MULTIPLE PRIMARY NEOPLASMS IN PATIENTS WITH TESTICULAR GERM-CELL TUMOR

The study of multiple primary neoplasms may provide more insight into the pathogenesis of specific cancers and, secondly, it addresses the i ssue of treatment-related induction of second tumors. 584 consecutive patients with testicular germ cell tumors treated during 1969-1992 in Berlin were retrospectively analyzed for the prevalence of multiple pr imary neoplasms. 23 patients (16 pure seminoma, 7 nonseminoma) develop ing nontesticular malignancies in addition to testis cancer were ident ified (3.9%, 95 confidence intervals +/- 1.6%). The mean age at the ti me of the testis cancer was 42.8 years, and mean age at the time of no ntesticular malignancy was 50.2 years. In 4 cases, the nontesticular m alignancy preceded testis cancer, in 3 patients both neoplasms occurre d simultaneously, and in 16, nontesticular malignancies developed subs equently to testis cancer. In 4 patients, triple malignancies were obs erved. Bladder carcinoma and bronchogenic cancer with each 3 cases wer e the most frequent second neoplasms seen in these patients. 9 consecu tive cancers developed within radiation fields, the median latency per iod in these cases was 12 years. None of the subsequent cancers develo ped after chemotherapy. It is concluded that genetic predisposition an d radiation effects are the most important factors contributing to the occurrence of multiple primary neoplasms in patients with testicular germ cell cancer. The high rate of multiple primary neoplasms in these patients lends further evidence to the theory of genetic anticipation of germ cell cancer.