J R Germà

Publications (25)99.31 Total impact

• Article: Clinico-pathological risk factors of stage II colon cancer:results of a prospective study.

  C Santos, A López-Doriga, M Navarro, J Mateo, S Biondo, M Martínez Villacampa, G Soler, X Sanjuan, M J Paules, B Laquente, E Guinó, E Kreisler, R Frago, J R Germà, V Moreno, R Salazar
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  ABSTRACT: Aim:  Adjuvant 5-flourouracil based chemotherapy has demonstrated benefit in stage III colon cancer (CC) but still remains controversial in stage II. The aim of this study was to analyse the prognostic impact of clinico-pathological factors that may help guide treatment decisions in stage II CC. Method:  Between 1996 and 2006 data from patients diagnosed with colorectal cancer at Hospital Universitari Bellvitge (HUB) and its referral comprehensive cancer center, Institut Català d'Oncologia (ICO)/ L'Hospitalet, were prospectively included in a database. We identified 432 patients with stage II CC operated at HUB. 5-year relapse free survival (RFS) and colon cancer specific survival (CCSS) were determined. Results:  5-year RFS and CCSS were 83% and 88%, respectively. Lymphovascular or perineural invasion was associated with RFS (HR of 1.84; 95% CI, 1.01-3.35). Gender (women HR of 0.48; 95% CI, 0.23-1) and lymphovascular or perineural invasion (HR 3.51; 95% CI, 1.86-6.64), along with pT4 (HR 2.79; 95% CI, 1.44-5.41) influenced CCSS. In multivariate analysis pT4 and lymphovascular or perineural invasion remained significantly associated with CCSS. We performed a risk index with those factors with prognostic impact. Patients with pT4 tumours and lymphovascular or perineural invasion had a 5-year CCSS of 61%, versus the 93% (HR 5.87; 95 CI, 2.46-13.97) of those without any of these factors. Conclusion:  pT4 and lymphatic, venous, or perineural invasion are confirmed as significant prognostic factors in stage II CC and should be taken into account in the clinical validation process of new molecular prognostic factors. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
  Colorectal Disease 09/2012; · 2.93 Impact Factor
• Article: SEOM clinical guidelines for diagnosis and treatment of testicular seminoma (2010).

  Jorge Aparicio, Javier Sastre, José Ramón Germà, Dolores Isla
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  ABSTRACT: Testicular cancer represents the most common malignancy in males aged 15-34 years. Nearly 40% of cases correspond to seminomas and three quarters of them are diagnosed with stage I disease. After orchiectomy, clinical staging should include serial tumour marker assays (alphafetoprotein must be negative), abdominal CT scan and chest X-ray films. Patients with stage I disease can be followedup (active surveillance) or receive adjuvant carboplatin chemotherapy (those with rete testis invasion or non-compliant with follow-up). More advanced disease (stage II and III) and patients with extragonadal seminomas should receive chemotherapy (3-4 courses of BEP) according to IGCCCG risk classification. Residual lesions must be managed by surveillance if they are smaller than 3 cm, while those larger than 3 cm should be evaluated by means of PET. Surgery is only recommended in PET-positive lesions.
  Clinical and Translational Oncology 08/2011; 13(8):560-4. · 1.33 Impact Factor
• Source

  Available from: Alvaro Rodríguez-Lescure

  Article: Treatment of cancer with oral drugs: a position statement by the Spanish Society of Medical Oncology (SEOM).

  R Colomer, E Alba, A González-Martin, L Paz-Ares, M Martín, A Llombart, A Rodríguez Lescure, J Salvador, J Albanell, D Isla, M Lomas, C A Rodríguez, J M Trigo, J R Germà, J Bellmunt, J Tabernero, R Rosell, E Aranda, R Cubedo, J Baselga
  Annals of Oncology 02/2010; 21(2):195-8. · 6.43 Impact Factor
• Article: Lessons learned in the implementation of a cancer care network in Catalonia

  J. M. Borras, A. Boyd, M. Martinez-Villacampa, J. Brunet, R. Colomer, J. R. Germà
  Journal of Management & Marketing in Healthcare. 01/2009; 2(2):174-183.
• Article: The oncology acute toxicity unit (OATU): an outpatient facility for improving the management of chemotherapy toxicity.

  M Majem, M Galán, F J Pérez, M Muñoz, S Chicote, G Soler, M Navarro, M Martínez-Villacampa, X García del Muro, E Dotor, B Laquente, J R Germà
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  ABSTRACT: To provide an outpatient facility to improve the management of chemotherapy toxicity in cancer patients. We set up an oncology acute toxicity unit (OATU) to improve toxicity management. A telephone helpline was the initial contact which filters out inappropriate non-toxicity-related events. Patients were provided an information booklet describing the possible side effects of the chemotherapy and the helpline telephone number. A specialist nurse received the calls and consulted the doctor if necessary. Depending on requirements, the patient's problem was resolved by telephone, or a consultation visit at the OATU was arranged. Between February 1999 and August 2001, 1126 patients made 2007 contacts with the OATU. The most common tumours were breast (26%), colorectal (20%) and lung (20%). The telephone helpline was used in 87% of contacts and 37% were considered inappropriate. Of the 1263 appropriate contacts, the most frequent chemotherapy schedules that had been administered were 5FU-leucovorin (11.2%) and CMF (10.4%). The most frequent side effects were fever (35.5%), diarrhoea (18.5%), mucositis (16.2%) and emesis (13%). The problem was resolved by telephone in 48% of cases and 52% required attendance in the OATU, of which 40% required hospital admission, i.e., 21.1% of the initial appropriate helpline contacts. The most frequent reason was Grade 3-4 neutropenic fever (56.5%). The OATU enables prompt and efficient access of patients to medical oncology facilities in the event of toxicity due to chemotherapy. Unnecessary emergency room use is avoided while oncology outpatient and hospitalisation facilities are optimised.
  Clinical and Translational Oncology 01/2008; 9(12):784-8. · 1.33 Impact Factor
• Article: Metronomic chemotherapy: an antiangiogenic scheduling.

  B Laquente, F Viñals, J R Germà
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  ABSTRACT: Conventional cytotoxic anticancer chemotherapeutic drugs were developed with the intent of treating cancer by direct killing or inhibition of growth of cycling tumour cells. Recently, however, there has been considerable interest in the notion of exploiting such drugs as angiogenesis inhibitors. The rationale is based on the fact that virtually all classes of cancer chemotherapeutic drugs are designed to damage DNA or disrupt microtubules of dividing cells, and endothelial cell division takes place during new blood vessel formation, including tumour angiogenesis. The results of recent experimental studies have suggested that frequent administration of certain cytotoxic agents at low doses, known as "metronomic chemotherapy", increases the putative antiangiogenic activity of certain drugs. Metronomic chemotherapy refers to the chronic administration of comparatively low doses of cytotoxic drugs at close, regular intervals, with no prolonged drug-free interruptions. The advantage of this strategy is lower toxicity and risk of emergence of drug-resistant tumour cells than conventional administration. This review describes the possible antiangiogenesis basis of this therapeutic strategy, the experimental studies published and the recent clinical studies that explore this less toxic schedule.
  Clinical and Translational Oncology 03/2007; 9(2):93-8. · 1.33 Impact Factor
• Article: Treatment of stage I testicular germ-cell tumors.

  Jorge Aparicio, J R Germà
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  ABSTRACT: More than a half of patients with testicular cancer are diagnosed with clinical stage I disease. In this setting, definitive cure is the rule. However, there is no consensus on the optimal treatment choice. A literature review (1990-2005) was performed in order to identify the pros and the cons associated with each therapy, as well as their long-term outcomes. Several treatment alternatives yield similar efficacy results. Thus, therapy-related morbidity, economic costs, quality-of-life issues, and patient preferences should be considered. Refinement in the knowledge of predictive factors for relapse and amounting experience with both surveillance and adjuvant chemotherapy have led to consideration of risk-adapted treatment policies as an alternative to more traditional approaches (i.e., prophylactic irradiation for seminomas and retroperitoneal lymph node dissection for non-seminomas). In conclusion, with cure rates approaching 100%, close surveillance for low-risk patients and adjuvant chemotherapy for those at high risk of relapse seems the preferred option for clinical stage I testicular cancer, in both seminoma and non-seminoma cases.
  Medical Oncology 02/2006; 23(3):305-15. · 2.14 Impact Factor
• Source

  Available from: Ramon Colomer

  Article: Cancer care in rural areas.

  R Colomer, J R Germà, R Rosell, J M Borràs
  British Journal of Cancer 05/2004; 90(8):1688; author reply 1689. · 5.04 Impact Factor
• Article: Treatment of malignant superior vena cava syndrome by endovascular stent insertion. Experience on 52 patients with lung cancer.

  A Urruticoechea, R Mesía, J Domínguez, C Falo, E Escalante, A Montes, C Sancho, F Cardenal, M Majem, J R Germà
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  ABSTRACT: Superior vena cava syndrome (SVCS) is a frequent presentation of malignancies involving the mediastinum and can seriously compromise treatment options and prognosis. Stenting of superior vena cava is a well-known but not so commonly used technique to alleviate this syndrome. Between August 1993 and December 2000 we performed 52 stenting procedures in patients affected by non-small cell lung cancer (NSCLC). Phlebographic resolution of the obstruction was achieved in 100% of cases with symptomatic and subjective improvement in more than 80%. One major complication was observed due to bleeding during anticoagulation. Re-obstruction of the stent occurred in only 17% of the cases, the majority due to disease progression. Improvement of the syndrome allowed hydration necessary for full dose platinum treatment when indicated in patients affected by lung cancer. Stenting of the superior vena cava syndrome is a safe and effective procedure achieving a rapid alleviation of symptoms in almost all patients, and allowing for full dose treatment in lung cancer patients. This procedure could change the traditional poorer prognosis attributed to non-small cell lung cancer patients presenting with this syndrome.
  Lung Cancer 03/2004; 43(2):209-14. · 3.43 Impact Factor
• Article: Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma.

  J Aparicio, X García del Muro, P Maroto, L Paz-Ares, E Alba, A Sáenz, J Terrasa, A Barnadas, D Almenar, J A Arranz, M Sánchez, A Fernández, J Sastre, J Carles, J Dorca, J Gumà, A L Yuste, J R Germà
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  ABSTRACT: After decades of irradiation as standard therapy for clinical stage I testicular seminoma, alternative treatment approaches have emerged including postorchiectomy surveillance and adjuvant chemotherapy. This study was performed to assess a dual policy of surveillance and selective single-agent carboplatin (for high-risk cases) in a multicenter setting. From 1994 to 1999, 203 patients with stage I seminoma were included. Sixty (29.6%) were considered poor-risk cases (i.e. with vascular invasion and/or pathological tumor stage pT2 or greater) and received two courses of adjuvant carboplatin, whereas 143 (70.4%) without risk criteria underwent close surveillance. Median follow-up was 52 months (range 14-92). Relapses were observed in two (3.3%) patients treated with carboplatin and in 23 patients (16.1%) on surveillance, with a median time to recurrence of 11 months (range 3.9-39.6). All relapsing patients were rendered disease-free, mainly with cisplatin-based chemotherapy. Four patients died from tumor-unrelated causes. Actuarial 5-year overall survival was 96.7% and cause-specific survival was 100%. Five-year disease-free survival was 83.5% for patients on surveillance, and 96.6% for those receiving carboplatin. This dual treatment policy is feasible in a multicenter setting and preserves 70% of patients from adjuvant chemotherapy. Single-agent carboplatin is effective in reducing the relapse rate in patients with high-risk stage I seminoma. A better definition of local risk features would probably improve patient selection, thus minimizing the incidence of recurrences on surveillance.
  Annals of Oncology 07/2003; 14(6):867-72. · 6.43 Impact Factor
• Article: Mismatch repair gene analysis in Catalonian families with colorectal cancer.

  M Palicio, J Balmaña, S González, I Blanco, E Marcuello, M A Peinado, G Julià, J R Germà, J J López López, J Brunet, G Capellà
  Journal of Medical Genetics 07/2002; 39(6):E29. · 6.36 Impact Factor
• Article: [Clinical pattern and therapeutic results obtained in Germ-Cell testicular cancer in Spain based on a consecutive series of 1250 patients].

  J R Germà, X García Del Muro, P Maroto, P Lianes, J A Arranz, J Gumà, J Aparicio, J Sastre, E Alba, J Terrasa, A Sáenz, A Fernández
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  ABSTRACT: Even its low incidence, germ-cell testicular cancer is very relevant due to its presentation at young ages and its potential curability over 90%. Spanish Germ Cell Cancer Group (GG) joins the efforts of 51 different Spanish centres to share their experience on the diagnosis and treatment of these special tumours. We describe the clinical characteristics and the results of treatment in the first 1,250 patients registered throughout 6 years by the GG. 11% had previous criptorchidism. The most frequent initial local simptomatology was increased testis size (90%). 20% lasted more than six months in receiving the first treatment. Inguinal orquidectomy was done in 95% of patients. 435 cases (35%) were seminoma and 815 (65%)non-seminoma. 19% of seminoma and 78% of non-seminoma produced tumour markers. 75% of seminoma but only 56% of non-seminoma were clinical stage I. Following the IGCCCG prognosis classification,20% of non-seminoma fitted in the poor-prognosis group. Stage I seminoma treatment was surveillance, chemotherapy and complementary radiotherapy in 60, 32 and 6%, respectively. Those features were 65, 35% and none in non-seminoma cases. Chemotherapy schedules used in advanced cases were EP for seminoma and BEP or BOMP-EPIin non-seminoma, according to whether the patient was in the good or bad prognosis IGCCCG group. With a median of follow-up in all serie of 30 months, we have obtained a three years overall survival of 98% (CI 95%, 96,4-9,6), whereas non-seminoma patients had a three years overall survival of 94% (CI 95%, 92-96). The Spanish germ cell testicular cancer clinical pattern is similar to that registered in other occidental countries. Co-operative structures like GG,are able to gather an extensive experience in a short period of time that results in achieving a very high number of cured patients.
  Medicina Clínica 05/2001; 116(13):481-6. · 1.38 Impact Factor
• Article: K-ras and p16 aberrations confer poor prognosis in human colorectal cancer.

  M Esteller, S González, R A Risques, E Marcuello, R Mangues, J R Germà, J G Herman, G Capellà, M A Peinado
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  ABSTRACT: Mutations in the K-ras gene are frequent in human cancer. ras activation in primary cells results in a cellular senescence phenotype that is precluded by inactivation of p16. At the clinical level, this may imply a differential behavior for tumors with alternative or cooperative activation of K-ras function and impairment of p16 pathways. We have determined the presence of mutations in the K-ras gene and the methylation status of p16 promoter in a series of 119 prospectively collected colorectal carcinomas. p53 mutations and p14 alternative reading frame methylation status were also assessed. Associations with survival were investigated. K-ras mutations were present in 44 (38%) of 115 cases, and p16 methylation was present in 42 (37%) of 113 cases. p53 mutations were detected in 50% (56 of 115) and p14 methylation in 29% (32 of 112) of cases. K-ras and p16 alterations were independent genetic events. Presence of K-ras or p16 genetic alterations (analyzed independently) was associated with shorter survival, although differences were not statistically significant. Cox analysis of the two variables combined showed a diminished survival as the results of an interaction between p16 and K-ras. Alternative alteration of K-ras and p16 genes was an independent prognostic factor in human colorectal cancer in univariate and multivariate analysis. Differences were maintained when cases undergoing radical surgery and without distant metastases were considered. These results suggest that the combined K-ras and p16 analyses may be of prognostic use in human colorectal cancer.
  Journal of Clinical Oncology 02/2001; 19(2):299-304. · 18.37 Impact Factor
• Article: Prognostic value of the expression of E-cadherin and beta-catenin in bladder cancer.

  X Garcia del Muro, A Torregrosa, J Muñoz, X Castellsagué, E Condom, F Vigués, A Arance, A Fabra, J R Germà
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  ABSTRACT: The purpose of this study was to assess the prognostic effect of the expression of E-cadherin, beta-catenin and CD44 adhesion molecules in bladder carcinoma. 22 superficial and 18 invasive bladder tumour samples were studied by immunohistochemistry. The median follow-up was 24 months (range: 1-50 months). Loss of E-cadherin and beta-catenin immunoreactivity was found in 14 (35%) and 17 (43%) tumours, respectively, and was significantly associated with invasiveness, high grade and p53 overexpression. There was no correlation between CD44 variant expression and clinicopathological findings. Loss of E-cadherin expression was an independent predictor of poor survival in a multivariate analysis, when assessed with age, grade, stage and p53 status (hazards ratio adjusted (HRa)=4.45 [95% confidence interval (CI), 1.06-18.63]). This effect was particularly augmented in patients with invasive bladder cancer. When expression of E-cadherin and beta-catenin were evaluated simultaneously, loss of immunoreactivity of both proteins was a strong predictor of poor survival (HRa=13.06 [95% CI, 0.95-178.55]). The same pattern was found when progression-free survival in relation to these variables was assessed. In conclusion, assessment of E-cadherin and beta-catenin immunoreactivity may be a useful prognostic marker in bladder cancer complementary to established prognostic factors.
  European Journal of Cancer 03/2000; 36(3):357-62. · 5.54 Impact Factor
• Article: Peripheral blood CD34+ cell immunomagnetic selection in breast cancer patients: effect on hematopoietic progenitor content and hematologic recovery after high‐dose chemotherapy and autotransplantation

  J.A. Cancelas, S. Querol MD Investigator, C. Canals, M. Picón, C. Azqueta, C. Solà, A. Montes, B. Amill, E. Griera, J.R. Inglés, J.J. López, J.R. Germà, J. García-López
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  ABSTRACT: BACKGROUND: Tumor cells have been detected in mobilized peripheral blood of breast cancer patients, and they may contribute to tumor recurrence after the transplantation of peripheral blood progenitor cells. One of the most widespread technologies for tumor purging of the graft is immunomagnetic hematopoietic progenitor cell selection. STUDY DESIGN AND METHODS: The study assessed the effectiveness of a magnetic cell-separation system in selecting functional subpopulations of hematopoietic progenitors from 14 blood-derived harvests of 11 patients with high-risk breast cancer after mobilization following cytotoxic chemotherapy supported by granulocyte–colony-stimulating factor, as well as the feasibility of transplanting these selected subpopulations. RESULTS: CD34(+)-enriched cell fractions had a median purity of 93.0 percent (72.7-98.5%). The procedure yielded 52.6 percent of the CD34+ cell input (39.4-116.8%). Median recoveries of colony-forming units (CFUs) (36.87%) and cobblestone area-forming cells (CAFCs) (152.5%) were, respectively, 0.70 and 2.87 times those of CD34+ cells (52.6%). Moreover, CAFC efficiency in the positive cell fraction was 2.57 times that in the starting cell fraction. Peripheral blood neutrophil counts of 0.5 × 10(9) per L and platelet counts of 20 × 10(9) per L were reached after median times of 9 and 11 days, respectively. The number of transfused CAFCs per kg, CD34+ cells per kg, and postthaw CFU- granulocyte-macrophage per kg was correlated, respectively, with the speed of engraftment of neutrophils, platelets, or both. Tumor cells detected in one patient's peripheral blood were not found after CD34+ cell selection. CONCLUSION: Transplantation of immunomagnetically purified peripheral blood CD34+ cells does not increase transplantation- related morbidity. It induces a selective enrichment of more immature hematopoietic progenitors, which makes it suitable for use in cell expansion and gene therapy protocols.
  Transfusion 11/1998; 38(11‐12):1063 - 1070. · 3.22 Impact Factor
• Article: CDC group IV c-2 infection in a stem cell transplant recipient.

  A Arance, A Montes, M Cisnal, R Mesía, C Falo, J García del Muro, J R Germà
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  ABSTRACT: Patients undergoing high-dose chemotherapy for cancer are at a high risk of infections caused by unusual microorganisms. Previous chemotherapy, use of indwelling catheters and prior antibiotic treatment are common predisposing factors. We present a case of septicaemia due to a rare non-fermentative bacillus, CDC group IV c-2, found in the blood and venous catheter from a patient with a testicular germ cell tumour undergoing high-dose consolidation chemotherapy.
  Bone Marrow Transplantation 01/1998; 20(11):1005-6. · 3.75 Impact Factor
• Article: Alpha-fetoprotein-concanavalin A binding as a marker to discriminate between germ cell tumours and liver diseases.

  J Mora, N Gascón, J M Tabernero, J R Germà, F González
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  ABSTRACT: In order to differentiate whether slight alpha-fetoprotein (AFP) increases observed in any patient are due to germ cell tumours (GCT) or to liver diseases (including hepatotoxicity of chemotherapy), we measured the binding ratio of the AFP to concanavalin A (ConA). A total of 218 serum samples were studied: 102 samples from 72 GCT patients and 116 from patients with liver diseases. Considering a cut-off value to be a ConA binding ratio of 15%, we distinguished AFP produced by GCT (> 15%) from AFP produced by tumoral and non-tumoral liver diseases (< or = 15%) with a sensitivity of 98% and specificity of 100%. The difference between mean ConA binding ratios was statistically significant (P < 0.0001). We did not distinguish AFP produced by tumoral and non-tumoral liver diseases. ConA binding ratio may be a sensitive index to distinguish whether an increase of AFP concentration as low as 15 U/ml in a GCT patient during the follow-up is produced by the tumour or by liver dysfunction (including hepatotoxicity of chemotherapy).
  European Journal of Cancer 12/1995; 31A(13-14):2239-42. · 5.54 Impact Factor
• Article: False elevations of alpha-fetoprotein associated with liver dysfunction in germ cell tumors.

  J R Germà, M Llanos, J M Tabernero, J Mora
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  ABSTRACT: Determination of serum concentration human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) is crucial in diagnosis, prognosis, treatment, and follow-up of patients with germ cell tumors. Elevation of these markers almost indicates progression or recurrence of the germ cell tumor. However, an increase in these tumor markers can be produced by several benign causes. The authors report nine cases of gonadal germ cell tumors that had increased serum levels of AFP without tumoral progression, recurrence, or residual tumor. The AFP elevations were attributed to liver damage secondary to drugs (chemotherapy, anesthetics, or antiepileptics), virus, or alcoholism. No clinical evidence (or in some cases surgical evidence) of malignant tumor activity was found in any of the patients. The elevation of serum levels of AFP in patients with germ cell tumors can be produced by liver dysfunction. These elevations must be interpreted with caution to avoid unnecessary treatments.
  Cancer 11/1993; 72(8):2491-4. · 4.77 Impact Factor
• Article: Repair of human sperm chromosome aberrations in the hamster egg.

  A Genescà, M R Caballín, R Miró, J Benet, J R Germà, J Egozcue
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  ABSTRACT: In order to study the repair capacity of fertilized hamster eggs for the lesions present or induced in human sperm, we have examined the potentiating effect of caffeine, a DNA repair inhibitor, on the frequency and types of sperm chromosome aberrations. Sperm samples were donated by an individual treated with chemotherapy for a testicular cancer 3 years previously. Exposure of spermatozoa and inseminated oocytes to caffeine led to an increase of sperm chromosome aberrations, indicating that the damage to human sperm can be repaired in untreated hamster egg cytoplasm. The potentiating effect of caffeine was mainly reflected in an increase of unrejoined aberrations, indicating that the formation of chromosomal rearrangements is also inhibited. Since both chromatid-type and chromosome-type aberrations increase after treatment with caffeine, damage to human sperm can probably be repaired inside the hamster egg cytoplasm by pre- and post-replication repair mechanisms.
  Human Genetics 06/1992; 89(2):181-6. · 5.07 Impact Factor
• Article: Significance of structural chromosome aberrations in human sperm: analysis of induced aberrations.

  A Genescà, J Benet, M R Caballín, R Miró, J R Germà, J Egozcue
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  ABSTRACT: A significant increase in the incidence of structural chromosome anomalies has been observed in the sperm of patients treated with radio and/or chemotherapy for different types of cancer when analyzed by the interspecific fertilization of hamster eggs. The analysis of these aberrations shows that while in controls only 9.4% of structural abnormalities are of the stable type, in treated patients this figure increases to 39.3%, thus indicating that the anomalies have not been produced during the fertilization of the hamster egg. However, it is possible that part, or even most, of the breaks appear as a result of a reduced repair capacity of sperm chromosomes in the cytoplasm of the hamster egg.
  Human Genetics 11/1990; 85(5):495-9. · 5.07 Impact Factor