Sidney Kimmel Comprehensive Cancer Centre, Johns Hopkins School of Medicine, 1650 Orleans Street, CRB 1, Room 186, Baltimore, MD 21231-1000, USA.
Eur Urol. 2009 Jul;56(1):57-64. doi: 10.1016/j.eururo.2009.03.018. Epub 2009 Mar 13.
High-dose chemotherapy (HDCT) with stem cell transplantation (SCT) has been investigated as a treatment strategy for advanced germ cell cancer (GCC) for >2 decades. In an effort to improve on the overall cure rates of 80% achievable with conventional chemotherapy, researchers have investigated this therapeutic option as a first-line therapy for those with poor-prognosis disease and as a salvage therapy for those with relapsed or refractory disease.
The primary objective of this review is to define the role of HDCT plus SCT in advanced GCC. Prognostic indicators for this group of patients are also presented.
A Medline search of English-language literature was performed to identify studies published in the last 20 yr relating to the use of HDCT plus SCT in advanced GCC. Phase 1, phase 2, and phase 3 trials were included, as were retrospective reviews and meta-analyses.
Phase 2 trials investigating HDCT plus SCT as a therapeutic option for advanced germ cell cancer have indicated a survival advantage over conventional chemotherapy. This has not been confirmed in the phase 3 setting. Alternative chemotherapeutic strategies and options following failure of HDCT plus SCT are discussed.
Studies to date have not indicated a survival advantage for the use of HDCT plus SCT in advanced germ cell cancer. Many questions, however, remain unanswered, and further research is required to identify whether optimising the strategy of HDCT plus SCT will improve outcome in this predominantly young group of patients.
高强度化疗（HDCT）联合干细胞移植（SCT）已被研究用于治疗晚期生殖细胞瘤（GCC）超过 20 年。为了提高常规化疗可实现的 80%的总治愈率，研究人员将该治疗选择作为预后不良患者的一线治疗方法，并作为复发或难治性疾病的挽救治疗方法进行了研究。
本综述的主要目的是确定 HDCT 联合 SCT 在晚期 GCC 中的作用。还提出了该组患者的预后指标。
对过去 20 年中与 HDCT 联合 SCT 在晚期 GCC 中的应用相关的英文文献进行了 Medline 搜索。包括 1 期、2 期和 3 期试验，以及回顾性研究和荟萃分析。
研究 HDCT 联合 SCT 作为晚期生殖细胞瘤治疗选择的 2 期试验表明，与常规化疗相比具有生存优势。但这在 3 期试验中并未得到证实。讨论了 HDCT 联合 SCT 失败后替代的化疗策略和选择。
迄今为止的研究并未表明在晚期生殖细胞瘤中使用 HDCT 联合 SCT 具有生存优势。然而，仍有许多问题尚未得到解答，需要进一步研究以确定优化 HDCT 联合 SCT 策略是否会改善这一主要为年轻患者群体的预后。
