Banna Giuseppe Luigi, De Giorgi Ugo, Ferrari Benvenuto, Castagna Luca, Alloisio Marco, Marangolo Maurizio, Rosti Giovanni, Santoro Armando
Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
Biol Blood Marrow Transplant. 2006 Oct;12(10):1085-91. doi: 10.1016/j.bbmt.2006.06.008.
Patients with primary mediastinal nonseminomatous germ cell tumors have a poor prognosis, with a 5-year overall survival of nearly 50%. We investigated the feasibility and activity of early high-dose chemotherapy (HDCT) in these patients. After conventional induction chemotherapy, patients underwent a single shot of HDCT consisting of carboplatin, etoposide, and cyclophosphamide, followed by peripheral blood progenitor cell support. Twenty-one patients were considered for treatment with HDCT. Median age was 29 years (range, 19-55 years). Eight (38%) patients had lung metastases. After primary chemotherapy, 7 patients achieved complete remission, 4 achieved partial remission with negative marker, 1 achieved partial remission with positive marker, 2 had stable disease, and 7 progressive disease. Twelve patients were not treated with HDCT due to progressive disease and poor physical conditions. No HDCT-related deaths or irreversible organ toxicities were observed. Residual surgery after HDCT was performed in 4 patients and resulted in 3 pathologic complete remissions. With a median follow-up of 52 months (range, 15-71 months) in 9 patients treated with HDCT, 8 have been continuously free of disease. Of 12 patients who did not receive HDCT, 0 was alive at 2 years from diagnosis. A single course of HDCT after induction chemotherapy appeared to be inapplicable in most of our patients, mainly due to early progressive disease. These data should be considered in the analysis of retrospective series and in the design of new prospective trials with HDCT in these patients. Earlier HDCT administration followed by residual surgery should be considered for further investigation.
原发性纵隔非精原细胞瘤患者预后较差，5年总生存率接近50%。我们研究了早期大剂量化疗（HDCT）在这些患者中的可行性和疗效。在进行常规诱导化疗后，患者接受了由卡铂、依托泊苷和环磷酰胺组成的单次HDCT治疗，随后接受外周血祖细胞支持治疗。21例患者被考虑接受HDCT治疗。中位年龄为29岁（范围19 - 55岁）。8例（38%）患者有肺转移。初始化疗后，7例患者达到完全缓解，4例达到标志物阴性的部分缓解，1例达到标志物阳性的部分缓解，2例病情稳定，7例病情进展。12例患者因病情进展和身体状况差未接受HDCT治疗。未观察到与HDCT相关的死亡或不可逆器官毒性。4例患者在HDCT后进行了残留手术，其中3例达到病理完全缓解。9例接受HDCT治疗的患者中位随访52个月（范围15 - 71个月），8例持续无病生存。12例未接受HDCT治疗的患者中，从诊断起2年时无1例存活。诱导化疗后单次HDCT疗程似乎不适用于我们的大多数患者，主要原因是早期病情进展。在分析回顾性系列研究以及设计针对这些患者的HDCT新前瞻性试验时应考虑这些数据。应考虑更早给予HDCT并随后进行残留手术以作进一步研究。
