Onkológia 3/2022

Treatment of germinal tumor during the COVID-19 pandemic

Introduction: In the times of the onset of the COVID-19 pandemic, when clinicians faced vaccine unavailability, clinical decisions about the possibility of postponing systemic treatment in the event of infection in chemosensitive malignancies were a relevant clinical problem. The presented case study describes the experience with chemotherapy in a patient with testicular germ cell tumor with extensive metastatic lung involvement and the course of complications of cytotoxic treatment and active infection. Case report: A 36-year-old patient with the diagnosis of a mixed type germ cell tumor of testis comes at a time of symptomatic relapse of the disease with hemoptysis accompanying multiple bilateral lung metastases and mediastinal lymphadenopathy. SARS-CoV-2 positivity is found during the patient’s screening examination. Given the extent of the disease and the imminent risk of further progression with life-threatening complications, the multidisciplinary team decides to initiate salvage chemotherapy. The case is interesting in monitoring the concurrent development of pneumonia and complications associated with systemic treatment, including neutropenia, thrombocytopenia. Clinical manifestations of extensive lung parenchymal involvement, symptom dynamics, and comprehensive treatment are described. The patient underwent repeated PCR examinations, antigen testing, monitoring of specific antibody levels, and the dynamics of lung findings were assessed by imaging studies. The patient is treated in a specialized center based on the data available at that time. Conclusion: The case is unique due to the extent of the chemosensitive disease with an immediate threat to the patient’s life when postponing systemic treatment until the time after resolution of the infection. With today’s availability of vaccination and reduced lethality of the SARS-CoV-2 virus, the present case is rare.

Keywords: germ-cell testicular tumor, COVID-19, metastatic cancer, systemic treatment, complications