Azrif Muhammad, Leong Yu Kong, Aslan Nik Muhammad, Fong Kua Voon, Ismail Fuad
Department of Radiotherapy and Oncology, UKM Medical Centre, Malaysia.
Asian Pac J Cancer Prev. 2012;13(6):2467-71. doi: 10.7314/apjcp.2012.13.6.2467.
Although bleomycin/etoposide/cisplatinum (BEP) chemotherapy is established as the standard treatment for germ cell tumours, it requires significant experience in administration and toxicity management to maintain optimal dose intensity. A retrospective review of 30 patients was conducted at UKMMC to study treatment outcomes.
Patients with GCTs and treated with at least two cycles of BEP chemotherapy between January 2003 and Oct 2009 were eligible for this study. Patients received 4-6 cycles of bleomycin 30,000IU IV D1, D8 and D15 and either etoposide 100mg/m2 IV D1- D5 and cisplatin 20mg/m2 IV D1- D5 (5 day BEP regimen) or etoposide 165 mg/m2 D1- D3 and cisplatin 50mg/m2 D1-3 (3 day BEP regimen) every three weeks per cycle. All patients received prophylactic granulocyte colony-stimulating factor (GCSF) from days 6 to 10 of each cycle. The overall response rates, 2 year progression-free survival and overall survival of the whole cohort were assessed.
Thirty patients fulfilled the inclusion criteria. Non-seminomatous GCTs comprised 93.3% of cases and gonadal and mediastinal primary sites were the most common. Sixty percent were classified as IGCCCG poor risk disease. Median follow-up was 26.6 months. The overall response rate (CR+PR) was 70%. The two year PFS and OS were 70% and 66%. There was a significant difference in terms of the overall response rate (85% vs 40%, p = 0.03) and in PFS (94.7% vs 50%, p = 0.003) between gonadal and extragonadal primary sites.
It is possible to achieve outcomes similar to those in international clinical trials with close monitoring and good supportive care of patients undergoing BEP chemotherapy. There is a strong argument for patients with IGCCCG poor prognosis disease to be treated in specialist tertiary centres to optimize treatment outcomes.
尽管博来霉素/依托泊苷/顺铂（BEP）化疗已被确立为生殖细胞肿瘤的标准治疗方法，但要维持最佳剂量强度，在给药和毒性管理方面需要丰富经验。英国曼彻斯特大学医学中心对30例患者进行了回顾性研究，以探讨治疗效果。
2003年1月至2009年10月期间接受至少两个周期BEP化疗的生殖细胞肿瘤患者符合本研究条件。患者每三周接受4 - 6个周期的化疗，博来霉素30,000IU静脉注射，第1、8和15天；依托泊苷100mg/m²静脉注射，第1 - 5天，顺铂20mg/m²静脉注射，第1 - 5天（5天BEP方案），或依托泊苷165mg/m²第1 - 3天，顺铂50mg/m²第1 - 3天（3天BEP方案）。每个周期的第6至10天，所有患者均接受预防性粒细胞集落刺激因子（GCSF）治疗。评估了整个队列的总体缓解率、2年无进展生存率和总生存率。
30例患者符合纳入标准。非精原细胞瘤性生殖细胞肿瘤占病例的93.3%，性腺和纵隔原发部位最为常见。60%被归类为国际生殖细胞癌协作组（IGCCCG）高危疾病。中位随访时间为26.6个月。总体缓解率（完全缓解+部分缓解）为70%。2年无进展生存率和总生存率分别为70%和66%。性腺和性腺外原发部位在总体缓解率（85%对40%，p = 0.03）和无进展生存率（94.7%对50%，p = 0.003）方面存在显著差异。
对于接受BEP化疗的患者，通过密切监测和良好的支持治疗，有可能取得与国际临床试验相似的结果。对于IGCCCG预后不良疾病的患者，有充分理由在专科三级中心进行治疗，以优化治疗效果。
