Kawai Koji
Department of Urology, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Ten-nodai, Tsukuba-shi, Ibaraki 305-8575, Japan.
Gan To Kagaku Ryoho. 2003 Feb;30(2):171-80.
Approximately eighty percent of patients with disseminated testicular cancer can currently be cured because of the progress in cisplatin-based chemotherapy. For good risk disseminated disease, three courses of bleomycin, etoposide and cisplatin (BEP) is the most reliable induction chemotherapy. Cisplatin, ifostamide and either etoposide or vinblastine (VIP or VeIP) is effective standard-dose salvage chemotherapy, especially for relapsed patients with good prognosis features. However, remission is of short duration in many cases, resulting in an overall long-term disease-free survival rate of 10% to 25%. One possible approach to improve outcome is drug-dose increment. In recent years, high-dose chemotherapy (HDCT) with autologous stem-cell rescue has been used with some success in the first relapse cases and refractory cases. Although these non-randomized data are promising, the clinical benefit of HDCT remains to be confirmed in an ongoing randomized study. Another strategy is to include a new active drug in the chemotherapy regimen. Recent studies combining new active agents such as paclitaxel, gemcitabine and irinotecan have showed promising results in patients with poor prognostic disease or as salvage therapy.
由于基于顺铂化疗的进展，目前约80%的播散性睾丸癌患者可以治愈。对于预后良好的播散性疾病，三个疗程的博来霉素、依托泊苷和顺铂（BEP）是最可靠的诱导化疗方案。顺铂、异环磷酰胺以及依托泊苷或长春花碱（VIP或VeIP）是有效的标准剂量挽救化疗方案，尤其适用于预后良好特征的复发患者。然而，在许多情况下缓解期较短，导致总体长期无病生存率为10%至25%。一种可能改善预后的方法是增加药物剂量。近年来，高剂量化疗（HDCT）联合自体干细胞救援在首次复发病例和难治性病例中取得了一些成功。尽管这些非随机数据很有前景，但HDCT的临床益处仍有待正在进行的随机研究证实。另一种策略是在化疗方案中加入一种新的活性药物。最近将紫杉醇、吉西他滨和伊立替康等新活性药物联合使用的研究在预后不良疾病患者或作为挽救治疗方面显示出有前景的结果。
