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Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Systematic follow-up examinations of patients cured of testicular cancer first gained attention by caregivers in the 1980s only after the management of the disease had significantly been improved by the introduction of cisplatin-based chemotherapy and almost synchronously, by the implementation of computerized tomography (CT) and serum tumor markers. Follow-up involves three aims: early diagnosis of recurrence, detection of treatment-related toxicity, and detection of secondary diseases. As the clinical presentation of testicular cancer is very heterogeneous, there is no uniform follow-up for the disease. Instead, risk-adapted follow-up schedules are required. Since the release of the German AWMF S3 guideline for the management of testicular cancer in 2019, high level evidence has accumulated for the noninferiority of magnetic resonance imaging (MRI) to CT with regard to abdominal imaging. Therefore, it is appropriate to modify the recommendations for follow-up given in the 2019 issue of the S3 guidelines. The modifications recommended herein relate to three issues: (1) Only three risk groups (instead of formerly four) are identified, i.e., seminoma (all stages); nonseminoma clinical stage 1b (i.e., pT2, with lymphovascular invasion) on surveillance; nonseminoma all other stages. All patients cured from poor risk disease or from relapses require individual follow-up schedules not included in the recommendations tabulated herein. (2) CT and abdominal sonography are replaced by MRI. (3) Chest X‑ray imaging during follow-up of seminoma patients is no longer recommended., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction:  More than 90 % of all patients with testicular germ cell tumours can be cured effectively. The mainstay of treatment is chemotherapy with cisplatin, etoposide and bleomycin (PEB). This regimen is usually well tolerated and does not lead to serious adverse events. Cardiovascular complications are encountered very rarely, but have gained increasing attention in recent years., Case Description:  A 33-year-old man with a testicular seminoma, clinical stage 2b, was subjected to PEB chemotherapy. At the end of the first treatment course, he had an acute ST-elevation myocardial infarction. Coronary angiography revealed a circumscribed stenosis of the left circumflex branch of the left coronary artery with intima dissection and thrombotic deposits. No atherosclerotic changes were found. Management consisted of placement of a drug-eluting coronary stent. Chemotherapy was discontinued and the seminoma treatment completed by radiotherapy with 30 Gy applied to the retroperitoneal mass and a paraaortic template. Complete remission was achieved. 6 months thereafter, the patient was doing well and was disease-free., Comment:  About 0.3 % of all testis cancer patients undergoing cisplatin-based chemotherapy develop cardiovascular complications. Cisplatin-related endothelial damage with secondary thrombotic clotting is assumed to be etiologic in these cases. As there is little comorbidity, the prognostic outlook is favourable in most cases. Caregivers in charge of testis cancer management should be vigilant regarding cardiovascular complications to ensure immediate diagnostic and therapeutic measures in incident cases., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

We report the case of a 42-year-old patient with contralateral inguinal seminoma metastasis. He had a history of prior bilateral open inguinal hernia repair and scrotal vasectomy. Staging CT revealed no further lymphoma or organ metastases. After discussion of adjuvant treatment options and contacting a referral centre for testicular cancer, adjuvant treatment was performed with 3 cycles of cisplatin, etoposide and ifosfamide. The development of the contralateral inguinal metastasis is most likely caused by the prior inguinal and scrotal surgery, whereas a primary atypical retrograde metastatic route can't be ruled out. Physical examination of the inguinal lymph nodes should be performed in all patients with testicular cancer and prior inguinal and scrotal surgery., (© Georg Thieme Verlag KG Stuttgart · New York.)

As a consequence of the unsatisfactory results of conventional dose salvage regimens, in particular for patients with poor prognostic features at the time of relapse or in patients with refractory disease, high-dose chemotherapy (HDCT) was introduced into clinical practice in the late 1980s. The combination of carboplatin and etoposide (CE) still remains the backbone of most high-dose regimens. Multiple modifications with more dose escalations or addition of further drugs have been explored, most often with increased toxicity. With improved expertise in supportive care and the use of peripheral blood stem cells, hematopoetic recovery has been significantly shortened and the initial high treatment-related mortality reduced from more than 10% to about 3%. Since the incorporation of HDCT, even patients with unfavorable prognostic features or patients with second or subsequent relapses can achieve long-term remission. Following HDCT residual tumor resection plays a major role in achieving these long-term results. The proportion of vital residual tumor after HDCT is much higher than in patients after conventional chemotherapy. The role of HDCT remains controversial particularly as a first-line treatment and less so in the first salvage setting. As these patients are rare HDCT and residual tumor resection should only be be provided by high-volume centers with sufficient expertise in performing these complex procedures.

Background: Meta-analysis evaluating the accuracy and sensitivity of FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) positron emission tomography (PET) to predict viable residual tumours in patients with metastatic seminoma., Material and Methods: Altogether 5 studies with 130 patients were identified. Both FDG PET and the size of the residual lesions on conventional computed tomography (CT; lesions either ≤ or > 3 cm) were correlated with the presence or absence of viable residual tumour., Results: The specificity (92 vs 59%), sensitivity (72 vs 63%), positive (70 vs 28%) and negative (93 vs 86%) predictive value of FDG PET were superior to data obtained by assessing residual tumour size (either ≤ or > 3 cm) applying CT scans alone., Conclusion: In view of the data currently available, FDG PET seems to be a clinically useful predictor of viable tumour in post-chemotherapy residuals of pure seminoma.

The management of patients with germ cell tumors must be based upon complete staging and should be risk-adapted. Seminoma stage I can be managed by either active surveillance, adjuvant carboplatin therapy, or radiotherapy. Seminoma stage IIA should receive radiotherapy, stage IIB can be managed with either radiotherapy or chemotherapy. Seminoma stage IIC and III are treated with three (to four) cycles of PEB (cisplatin, etoposide, bleomycin). Nonseminoma stage I should be managed by either active surveillance or adjuvant chemotherapy with one (to two) cycles of PEB, based upon the risk factor vascular invasion. Treatment of advanced nonseminoma consists of either 3 or 4 cycles of PEB and must be guided by the IGCCCG prognostic subgroup. Prognosis is particularly poor in patients with either primary mediastinal nonseminoma, and/or metastases to liver, brain or bone, or inadequate tumor marker decline. In these cases, intensification of therapy with high dose chemotherapy can be justified. Complex cases with poor prognosis and all patients with relapsed disease should exclusively be treated by experts in a tertiary care setting to achieve highest possible cure rates in these young patients.

Up to now systemic therapy with curative intent is possible in only a few tumors. Concerning advanced malignant tumors in urology only testicular cancer can be cured. In metastatic urothelial cancer of the bladder this might be possible in single cases. In advanced renal cell carcinoma a recent group of new substances, so-called target-specific substances, have gained attention. In several phase III studies with sunitinib, sorafenib, and temsirolimus at least progression-free survival could be clearly prolonged. The amazing results in testicular cancer were possible by consistent performance of clinical trials. The success in treatment also is an example for interdisciplinarity. Especially in advanced stages treatment consists of two components, chemotherapy, correctly performed concerning dose and interval, followed by complete residual tumor resection.

Purpose: To assess the ability of [(18)F]FDG-PET, CT/MRI and serum tumor marker (TM) for the early prediction of response in patients with metastatic germ cell tumors (GCT) undergoing salvage high-dose chemotherapy (HD-CTX)., Materials and Methods: Before commencement of HD-CTX, 19 patients with metastases from GCT were evaluated with [(18)F]FDG-PET, CT or MRI and TM after 2-3 cycles of induction chemotherapy and the results compared with those of the baseline examinations. PET was analyzed visually and quantitatively by calculating the standard uptake value (SUV). CT or MRI was evaluated for changes in tumor size (progressive disease/stable disease PD/SD = viable lesion; partial remission/complete remission PR/CR = nonviable lesion), density or signal intensity, homogeneity and contrast enhancement. For the prognosis, the worse case, i.e., the most vital lesion detected in a patient, was considered. The reference standard was the result of the histology after resection of any residual masses (N = 10) and/or the clinical-radiological follow-up for at least 6 months after completion of the treatment (N = 9)., Results: Six of nineteen patients (32 %) remained progression-free for over 6 months following treatment, whereas 13 (68 %) progressed. The outcome of HD-CTX was correctly predicted by PET, CT and TM in 89 %, 67 % and 88 %, respectively. In 5 of 6 patients with successful HD-CTX, PET was negative (mean SUV = 1.8), with CT or MRI showing a partial regression of the tumor in 4 of 5 patients. Of the 13 patients not cured by HD-CTX, the PET data were positive in all (mean SUV = 2.7), and the CT/MRI results were true positive (PD or SD) in 8 and false negative (PR) in 5 patients. The combined assessment of CT and TM corrected 3 false negative prognoses and 1 false positive CT prognosis. Two patients with unfavorable outcome despite a favorable response by CT and TM criteria were exclusively identified by PET. The resultant sensitivities and specificities for the prediction of therapy response are as follows: PET 100% and 67%; CT/MRI 62% and 80%; TM 83% and 100%; CT+TM 85% and 83%., Conclusion: FDG-PET has a high prognostic value for predicting the response to chemotherapy in patients with metastatic GCT early in the course of treatment and may improve patient selection for subsequent HD-CTX protocols. Especially in patients with response to induction chemotherapy according to CT or TM evaluation, PET offers additional information to detect patients with an overall unfavorable outcome.

Between 1/1990-8/1997 two courses of single agent Carboplatin had been given to 36 patients with clinical stage I seminoma. Within an median follow up period of 52 months (17-88) 29 out of 34 patients were analyzed retrospectively. During this period no recurrences had been noted and nobody of our patients died (0% relapsrate, 100% survival-rate). The Carboplatin-therapy was well tolerated. Myelosuppression after chemotherapy was mild (WHO grade I). The experienced acute toxic side effects (max. grade II WHO) during and after chemotherapy had been nausea (37%), vomiting (14%) and mild hairloss (11%). Until now no long term side effects were noticed. A standardized questionnaire had been used to evaluate the impairment of quality life after single agent carboplatin therapy. After a minimum of one year follow up averagly 79% (62-92%) of the asked patients showed no impairment of their quality of life, whereas 19% (8-38%) of the people experienced mild impairment of their quality of life. Because of the shown low recurrence rate, the minimal toxicity and no relevant impairment of the quality of life single agent carboplatin therapy will be an alternative approach for clinical stage I seminoma.

Although the association between administration of the antitumor agent bleomycin and the development of cutaneous fibrosis is established, there are only a small number of cases of bleomycin-induced scleroderma described in the literature. We report the development of generalised scleroderma with wide spread hyperpigmentation in a 52-year-old male patient, who received a total dose of 360 mg bleomycin in combination with cisplatin and etoposid for therapy of a malignant testicular seminoma. The clinical cutaneous alterations as well as the histological findings were indistinguishable from those encountered in progressive systemic sclerosis (PSS). In contrast to PSS however, Raynaud's phenomenon, cutaneous calcinosis, teleangiectasia, arthritis and involvement of additional organs were all absent. PSS-typical auto-antibodies were negative. Even 18 months after discontinuation of the drug and treatment with UVA1 phototherapy (3-4 times per week with 20 J/cm2) as well as physiotherapy, the skin changes had still not resolved. Based on our case and a detailed review of the literature, we discuss characteristics of bleomycin-induced scleroderma including pathogenesis, treatment modalities and course.

Background and Objective: Early evidence of drug-induced cardiomyopathy (CMP) is of great importance in haematological treatment, especially with anthracyclines. Stress echocardiography (SEC) has proved of value in determining left ventricular function at rest and under stress in patients with heart disease. The study was undertaken to assess the value of SEC in comparison with radionuclide ventriculography (RNV)., Patients and Methods: 63 unselected patients with malignant tumour (20 women, 43 men; mean age 49 +/- 15 years) underwent SEC and RNV. No chemotherapy had yet been started in 17 of them, 43 had received anthracyclines as main component of the chemotherapy (mean anthracycline dose 339 +/- 251 mg/m2). Left ventricular ejection fraction (LVEF) was measured by both SEC and RNV at rest and during standardized stress (recumbent ergometry). Both methods were applied and results measured independently by two examiners., Results: The time interval between the two tests averaged 1 = 2 days. EC could be performed at rest in 62 of 63 and under stress in 59 of 63 patients (RNV: 63 of 63 and 54 of 63, respectively). Resting LVEF was 61 +/- 8% by SEC and 64 +/- 9% by RNV (P < 0.05). LVEF during stress, measured by SEC, was 71 +/- 11% and 73 +/- 10% by RNV (not significant). Mean LVEF increase between rest and stress was 9 +/- 10% by SEC and 9 +/- 8% by RNV (not significant)., Conclusion: SEC is a satisfactory alternative to RNV in the assessment of ventricular function in patients receiving chemotherapy. It is less involved and more cost-effective than RNV, avoids radiation exposure and provides additional information on heart size and segmental contraction abnormalities.

This is a report on three patients with primary mediastinal seminoma. Two patients had no symptoms, and one had had thoracic pain for the last few years. The preoperative diagnosis was thymoma in all cases, and in one patient the radiologist had suspected a seminoma. We removed the tumor after performing median sternotomy (n = 2) and anterolateral left thoracotomy (n = 1). The presence of a primary gonadal seminoma was excluded with a urological and ultrasound examination. All patients are still alive following adjuvant chemotherapy (n = 2; 120 and 8 months) and radiotherapy (n = 1; 84 months). Chemotherapy consisted of four cycles of cisplatin, etoposide and ifosfamide or combination therapy with cisplatin, bleomycin and velbe.