendricks D, et al. Extragonadal germ cell tumor of the prostate. J Urol. 2001G166F611-2.iⅤj

6j Hanna NH, Ulbright TM, Einhorn LH. Primary choriocarcinoma of the baldder with the detection of isochromosome 12p. J Urol. 2002G167F1781.iⅤj

7j Oosterhuis JW, Stoop H, Honecker F, et al. Why human extragonadal germ cell tumors occur in the midline of the bodyFold concepts, new perspectives. Int J Androl. 2007G30F256-64.

8j Hasle H, Mellemgaard A, Nielsen J, et al. Cancer incidence in men with Klinefelter syn-drome. Br J Cancer. 1995G71F416-20.iⅣaj

9j Bokemeyer C, Nichols CR, Droz JP, et al. Extragonadal germ cell tumors of the mediastinum and retrpperitoneumFresults from an international analysis. J Clin Oncol. 2002G20F1864-73.iⅣbj

10j Nichols CR, Roth BJ, Heerema N, et al. Hematologic neoplasia associated with primary mediastinal germ-cell tumors. N Engl J Med. 1990G322F1425-9.iⅤj

11j Moran CA, Suster S. Primary germ cell tumors of the mediastinum I. analysis of 322 cases with special emphasis on teratomatous lesions and a proposal for histopathologic classification and clinical Staging. Cancer. 1997G80F681-90.iⅣbj

12j Iczkowski KA, Butler SL, Shanks JH, et al. Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors. Hum Pathol. 2008G39F275-81.iⅣbj

13j Motzer RJ, Rodriguez E, Reuter VE, et al. Molecular and cytogenetic studies in the diagnosis of patients with poorly differentiated carcinomas of unknown primary site. J Clin Oncol. 1995G13F274-82.iⅣbj

14j Fosså SD, Aass N, Heilo A, et al. Testicular carcinoma in situ in patients with extragonadal germ-cell tumoursFthe clinical role of pretreatment biopsy. Ann Oncol. 2003G14F1412-8.iⅣbj

15j Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancerFa report of the second meeting of the European Germ Cell Cancer Consensus groupFPart Ⅰ. Eur Urol. 2008G53F478-96.iⅠj

16j Hartmann JT, Fosså SD, Nichols CR, et al. Incidence of metachronous testicular cancer in patients with extragonadal germ cell tumors. J Natl Cancer Inst. 2001G93F1733-8.iⅠj


CQ 28

œŤ‘BŠOăó×–EŤŽîᇂɂ¨‚˘‚Ăǂ̂悤‚ČŽĄ—Ă‚Ş„§‚ł‚ę‚é‚ŠH


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A
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Ť‘BŠO”ńƒZƒ~ƒm[ƒ}‚Ě—\Œă‚́CcŠuŒ´”­287 —ái‰“Šu“]ˆÚ‚Č‚ľ51“j‚ł́C5 ”N–ł‘ˆŤś‘ś—ŚC‚¨‚ć‚ѐś‘ś—Ś‚Í44“C45“‚Ĺ‚ ‚Á‚˝4jBˆę•űCŒă• –ŒŒ´”­227—ái‰“Šu“]ˆÚ‚Č‚ľ24“j‚ł́C‚ť‚ę‚ź‚ęC45“‚¨‚ć‚Ń62“‚Ĺ‚ ‚čC”ńƒZƒ~ƒm[ƒ}‚ł́CcŠuŒ´”­‚Ě—\Œă‚ŞŒă• –ŒŒ´”­‚ć‚č‚ŕ•s—Ç‚Ĺ‚ ‚éB

Ť‘BŠO”ńƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚Ä‚ŕC¸‘ƒŒ´”­”ńƒZƒ~ƒm[ƒ}‚Ć“Ż—l‚ɁCIGCCC ‚É‚ć‚é—\Œă•Ş—ނɉž‚ś‚˝‰ťŠw—Ă–@‚đs‚¤B‚ˇ‚Č‚í‚żCBEP —Ă–@4 ƒR[ƒX‚ސ„§‚ł‚ę‚é10jBIGCCC ‚Ě•s—Ç—\ŒăŒQ‚ɑ΂ˇ‚鏉‰ń‰ťŠw—Ă–@‚Ć‚ľ‚āC‘˘ŒŒŠ˛×–EˆÚA‚đ•š—p‚ľ‚˝‘ĺ—ʉťŠw—Ă–@‚Ě—L—pŤ‚ÍŘ–ž‚ł‚ę‚Ä‚˘‚Č‚˘11jB’†ŠÔC‚¨‚ć‚Ń•s—Ç—\ŒăŒQ‚É‚¨‚˘‚āC‹‘ĺ‚ȏcŠuŽîᇂ⑽”­Ť”x“]ˆÚ‚Č‚Ç‚ĹŒÄ‹z‹@”\’ቺ‚Ş‚ ‚čCƒuƒŒƒIƒ}ƒCƒVƒ“‚É‚ć‚é”xáŠQ‚Ě”­Ç‚ŞŒœ”O‚ł‚ę‚éę‡‚ɂ́CBEP —Ă–@‚É‘ă‚í‚čCVIP —Ă–@4 ƒR[ƒX‚ŕ‘I‘đ‰Â”\‚Ĺ‚ ‚é12, 13jB‚˝‚ž‚ľCVIP —Ă–@‚́CBEP —Ă–@‚ć‚č‚ŕœ‘—}§‚Ş‹­‚˘B¸‘ƒŒ´”­‚Ć“Ż—l‚ɁC‰ťŠw—Ă–@I—šŒăCŽîᇃ}[ƒJ[‚ސłí‰ť‚ˇ‚ę‚΁CŽc‘śŽîᇂ̐؏œ‚ŞŠŠ‚ß‚ç‚ę‚éB

Ť‘BŠO”ńƒZƒ~ƒm[ƒ}‚̏‰‰ń‰ťŠw—Ă–@’†‚Ě‘ˆŤC‚¨‚ć‚яI—šŒă‚ĚÄ”­142 —áicŠuŒ´”­56“j’†19“‚Ĺ‹~‰‡‰ťŠw—Ă–@Œă‚É–ł•aó‘Ԃł̐ś‘ś‚Ş”F‚ß‚ç‚ę‚˝‚ށC‚¤‚żcŠuŒ´”­‚͂킸‚Š8.8“i9/79 —áj‚Ć—\Œă•s—Ç‚Ĺ‚ ‚Á‚˝4jBcŠuŒ´”­”ńƒZƒ~ƒm[ƒ}‚ɑ΂ˇ‚鉝Šw—Ă–@Œă‚ĚŠO‰ČŘœ158 —á‚ĚŒŸ“˘‚ł́CpŒă‚ĚŠĎŽ@ŠúŠÔ’†‰›’l‚Ş34 ƒJŒŽi1-194 ƒJŒŽj‚ĚŽž“_‚ŁC92 —á‚ɐś‘śi–ł•aó‘Ԃł̐ś‘ś89 —áj‚Ş”F‚ß‚ç‚ęCŽčpŽž‚ĚŽîᇃ}[ƒJ[łí‰ť‚Ě—L–ł‚Í—LˆÓ‚Č—\ŒăˆöŽq‚Ĺ‚Í‚Č‚Š‚Á‚˝B‚ą‚Ě‚˝‚߁C‰ťŠw—Ă–@Œă‚ɁCŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚Ä‚˘‚Č‚˘Ç—á‚É‚¨‚˘‚Ä‚ŕCŽc‘śŽîá‡‚ŞŘœ‰Â”\‚Ĺ‚ ‚ę‚΁CŠO‰ČŘœ‚ލl—ś‚ł‚ę‚éB

cŠuŒ´”­‚̐ŹnŠďŒ`Žî‚ɑ΂ľ‚ẮC‰ťŠw—Ă–@‚Í–łŒř‚Ĺ‚ ‚čCŠO‰ČŘœ‚Ş‘I‘đ‚ł‚ę‚éBcŠuŒ´”­‚Ě”ńƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚āCŠďŒ`Žî‚ĆˆŤŤ‚Ěăó×–EŽîᇂލŹÝ‚ˇ‚éę‡C‰ťŠw—Ă–@I—šŒă‚ÉŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚˝‚É‚ŕŠÖ‚í‚炸CŽîᇑ‘ĺ‚Ş”F‚ß‚ç‚ę‚é‚ą‚Ć‚Ş‚ ‚éB‚ť‚̂悤‚ČÇ—á‚đŘœ‚ľ‚˝ę‡CŠďŒ`Žî‚̐Ź•Ş‚ŞŽĺ‘Ě‚Ĺ‚ ‚é‚ą‚Ć‚Ş‘˝‚­C‚ą‚ę‚ç‚Ígrowing teratoma syndrome ‚ĆŒÄ‚Î‚ę‚Ä‚˘‚é15jBcŠuŒ´”­‚Ě”ńƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚āC‰ťŠw—Ă–@I—šŒă‚ÉŽîᇃ}[ƒJ[‚ސłí‰ť‚ľ‚˝‚É‚ŕŠÖ‚í‚炸CŽîᇑ‘ĺ‚Ş”F‚ß‚ç‚ę‚˝ę‡CŠO‰ČŘœ‚đŒŸ“˘‚ˇ‚éB

y•śŒŁz

1j Bokemeyer C, Droz JP, Horwich A, et al. Extragonadal seminomaFan international multicenter analysis of prognostic factors and long term treatment outocome. Cancer. 2001G91F1394-401.iⅣbj

2j International Germ Cell Cancer Collaborative Group. International germ cell consensus classificationFa prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol. 1997G15F594-603.iⅤj

3j Jain KK, Bosl GJ, Bains MS, et al. The treatment of extragonadal seminoma. J Clin Oncol. 1984G2F820-827.iⅤj

4j Bokemeyer C, Nichols CR, Droz JP, et al. Extragonadal germ cell tumors of the mediastinum and retrpperitoneumFresults from an international analysis. J Clin Oncol. 2002G20F1864-73.iⅣbj

5j de Wit R, Wilkinson PM, de Mulder PHM, et al. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5- day schedule in good-prognosis germ cell cancerFa randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. 2001G19F1629-40.iⅡj

6j Culine S, Kerbrat P, Kramar A, et al. Refining the optimal chemotherapy regimen for good-risk metastatic nonseminomatous germ-cell tumorsFa randomized trial of the Genito-Urinary Group of the French Federation of Cancer CentersiGETUG T93BPj. Ann Oncol. 2007G18F917-24.iⅡj

7j de Wit R, Skoneczna I, Daugaard G, et al. Randomized phase Ⅲ study comparing paclitaxel-bleomycin, etoposide, and cisplatiniBEPjto standard BEP in intermediate-prognosis germ-cell cancerFIntergroup Study EORTC 30983. J Clin Oncol. 2012G30F792-9.iⅡj

8j Puc HS, Heelan R, Mazumdar M, et al. Management of residual mass in advanced seminomaFresults and recommendations from the Memorial Sloan-Kettering Cancer Center. J Clin Oncol. 1996G14F454-60.iⅤj

9j Santis MD, Becherer A, Bokemeyer C, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography Is a Reliable Predictor for Viable tumor in postchemotherapy seminomaFan update of the prospective multicentric SEMPET Trial. J Clin Oncol. 2004G22F1034-9.iⅢj

10j Culine S, Kramar A, Theodore C, et al. Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate-and poor-risk metastatic nonseminomatous germ cell tumorsFGenito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol. 2008G26F421-7.iⅡj

11j Daugaard G, Skoneczna I, Aass N, et al. A randomized phase Ⅲ study comparing standard dose BEP with sequential high-dose cisplatin, etoposide, and ifosfamideiVIPjplus stem-cell support in males with poor-prognosis germ-cell cancer. An intergroup study of EORTC, GTCSG, and Grupo GerminaliEORTC 30974j. Ann Oncol. 2011G22F1054-61.iⅡj

12j de Wit R, Stoter G, Sleijfer DTh, et al. Four cycles of BEP vs four cycles of VIP in patients with intermediate-prognosis metastatic testicular non-seminomaFa randomized study of the EORTC Genitourinary Tract Cancer Cooperative Group. Br J Cancer. 1998G78F828-32.iⅡj

13j Hinton S, Catalano PJ, Einhorn LH, et al. Cisplatin, etoposide and wither bleomycin or ifosfamide in the treatment of disseminated germ cell tumorsFfinal analysis of an intergroup trial. Cancer. 2003G97F1869-75.iⅡj

14j Kesler KA, Rieger KM, Hammoud ZT, et al. A 25-year single institution experience with surgery for primary mediastinal nonseminomatous germ cell tumors. Ann Thorac Surg. 2008G85F371-8.iⅤj

15j Kesler KA, Patel JB, Kruter LE, et al. Theegrowing teratoma syndromefin primary mediastinal nonseminomatous germ cell tumorsFcriteria based on current practice. J Cardiovasc Surg. 2012G144F438-43.iⅤj


CQ 29

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ŽĄ—Ă•ű–@‚Ě•Ď‘J‚É‚ć‚čC1980 ”NˆČ‘O‚Ć”äŠr‚ľ‚ÄŠ„‡‚ÍŒ¸­‚ľ‚˝‚ŕ‚̂́C¸‘ƒŽîᇂɑ΂ˇ‚鉝Šw—Ă–@‚â•úŽËü—Ă–@‚É‚ć‚é“ńŽŸ”­Šŕ‚ŞŒœ”O‚ł‚ęC‚ť‚ĚƒŠƒXƒN‚đl—ś‚ľ‚˝ă‚Ĺ‚ĚŽĄ—Ă•ű–@‚Ě‘I‘đ‚âTd‚ČŒo‰ßŠĎŽ@‚Ş–]‚Ü‚ę‚éB“ńŽŸ”­Šŕ‚ĚƒŠƒXƒN‚ÍŽĄ—ĂŒă20 ”N‚Ü‚Ĺ‚Í‘‰Á‚ľ‚Č‚˘‚ށC20 ”NˆČ~‚É‚Č‚é‚Ć‘Š‘ÎŠëŒŻ“x‚Ş2.18 ”{‚É‘‰Á‚ˇ‚é‚Ć‚Ě•ń‚ŕŒŠ‚ç‚ę‚é1jB“ńŽŸ”­Šŕ‚Ě‘Š‘ÎŠëŒŻ“x‚́C‰ťŠw—Ă–@’P“Ć‚Ĺ1.8 ”{C•úŽËü—Ă–@’P“Ć‚Ĺ2.0 ”{C‰ťŠw—Ă–@{•úŽËü—Ă–@‚Ĺ2.9 ”{‚Ĺ‚ ‚é2jB1975 ”N‚Ě‘OŒă‚Ĺ”äŠr‚ˇ‚é‚Ć”ńƒZƒ~ƒm[ƒ}ŠłŽŇ‚É‚¨‚˘‚Ä“ńŽŸ”­śŒĹŒ`Šŕ‚ĚƒŠƒXƒN‚Í1975 ”NˆČ~‚ÉŒ¸­‚ľ‚Ä‚˘‚éB‚ą‚ę‚́C‚ć‚čŒř‰Ę“I‚ȉťŠw—Ă–@‚ĚŠJ”­‚âĆŽËü—Ę‚Ě’áŒ¸‚É‚ć‚é‚ŕ‚Ě‚Ćl‚Ś‚ç‚ę‚éB‚ľ‚Š‚ľŽc”O‚Č‚Ş‚çC•úŽËü—Ă–@‚Ě’áŒ¸‚ލ˘“ď‚ČƒZƒ~ƒm[ƒ}‚É‚¨‚˘‚Ä‚Í‚ą‚ĚŒXŒü‚Í”F‚ß‚ç‚ę‚Ä‚˘‚Č‚˘3jBˆę”Ę“I‚É“ńŽŸ”­śŠŕ‚É‚ć‚鎀–S—Ś‚͐¸‘ƒŽîᇂ̎€–S—Ś‚Ć•Ď‚í‚ç‚Č‚˘4jB‚ľ‚Š‚ľC1973-1979 ”N‚ɐ¸‘ƒŽîᇂƐf’f‚ł‚ę‚˝Ç—á‚ÉŒŔ‚Á‚Ä‚Ý‚é‚ƁC•úŽËüĆŽË—Ę‚Ş‘˝‚˘Ž–‚ŞŒ´ˆö‚ŁC‰ĄŠu–Œ‰ş•ű‚Ě“ńŽŸ”­śŠŕ‚â“ńŽŸŤ”xŠŕ‚ĚŽ€–S—Ś‚͐¸‘ƒŽîᇎŠ‘Ě‚ĚŽ€–S—Ś‚ć‚č‚‚˘4jB

äNă÷Žîᇂ͓ńŽŸ”­śŠŕ‚Ć‚ľ‚ďd—v‚Ĺ‚ ‚éB•úŽËü—Ă–@‚≝Šw—Ă–@‚ŕ‚ľ‚­‚Í—źŽŇ‚đs‚Á‚˝ę‡‚ť‚Ě“ńŽŸŤäNă÷Šŕ”­ś‚Ě‘Š‘ÎŠëŒŻ“x‚Í4.5 ”{‚Ć‚Č‚é5jB‚ą‚ą‚Ĺ’–Ú‚ˇ‚ׂŤ“_‚́C“ńŽŸŤäNă÷ŠŕŠłŽŇ‚Ě82“‚Í’°œ—Ěˆć‚ĚƒŠƒ“ƒpßĆŽË‚đŽó‚Ż‚Ä‚¨‚čC–T‘ĺ“Ž–ŹƒŠƒ“ƒpßĆŽË‚ŞŽĺ‚Ć‚Č‚Á‚˝1980 ”NˆČ~‚́C“ńŽŸŤäNă÷Šŕ”­ś•p“x‚ÍŒ¸­‚ľ‚Ä‚˘‚é‚ƍl‚Ś‚ç‚ę‚é5jB‘˝Ü•š—p—Ă–@‚É‚¨‚˘‚āCƒGƒgƒ|ƒVƒh‚Í“ńŽŸŤ”’ŒŒ•a‚ÉŠÖ—^‚ľC‚ť‚Ě‘Š‘ÎŠëŒŻ“x‚Í3.5-4.5 ”{‚Ĺ‚ ‚é1, 6jB‚ą‚ę‚̓Gƒgƒ|ƒVƒh‚̗ݐϗʂ݂̂Ȃ炸CT1-2 ‰ń‚ĚˆŰŽ“Š—^‚É‚ŕŠÖ˜A‚ľ‚Ä‚˘‚é7jB‚Ü‚˝C‚ą‚ĚƒŠƒXƒN‚ÍŽĄ—ĂŒă10 ”N‚ރs[ƒN‚Ĺ‚ ‚čC‚ť‚ĚŒă‚͏™X‚ÉŒ¸­‚ˇ‚é1jB

ˆČă‚̂悤‚ɁC“ńŽŸ”­śŠŕ‚ĚŠëŒŻŤ‚́CŽĄ—ĂŽžŠúEŽĄ—Ă“ŕ—e‚Č‚Ç‚É‚ć‚č‘˝—lŤ‚Ş‚ ‚é‚˝‚߁CŒo‰ßŠĎŽ@‚É‚Í’ˆÓ‚Ş•K—v‚Ĺ‚ ‚éB

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SŽžŠł‚ĚƒƒJƒjƒYƒ€‚Í‚˘‚Ü‚ž–ž‚ç‚Š‚Ĺ‚Í‚Č‚˘‚ށCƒVƒXƒvƒ‰ƒ`ƒ“‚âƒuƒŒƒIƒ}ƒCƒVƒ“‚đŽ˛‚Ć‚ľ‚˝‰ťŠw—Ă–@Œă‚̐SŒŒŠÇŒn‡•šÇiCVDFCardiovascular diseasesj‚Ě‘Š‘ÎŠëŒŻ“x‚Şă‚Ş‚č8-10jC‚ą‚ę‚Í‹i‰Œ‚É‚ć‚éCVD ƒŠƒXƒN‚Ć“Ż“™‚Ĺ‚ ‚é5jB

BEP —Ă–@‚ȂǁCƒVƒXƒvƒ‰ƒ`ƒ“ƒx[ƒX‚̉ťŠw—Ă–@iand/or •úŽËü—Ă–@j‚͐SŽžŠł‚Ě”­ÇƒŠƒXƒN‚ƂȂ鎖‚Ş•ń‚ł‚ę‚Ä‚¨‚čC‚ť‚Ě”­Ç•p“x‚Í–ń8“‚Ć•ń‚ł‚ę‚Ä‚˘‚é11jB‚ľ‚Š‚ľCBEP —Ă–@‚͐¸‘ƒŽĄ—Ă‚Ěfirst line —Ă–@‚Ć‚ľ‚Ä‚Ěƒ|ƒWƒVƒ‡ƒ“‚đŠm—§‚ľ‚Ä‚¨‚čCƒŠƒXƒN& ƒxƒlƒtƒBƒbƒg‚đl—ś‚ľ‚ÄŽĄ—Ă–@‚đ‘I‘đ‚ˇ‚×‚Ť‚Ĺ‚ ‚éB

cŠuƒŠƒ“ƒpß‚ɑ΂ˇ‚é•úŽËüĆŽË‚≝Šw—Ă–@•š—p•úŽËü—Ă–@‚É‚ć‚éCVD ƒŠƒXƒN‚͍‚‚˘B‚ľ‚Š‚ľC1980 ”N‘ă’†”ŐˆČ~Cˆę•”‚ĚÇ—á‚đœ‚˘‚Ĉę”Ę‚É‚ą‚̂悤‚ČŽĄ—Ă–@‚͍s‚í‚ę‚Č‚­‚Č‚Á‚Ä‚˘‚éBŽĺ‚ɃZƒ~ƒm[ƒ}‚Ĺ‚ ‚é‚ŞCSubdiaphragmatic ‚Ö‚Ě26-35 Gy ‚Ě•úŽËüĆŽË‚ÍCVD ‚ĚƒŠƒXƒN‚đ‚‚ß‚Č‚˘‚Ć‚ł‚ę‚Ä‚˘‚é5jB

CVD ‚ĚƒŠƒXƒN‚͈â“`Cƒ‰ƒCƒtƒXƒ^ƒCƒ‹C‚ƒRƒŒƒXƒeƒ[ƒ‹ŒŒÇE‚ŒŒˆłE”ě–žEƒƒ^ƒ{ƒŠƒbƒNƒVƒ“ƒhƒ[ƒ€‚Č‚Ç‚ĚCVD ”­ÇŠëŒŻˆöŽq‚É‚ŕ‰e‹ż‚ł‚ę‚é‚˝‚ß7jC¸‘ƒŽîᇎĄ—ĂŒă‚̓ŠƒXƒN‰ń”đ‚Ě‚˝‚ß‚Ě‹Ö‰Œ‚ސ„§‚ł‚ę‚éB

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ƒVƒXƒvƒ‰ƒ`ƒ“‚É‚ć‚é‹}Ťt‹@”\áŠQ‚Ě‘˝‚­‚͉‹tŤ‚Ĺ‚ ‚é‚ŞC20-30“’ö“x‚Í•s‰Â‹tŤ‚Ĺ‚ ‚é‚ƍl‚Ś‚ç‚ę‚é12jBƒVƒXƒvƒ‰ƒ`ƒ“‚É‚ć‚ét‹@”\áŠQ‚͗ݐϓŠ—^—Ę‚ÉˆË‘ś‚ˇ‚é‚ƍl‚Ś‚ç‚ę‚Ä‚¨‚č12jCƒVƒXƒvƒ‰ƒ`ƒ“‚Ě‘“Š—^—Ę‚Ş500 mg ‘OŒă‚Ĺ‚ ‚Á‚Ä‚ŕC20“‘OŒă‚ĚŽ…‹…‘Ěŕh‰ß—Ę‚Ě•s‰Â‹t“I‚Ȓቺ‚Ş‹N‚ą‚é‚Ć‚˘‚í‚ę‚Ä‚˘‚é13, 14jB‚Ü‚˝CƒVƒXƒvƒ‰ƒ`ƒ““Š—^–@‚Ídaily low dose ‚ć‚č‚ŕhigher single doseiexF100 mg/m2j‚Ĺ‚ć‚č‹­‚­t“ŐŤ‚Ş”­Œť‚ˇ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é3jBˆę•űCƒVƒXƒvƒ‰ƒ`ƒ“‚݂̂Ȃ炸Ct‹@”\áŠQ‚ĚƒŠƒXƒNƒtƒ@ƒNƒ^[‚́C•úŽËü—Ă–@‚Ě•š—pCt“ŐŤ‚đ—L‚ˇ‚é‘ź‚Ě–ňÜ‚Ě“Š—^C”N—îChydration ‚Ěó‹ľC–ňÜ“Š—^‘O‚Š‚ç‚̐t‹@”\áŠQ‚Ě—L–ł‚Č‚Ç‚É‚ŕˆË‘ś‚ˇ‚é12, 15jB

ƒZƒ~ƒm[ƒ}‚ōs‚í‚ę‚é• •”‚Ö‚Ě•úŽËüĆŽË‚́C’ˇŠú‚É‚í‚˝‚ét‹@”\áŠQ‚đŽw“E‚ˇ‚é•ń‚Ş‚ ‚é12jB—Տ°Çó‚đ’ć‚ł‚Č‚˘’ö“x‚̐t‹@”\áŠQ‚́C20 Gy –˘–ž‚Ě’áü—Ę•úŽËüĆŽË‚Ĺ‚ŕ‹N‚ą‚č‚Ś‚éB‚Ü‚˝C•úŽËüĆŽËŒă‚ɏ™X‚ɐt‹@”\‚Ş’á‰ş‚ľC””NŒă‚É”­Šo‚ˇ‚鎖‚ŕ‚ ‚é‚˝‚ß12jCŒo‰ßŠĎŽ@‚ޏd—v‚Ĺ‚ ‚éB

œ_ŒoáŠQ

¸‘ƒŽîᇂɑ΂ˇ‚鉝Šw—Ă–@‚͐_ŒoáŠQ‚ĚŒ´ˆö‚Ć‚Č‚č‚Ś‚éB––˝_ŒoáŠQ‚⍂‰šˆć’Ž—͏áŠQ‚ĚŒ´ˆö‚Ć‚ľ‚Ä—L–ź‚Č–ňÜ‚̓VƒXƒvƒ‰ƒ`ƒ“‚Ĺ‚ ‚čC‘“Š—^—Ę‚Ş_ŒoÇó‚ÉŠÖ—^‚ˇ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚éBƒVƒXƒvƒ‰ƒ`ƒ“‚Ě‘“Š—^—Ę‚Ş400 mg/m2ˆČă‚É’B‚ˇ‚é‚ƁC––˝_ŒoáŠQ‚Í27“C’Ž—͏áŠQ‚Í65“‚É”F‚ß‚ç‚ę‚é16jBĹ‹ßC”ÓŠú‚‰šˆć’Ž—͏áŠQ‚̐f’fƒc[ƒ‹‚Ć‚ľ‚ÄDPOAEidistortion product otoacoustic emissionsj‚Ş”ńNP“I‚ĹŠ´“x‚ލ‚‚˘‚Ć‚Ě•ń‚Ş”F‚ß‚ç‚ę‚é17jB

BEP —Ă–@Œă‚ĚŽlŽˆ‚Ě‚ľ‚тꊴCƒsƒŠƒsƒŠŠ´‚Í4 ƒN[ƒ‹I—šŒă‚Ĺ–ń20“‚É‚Ý‚ç‚ęCÇó‚Í3 ƒJŒŽ‚Š‚瑝‰Á‚ľ‚Ä6 ƒJŒŽ‚ĹĹ‘ĺ‚É‚Č‚čC‚ť‚ĚŒă‚ÍŒy‰ő‚ˇ‚é‚ŕ‚Ě‚Ě2 ”NŒă‚Ĺ‚ŕ22“‚ÍŽc‚é18jBƒpƒNƒŠƒ^ƒLƒZƒ‹‚Ě––˝_ŒoáŠQ‚Í–ń40“‚É”F‚ß‚ç‚ęCBEP —Ă–@‚ɒljÁ‚ľ‚˝ę‡‚Ĺ‚ÍBEP —Ă–@’P“Ć‚É”ä‚×–ń7“‘‰Á‚ľ‚˝19jB

ˆę•űCƒŒƒCƒm[ÇóiRaynaud PhenomenonFRPj‚ÍBEP —Ă–@‚âPVB —Ă–@‚ĚŠłŽŇ‚Ě–ń20“ˆČă‚É”F‚ß‚ç‚ę‚é20jBRP ‚ŕ‚Ü‚˝ƒuƒŒƒIƒ}ƒCƒVƒ“‚Ě—p—ĘˆË‘śŤ‚É”­Œť‚ľCƒuƒŒƒIƒ}ƒCƒVƒ“‘“Š—^—Ę‚Ş180,000 IU ˆČăi–{–MŠˇŽZ‚Ĺ‚Í187.2 mg ˆČăj‚ĹŽĄ—Ă‚Ş‚Č‚ł‚ę‚˝25“‚ĚŠłŽŇ‚ÉŽĄ—ĂŒă10 ”NŠÔ‚É‚í‚˝‚čRP ‚ŞŒŠŽó‚Ż‚ç‚ę‚é20jB

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Haugnes ‚ç21j‚́CƒVƒXƒvƒ‰ƒ`ƒ“‚đŽ˛‚Ć‚ľ‚˝‰ťŠw—Ă–@ŒăC‰ťŠw—Ă–@‚đŽ{s‚ľ‚Č‚Š‚Á‚˝ŒQ‚Ć”äŠr‚ľC–ń2 ”{‚ĚŠłŽŇ‚Ƀƒ^ƒ{ƒŠƒbƒNÇŒóŒQ‚Ş”­Ç‚ľ‚˝‚Ć•ń‚ľ‚Ä‚¨‚čC‘O€‚̐SŽžŠłƒŠƒXƒN‚Ć‚ĚŠÖ˜A‚Ş‚ ‚鎖€‚Ě‚˝‚ß’ˆÓ‚đ—v‚ˇ‚éB

—lX‚ČŠŕ‚̐ś‘śŽŇ‚É‚¨‚˘‚āC–Ť”ć˜JŠ´‚đ—L‚ˇ‚銳ŽŇ‚Ş‘˝‚˘Ž–‚Ş•ń‚ł‚ę‚Ä‚˘‚é22jBƒmƒ‹ƒEƒF[l‚ĚŒŸ“˘‚ŁC¸‘ƒŽîᇊłŽŇ‚Ĺ”N—îŠK‘w•Ę‚ɉđÍ‚đs‚˘CŒ’íl‚Ě10“‚Ć”äŠr‚ľ¸‘ƒŽîᇂ̐ś‘śŽŇ‚Ĺ‚Ě”ć˜JŠ´‚Ě—L‚銳ŽŇ‚Í16“‚ƍ‚’l‚Ĺ‚ ‚é‚Ć•ń‚ľ‚Ä‚˘‚é23jB‚ť‚ę‚́CŽá”N‚Ĺ‚ ‚鎖C•sˆŔŠ´C—}ŸTC•š‘śÇ‚Č‚Ç‚ĆŠÖ˜A‚ľ‚Ä‚¨‚č24jC¸‘ƒŽîᇊłŽŇ‚Ěƒƒ“ƒ^ƒ‹–Ę‚Ĺ‚ĚƒPƒA‚̏d—vŤ‚𮦍´‚ˇ‚éƒf[ƒ^‚Ĺ‚ ‚éB

ŒťÝC¸‘ƒŽîᇂ̎Ą—ĂŒř‰Ę”ť’č‚ÉFDG-PET ‚đ—p‚˘‚鎖‚Ş‚ ‚é‚ŞCƒuƒŒƒIƒ}ƒCƒVƒ““Š—^Œă‚ÉFDG ‚ĚŽć‚荾‚Ý‚Ş‘‹­‚ˇ‚éƒuƒŒƒIƒ}ƒCƒVƒ“”x‰Š‚Ě•ń25j‚ŕ‚ ‚čCƒuƒŒƒIƒ}ƒCƒVƒ“Žg—pŒă‚ÍPET ‹U—zŤ‚đ”O“Ş‚É’u‚˘‚Đf’f‚ˇ‚é•K—v‚Ş‚ ‚éB

y•śŒŁz

1j Robinson D, Møller H, Horwich A. Mortality and incidence of second cancers following treatment for testicular cancer. Br J Cancer. 2007G96F529-33.iⅣbj

2j Travis LB, Fosså SD, Schonfeld SJ, et al. Second cancers among 40,576 testicular cancer patientsFfocus on long-term survivors. J Natl Cancer Inst. 2005G97F1354-65.iⅣaj

3j Abouassaly R, Fosså SD, Giwercman A, et al. Sequelae of treatment in long-term survivors of testis cancer. Eur Urol. 2011G60F516-26.iⅠj

4j Schairer C, Hisada M, Chen BE, et al. Comparative mortality for 621 second cancers in 29356 testicular cancer survivors and 12420 matched first cancers. J Natl Cancer Inst. 2007G99F1248-56.iⅣaj

5j van den Belt-Dusebout AW, de Wit R, Gietema JA, et al. Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol. 2007G25F4370-8.iⅣaj

6j Richiardi L, Scélo G, Boffetta P, et al. Second malignancies among survivors of germ-cell testicular cancerFa pooled analysis between 13 cancer registries. Int J Cancer. 2007G120F623-31.iⅣaj

7j Pui CH, Ribeiro RC, Hancock ML, et al. Acute myeloid leukemia in children treated with epipodophyllotoxins for acute lymphoblastic leukemia. N Engl J Med. 1991G325F1682-7.iⅣbj

8j van den Belt-Dusebout AW, Nuver J, de Wit R, et al. Long-term risk of cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol. 2006G20G24F467-75.iⅣaj

9j Fosså SD, Gilbert E, Dores GM, et al. Noncancer causes of death in survivors of testicular cancer. J Natl Cancer Inst. 2007G99F533-44.iⅣaj

10j Zagars GK, Ballo MT, Lee AK, et al. Mortality after cure of testicular seminoma. J Clin Oncol. 2004G22F640-7.iⅣaj

11j Haugnes HS, Wethal T, Aass N, et al. Cardiovascular risk factors and morbidity in long-term survivors of testicular cancerFa 20-year follow-up study. J Clin Oncol. 2010G28F4649-57.iⅣaj

12j Fosså SD, Aass N, Winderen M, et al. Long-term renal function after treatment for malignant germ-cell tumours. Ann Oncol. 2002G13F222-8.iⅢj

13j Brillet G, Deray G, Jacquiaud C, et al. Long-term renal effect of cisplatin in man. Am J Nephrol. 1994G14i2jF81-4.iⅤj

14j Hartmann JT, Kollmannsberger C, Kanz L, et al. Platinum organ toxicity and possible prevention in patients with testicular cancer. Int J Cancer. 1999G83F866-9.iⅣbj

15j Bosl GJ, Leitner SP, Atlas SA, et al. Increased plasma renin and aldosterone in patients treated with cisplatin-based chemotherapy for metastatic germ-cell tumors. J Clin Oncol. 1986G4F1684-9.iⅤj

16j Bokemeyer C, Berger CC, Kuczyk MA, et al. Evaluation of long-term toxicity after chemotherapy for testicular cancer. J Clin Oncol. 1996G14F2923-32.iⅣbj

17j Biro K, Noszek L, Prekopp P, et al. Characteristics and risk factors of cisplatin-induced ototoxicity in testicular cancer patients detected by distortion product otoacoustic emission. Oncology. 2006G70F177-84.iⅣbj

18j Fosså SD, de Wit R, Roberts JT, et al. Quality of life in good prognosis patients with metastatic germ cell cancerFa prospective study of the European Organization for Research and Treatment of Cancer Genitourinary Group/Medical Research Council Testicular Cancer Study Groupi30941/TE20j. J Clin Oncol. 2003G21F1107-18.iⅡj

19j Wit RD, Skoneczna I, Daugaard G, et al. Randomized Phase Ⅲ Study Comparing Paclitaxel-Bleomycin, Etoposide, and CisplatiniBEPjto Standard BEP in Intermediate-Prognosis Germ-Cell CancerFIntergroup Study EORTC 30983. J Clin Oncol. 2012G30F792-9.iⅣaj

20j Glendenning JL, Barbachano Y, Norman AR, et al. Long-term neurologic and peripheral vascular toxicity after chemotherapy treatment of testicular cancer. Cancer. 2010G116F2322-31.iⅢj

21j Haugnes HS, Aass N, Fosså SD, et al. Components of the metabolic syndrome in long-term survivors of testicular cancer. Ann Oncol. 2007G18F241-8.iⅣaj

22j Servaes P, Verhagen C, Bleijenberg G. Fatigue in cancer patients during and after treatmentFprevalence, correlates and interventions. Eur J Cancer. 2002G38F27-43.iⅣj

23j Fosså SD, Dahl AA, Loge JH. Fatigue, anxiety, and depression in long-term survivors of testicular cancer. J Clin Oncol. 2003G21F1249-54.iⅡj

24j Orre IJ, Fosså SD, Murison R, et al. Chronic cancer-related fatigue in long-term survivors of testicular cancer. J Psychosom Res. 2008G64F363-71.iⅣaj

25j von Rohr L, Klaeser B, Joerger M, et al. Increased pulmonary FDG uptake in bleomycin-associated pneumonitis. Onkologie. 2007G30F320-3.iⅤj


CQ 30

œ‰ťŠw—Ă–@‘O‚̐¸Žq•Ű‘ś‚͐„§‚ł‚ę‚é‚ŠH


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