Current opinion in germ cell cancer 2000

Despite its relative rarity compared with the common adult cancers, scienti fic and clinical interest in germ cell cancer is increasing, from the point of view of epidemiology, the controversy about the relative importance of intrauterine versus postpubertal risk factors has continued. Evidence to su pport the importance of intrauterine factors comes from reports from Norway , Canada, and the US, confirming the Danish observation that the rising inc idence of germ cell cancer is linked to a birth cohort effect; evidence in support of the importance of postpubertal risk comes from three case/contro l studies demonstrating increased risk linked to postpubertal exposures suc h as pesticides, plastics, electromagnetic radiation, trauma, and infection s. There has been increasing interest in human endogenous retrovirus K10 as a possible factor explaining genetic susceptibility and providing a linkag e between the two groups of risk factors. In cytogenetics, progress was rep orted in identifying the deletion point of the suspected tumor suppressor g ene responsible for the i12p marker chromosome abnormality and development of FISH probes for diagnostic purposes. In molecular biology, the importanc e of DNA repair deficiency in normal germ cells as a factor in the exquisit e chemosensitivity of germ cell cancer has been highlighted by a report dem onstrating a low level of the xeroderma pigmentosa group A (XPA) protein an d induction of resistance in vitro by adding XPA. In the clinic, progress i n positron emission tomography scanning and laparoscopic lymph node staging are leading to changes in outlook on management of stage 1 cases and patie nts with small residual masses postchemotherapy. Salvage chemotherapy regim ens integrating dose dense and vertical dose intensification strategies rep orted 60% progression-free survival. New drugs such as gemcitabine demonstr ated continued therapeutic potential for chemotherapy in these tumors. A re port demonstrating the inadequacies of hormone replacement after bilateral orchidectomy and a report of the first child born after testis-conserving t herapy highlight the need for more attention to testis conservation as a qu ality of life issue. With the cure rates so high, the need for central refe rral is once again debated both for stage 1 and metastatic disease. With ne w ways of defining poor risk stage 1 patients and reports on impact of expe rience highlighting the worse outcome of patients treated in centers treati ng small numbers, views on this issue remain clearcut. Curr Opin Oncol 2000 12:249-254 (C) 2000 Lippincott Williams & Wilkins, Inc.