Case study level Ma Management of testicular cancer
- 9 91, 10 0.7 2.4 (2006) 20 30 20 20-40
AFP -hcg -hcg AFP
TNM T ptx pt0 ptis pt1 / pt2 / pt3 / pt4 / N NX N0 N1 2cm 1 2cm N2 2cm 5cm 1 5cm N3 5cm
TNM M MX M0 M1 -M1a -M1b (S) SX S0 S1 LDH<1.5 N -hcg<5,000miu/ml AFP<1,000ng/ml S2 LDH=1.5~10 N -hcg =5,000~50,000mIU/ml AFP =1,000~10,000ng/ml S3 LDH>10 N -hcg>50,000miu/ml AFP>10,000ng/ml : N LDH 618mIU/ml)
Stage A (pt1n0m0) B (pt2 4N0M0) A 5cm N1 2M0 B 5cm N3M0 (M1) A B C
StageI CBDCA 5% Stage 1st line 2nd line : BEP (EP ) : VIP
BEP B: BLM (i.v.20mg/m 2 <30mg/body) day2, 9, 16 E: VP-16 (i.v.100mg/m 2 ) day1~5 P: CDDP (d.i.v.20mg/m 2 ) day1~5 day1 day2 3 4 5 day9 day16 VP-16 CDDP BLM VP-16 CDDP VP-16 CDDP BLM BLM 3weeks/cool BEP : 1st line :
VIP V: VBL (d.i.v. 75mg/m 2 ) day1~5 I : IFM (i.v.1.2g/m 2 ) day1~5 P: CDDP (d.i.v.20mg/m 2 ) day1~5 day1 2 3 4 5 VBL IFM CDDP 3weeks/cool VIP : 2nd line :
Mr. AC (22) 2 BEP
Full blood count Hb: 16.1g/dl (13.1-16.5g/dl) WBC: 6600 /mm 3 (3490-9210 /mm 3 ) Neu: 3000 /mm 3 (1600-5600 /mm 3 ) Plt: 355 10 3 /mm 3 (150-400 10 3 /mm 3 ) Biochemistry Na: 140 meq (137-145 meq) K: 3.9 meq (3.6-5.0 meq) UN: 36.1 mg/dl (9-20 mg/dl) Scr 2.43 mg/dl (0.8-1.5 mg/dl) Renal function CL EDTA : 57ml/min. (80-120 ml/min.) Liver function T-Bil: ALT: AST: 0.9 mg/dl (0.4-1.3 mg/dl) 45 units/l (0-72 units/l) 122 units/l (38-126 units/l) -GTP: 20 units/l (15-73 units/l) Tumor markers -hcg: 3275 miu/ml (0-4 miu/ml) AFP: LDH 614 ng/ml (0-13 ng/ml) 751 miu/ml (313-618 miu/ml)
scan -Stage B ( )
#1 S: O: BEP -hcg 3275mIU/ml AFP 614ng/ml LDH 751mIU/ml A: P: Performance Status (PS) G-CSF GC 5-HT 3 H 2 NK-1
#2 S: O: UN Scr CL EDTA :36.1mg/dl :2.43mg/dl CL cr 59.4ml/min. (Cockcroft-Gaut) :57ml/min. A: P:
#3 O: A: P:
#4 O: - A: P: BEP
Q1 Scr CL EDTA AFP -hcg
Q2 PS
Q3 BEP B: BLM (i.v.30mg/body) day1, 8, 15 E: VP-16 (i.v.165mg/m 2 ) day1~3 P: CDDP (d.i.v.50mg/m 2 ) day1~2 day1 day2 day3 day8 day15 VP-16 CDDP BLM VP-16 CDDP VP-16 BLM BLM 3weeks/cool Ondansetron Dexamethasone Metoclopramide Domperidone suppositories 8mg p.o. b.d. for 1day 8mg p.o. b.d. for 3days 10mg p.o. q.d.s. for 3days 30mg p.r. q.d.s. or p.r.n.
Q3 5-HT3 NK-1 H2 PPI D2 <CTCAE Grade3) Hb (<8.0g/dl) WBC (<2000/mm 3 ) s.c. G-CSF Neu (<1000/mm 3 ) s.c. G-CSF Plt (<5 /mm 3 )
Q3 CDDP hydration 5-7 2 V.B12 V.B12
Q3 BLM 150mg/m 2 <300mg/body A-aDO2 PaO2 A-aDO2: PaO2:! 2 1
Q4 Height=182cm Weight=88kg BSA=2.1m 2 Scr=2.43mg/dl CL cr =59.4ml/min. PS Grade 0-1 60>CL cr >45 45>CL cr >30 30>CL cr CDDP 75% 50% VP-16 85% 80% 75% BLM 70% 60% CDDP(50mg/m 2 ) = 20 0.75 2.1= 79mg/body VP-16(165mg/m 2 ) = 165 2.1= 346mg/body BLM(20mg/m 2 ) = 20 2.1>30 = 30mg/body
Q5 Ondansetron 8mg p.o. b.d. for 1day Dexamethasone 8mg p.o. b.d. for 3days Metoclopramide 10mg p.o. q.d.s. for 3days Domperidone 30mg p.r. q.d.s. or p.r.n. suppositories
Q6 O: BEP 4 2-3 Ondansetron Dexamethasone Metoclopramide Domperidone suppositories 8mg p.o. b.d. for 1day 8mg p.o. b.d. for 3days 10mg p.o. q.d.s. for 3days 30mg PR q.d.s. for p.r.n.
Q6 A CTCAE grade2 2 P:
Q7 14 PS
day45 BEP 3 2 day69 BEP 3 -HCG, AFP CT
1. 2. National Comprehensive Cancer Network (NCCN) http://www.nccn.org/index.asp 3. http://ganjoho.jp/public/cancer/data/testis.html 4. 17 5. National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events v3.0 (CTCAE)