Search

Since 1977, advances in the treatment of germ-cell tumors have resulted in a declining mortality from testicular cancer. Simultaneously, a rising incidence of disease was seen in many developed parts of world. However, the frequency of and mortality from testicular cancer have not been reported from any third-world country, where larger and younger populations at risk reside. The age-specific annual incidence of testicular cancer was calculated from information in the cancer registry of Iraq (1986-1988). The data on management of 29 patients with testicular (n=15) and non-testicular (n=14) germ-cell tumors were retrospectively analyzed (9% of all non-seminoma testicular cancers in the country for the 1984-1990 period). The annual incidence of testicular cancer is low in Iraq. Transscrotal biopsy and transscrotal orchiectomy were frequently performed but did not adversely affect patient outcome. A poor outcome was associated with the lack of surveillance after surgery; inappropriate sequencing of chemotherapy, surgery and radiation treatment; and chemotherapy of a low-dose intensity. Tumor marker studies were infrequently done. In conclusion, the annual incidence of testicular carcinoma in this developing country is low, but mortality appears high due to the incomplete penetration of the current medical knowledge into clinical practice.

The cytotoxicity and antitumor effects of the acetogenin Bullatacin were evaluated in vitro in multiple ovarian cancer cell lines and in vivo in a murine ovarian teratocarcinoma (MOT) model in C3HeB/FeJ mice. The in vitro cytotoxicity of Bullatacin against four human ovarian epithelial tumor cell lines (OC-194, OC-222, OVCAR-3, and A-2780) was assessed in 48- and 72-h tetrazolium-dye (MTT) cytotoxicity assays. The percentage of cytotoxicity was determined on the basis of the mean optical density of the respective untreated cells and the dose effective against 50% of the cells (ED50) was calculated for each cell line. In vivo experiments were performed on adult female C3HeB/FeJ mice, which were injected i.p. with 10(5) MOT cells and varying amounts of Bullatacin given either in a single dose or in 5 subsequent doses over 72 h. All mice were observed for survival relative to that of the control groups, which were injected either with 10(5) MOT cells with or without serial injections of vehicle or with vehicle only. All four epithelial ovarian cancer cell lines displayed sensitivity to Bullatacin. The relative cytotoxic effects were very heterogeneous, with the ED50 value ranging between 10(-7) micrograms/ml for OC-194 and 4 micrograms/ml for the cisplatin-resistant cell line OVCAR-3 in a 72-h MTT cytotoxicity assay. All mice that had been injected i.p. with 10(5) MOT cells and 1.4 mg/kg or more of Bullatacin died within the first 24 h after injection, whereas all mice that had received 600 micrograms/kg of Bullatacin or less survived equally as long as the controls that had been injected with MOT only (21.1 +/- 0.9 days). Mice that had received Bullatacin at a dose ranging from 600 micrograms/kg to 1.4 mg/kg either died during the 1st day postinjection or survived, but not longer than the MOT control group. Serial i.p. injections of Bullatacin again either led to death of the mice within 24-48 h of the last dose of Bullatacin or did not have any effect on the survival of the mice as compared with the respective control groups, which had been injected with the tumor and serial injections of vehicle (22.5 +/- 2.2 days). In summary, Bullatacin showed no effect on MOT-caused animal death in C3HeB/FeJ mice at nonlethal dose ranges, whether it was given as a single i.p. dose or serially over 72 h. In vitro, however, it proved to be a very potent cytotoxic agent in a variety of ovarian cancer cell lines.(ABSTRACT TRUNCATED AT 400 WORDS)

Fifty-nine stage IV disseminated testicular cancer patients underwent 5 or more courses of cisplatin, vinblastine and bleocin (PVB) chemotherapy from August 1981 to July 1989. Tumour histology included 15 seminomas, 13 embryonal carcinomas, 13 teratocarcinomas and 18 mixed tumours. Thirty-four patients (58%) achieved complete remission with an average duration of 56+ months (range 3 to 113+), and 12 patients (20%) achieved partial remission with an average duration of 8.5 months (range 2 to 33). The overall response rate was 78%. Four patients achieved complete remission after adjunctive surgery. The best response was obtained in seminoma patients (73% complete remission). The 5-year survival is 88% for complete responders, 10% for partial responders, and 53% overall. The PVB combination has considerably improved the survival of disseminated testicular cancer patients, but the low survival rate in poor-risk patients necessitates more aggressive chemotherapy regimens.