Long-term outcome of salvage high-dose chemotherapy in patients with germ cell tumor with poor prognostic features

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• 作者：Ugo De Giorgi M.D.^a ; ¹ ; ^{ugo_degiorgi@yahoo.com"" rel=""nofollow} ; Giovanni Rosti M.D.^a ; Roberto Salvioni M.D.^b ; Giorgio Papiani M.D.^a ; Michela Ballardini Ph.D.^c ; ² ; Giorgio Pizzocaro M.D.^b ; Maurizio Marangolo M.D.^a
• 关键词：Germ cell tumor ; Testicular cancer ; High-dose chemotherapy ; Poor prognosis ; Cisplatin-refractory
• 刊名：Urologic Oncology: Seminars and Original Investigations
• 出版年：2011
• 出版时间：May-June 2011
• 年：2011
• 卷：29
• 期：3
• 页码：284-290
• 全文大小：524 K

文摘

Objective

High-dose chemotherapy (HDCT) represents an option as salvage treatment for patients with resistant/refractory germ cell tumor (GCT). The objective of this retrospective analysis was to evaluate the long-term results of a single-center experience with salvage HDCT for GCT patients, and to validate the prognostic model proposed by Einhorn and colleagues [9].

Materials and methods

Between 1986 and 2003, 100 GCT patients received salvage HDCT consisting of high-doses of carboplatin, etoposide ± cyclophosphamide, or ifosfamide. Twenty-four patients underwent a second HDCT cycle, and in 1 case, a third cycle was given with a median interval time of 6 weeks (range, 5–10).

Results

With a median follow-up of 8 years (range, 3–17); 6 of 32 (19 % ) patients with resistant GCT and 1 of 19 (5 % ) patients with cisplatin-refractory disease have been continuously disease-free, while none of the 16 patients with absolutely cisplatin-refractory GCT were alive at 1 year from HDCT treatment. In the PBPC era, HDCT appeared to be inapplicable in 32 % of patients, mainly due to progressive disease during the induction/mobilizing phase. The prognostic model by Einhorn et al. for tandem HDCT did categorize our patients treated with a single HDCT cycle or low-dose intensity regimens in a very similar manner, but with inferior overall results.

Conclusions

Long-term results with a single HDCT cycle or a low dose-intensity multicycle HDCT regimen remained poor in patients with adverse prognostic features. The tandem HDCT regimen represents a major option for refractory GCTs and relapsed tumors in third-line or later therapy, while a single course of HDCT should be abandoned for these patients.