Department of Oncology and Hematology, Istituto Oncologico Romagnolo-Santa Maria delle Croci Hospital, Ravenna, Italy.
Urol Oncol. 2011 May-Jun;29(3):284-90. doi: 10.1016/j.urolonc.2009.03.030. Epub 2009 Jun 24.
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].
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).
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.
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.
高剂量化疗（HDCT）是挽救耐药/难治性生殖细胞瘤（GCT）患者的一种选择。本回顾性分析的目的是评估单中心采用挽救性 HDCT 治疗 GCT 患者的长期结果，并验证 Einhorn 等人提出的预后模型[9]。
1986 年至 2003 年间，100 例 GCT 患者接受了挽救性 HDCT，方案包括高剂量卡铂、依托泊苷±环磷酰胺或异环磷酰胺。24 例患者接受了第二个 HDCT 周期，1 例患者接受了第三个周期，中位间隔时间为 6 周（范围为 5-10 周）。
中位随访 8 年（范围为 3-17 年）；32 例耐药 GCT 患者中有 6 例（19%）和 19 例顺铂耐药患者中的 1 例（5%）持续无病，而 16 例绝对顺铂耐药 GCT 患者无一例在 HDCT 治疗后 1 年存活。在 PBPC 时代，HDCT 在 32%的患者中似乎不适用，主要是由于诱导/动员阶段疾病进展。Einhorn 等人的用于串联 HDCT 的预后模型将我们接受单周期 HDCT 或低剂量强度方案治疗的患者进行了非常相似的分类，但总体结果较差。
对于具有不良预后特征的患者，单次 HDCT 周期或低剂量强度多周期 HDCT 方案的长期结果仍然较差。串联 HDCT 方案是难治性 GCT 和三线或更晚治疗中复发肿瘤的主要选择，而对于这些患者，应放弃单疗程 HDCT。
