Evre I Nonseminomatöz Testis Tümörlerinde Tedavi Yaklaşımları

Testis tümörleri 15-35 yaş aralığındaki erkeklerde en sık görülen solid tümörlerdir. Bununla birlikte tedavi ile kalıcı şifa sağlama oranı %85-90 gibi oldukça yüksektir. Bu açıdan tüm tümörler arasında özel bir yere sahiptir. Tüm testis tümörlerinin %90-95’i germ hücreli tümörlerdir. Bunlar da seminomatöz ve nonseminomatöz olarak iki büyük gruba ayrılmaktadır. Seminomatöz testis tümörlerinde tedavi uygulamalarında bir görüş birliği sağlandığı görülmektedir. Buna karşılık özellikle evre I nonseminamatöz testis tümörlerinin tedavisinde farklı ekollerin olduğu ve tartışmaların devam ettiği izlenmektedir. Tedavide yeni yaklaşımlar da gündeme gelmektedir. Bu derlemede; evre I nonseminomatöz testis tümörlerinin tedavisindeki alternatifler irdelenmiş, bu farklı yaklaşımların avantaj ve dezavantajları ortaya konmuştur. Sonuç olarak tedavi sonuçları açısından mevcut seçeneklerin başarı oranlarının birbirine yakın olduğu görülmektedir. Uygun tedavi seçiminde her bir hasta ayrı olarak ele alınmalıdır. Patolojik risk faktörlerini ve her yaklaşımın artı ve eksi yönlerini dikkate alarak hasta ve hekimin birlikte karar vermesi en doğru davranış olarak kabul edilmektedir

Anahtar Kelimeler:

Testiküler kanser, nonseminomatöz tumör, retroperitoneal lenf nodu diseksiyonu, izlem, kemoterapi, tedavi, evre I

Contemporary Approach in the Management of Stage I Nonseminomatous Testicular Tumors

Testicular cancer is the the most common malignancy in 15-35- year age group. However, current cure rates are up to 85 to 90% providing that it has a certain superioty being a model of sucess among solid tumors. About 90 to 95% of testicular cancers composed of germ cell tumors which are further subdivided into seminomatous and nonseminomatous testicular tumors. A concensus has been reached in the management of seminomatous germ cell tumors. However, an ongoing debade on the proper approach for the treatment of stage I nonseminomatous tumors is present. New concepts have been introduced in the management of stage I nonseminomatous tumors. In this review, the different alternatives in the management of stage I nonseminomatous tumors were disscussed including the whole spectrum of each treatment strategy in terms of proposed advantages and disadvantages. In summary, the cure rates of all current treatment approaches for stage I nonseminomatous tumors are comparable. Contemporarly in order to provide the proper management strategy for each individual patient with stage I nonseminomatous tumor, the physician should discuss all alternatives based on the prognostic factors related to the orchiectomy specimen. Obviously, this process shoud include the patients’ preferences considering the advantages and disadvantages of each treatment modelity. This approach of mutual responsibility of the physician and patient currently comprimises the most reasonable way in the management of stage I nonseminomatous tumors

Keywords:

Testicular cancer, nonseminomatous tumors, retroperitoneal lymph node di ssection, surveilance, chemotherapy, management, stage I,

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