Kennedy B J, Torkelson J L, Fraley E E
Division of Medical Oncology, University of Minnesota Medical School, Minneapolis, USA.
Am J Clin Oncol. 1996 Dec;19(6):541-5. doi: 10.1097/00000421-199612000-00001.
Removal of residual masses after cisplatin-based chemotherapy (cytoreductive surgery) for inoperable or metastatic testicular carcinoma has demonstrated that many partial regressions are defects without malignant cells. Such negative results allow a clarification of complete regression. Failure to achieve complete regression requires intensive salvage chemotherapy or bone marrow transplant. Extended initial chemotherapy could reduce these failures. Cytoreductive surgery was performed on 44 patients with inoperable stage II or stage III testicular cancer with residual defects following chemotherapy. The patients were evaluated according to whether (a) adequate treatment was given based on attaining normal markers followed by two additional courses of therapy, (b) normal markers were achieved but two additional courses were not administered, or (c) normal markers were never attained. These were subdivided into those receiving five or more courses of chemotherapy or fewer than five courses. Patients receiving two additional courses of chemotherapy after markers became normal had a low death rate (15.4%) and highest median follow-up. Fewer patients died if they had five or more courses of chemotherapy (11.8%). Of all those who attained normal markers with at least five or more courses of therapy, 10% are dead. The presence of residual malignant cells in those receiving five or more courses of therapy was 18.2% in contrast to 50% in those receiving fewer courses. Adequate chemotherapy and attainment of normal markers followed by two more courses of therapy results in fewer patients with residual malignant cells, a greater potential of cure, and less need for intensive salvage regimens.
对于无法手术切除或发生转移的睾丸癌，采用以顺铂为基础的化疗后进行残余肿块切除（细胞减灭术），结果表明许多部分缓解是无恶性细胞的缺损。这些阴性结果有助于明确完全缓解。未能实现完全缓解则需要强化挽救性化疗或骨髓移植。延长初始化疗疗程可减少此类失败情况。对44例无法手术切除的II期或III期睾丸癌患者在化疗后存在残余缺损时进行了细胞减灭术。根据以下情况对患者进行评估：(a) 在达到正常标志物后给予充分治疗并追加两个疗程的治疗；(b) 达到了正常标志物但未追加两个疗程的治疗；或(c) 从未达到正常标志物。这些情况又进一步细分为接受五个或更多疗程化疗的患者和接受少于五个疗程化疗的患者。在标志物恢复正常后接受两个追加疗程化疗的患者死亡率较低（15.4%），且中位随访时间最长。接受五个或更多疗程化疗的患者死亡人数较少（11.8%）。在所有接受至少五个或更多疗程治疗且达到正常标志物的患者中，10% 已死亡。接受五个或更多疗程治疗的患者中残余恶性细胞的比例为18.2%，而接受较少疗程治疗的患者这一比例为50%。充分化疗并达到正常标志物后再追加两个疗程的治疗，可使残余恶性细胞的患者减少，治愈潜力更大，且对强化挽救方案的需求更少。
