Beyer J, Kingreen D, Krause M, Schleicher J, Schwaner I, Schwella N, Huhn D, Siegert W
Department of Internal Medicine, Virchow Clinic, Humboldt University, Berlin, Germany.
Cancer. 1997 Jan 1;79(1):161-8.
The optimal treatment of patients with recurrent or refractory germ cell tumors is still a debated topic. High dose chemotherapy (HDCT) with autologous stem cell rescue (ASCR) might be promising for intensification of first or subsequent salvage treatment. However, the long-term results of this approach remain largely unknown.
Between August 1989 and September 1992, 74 patients with recurrent and/or refractory germ cell tumors were treated in a Phase I/II trial with HDCT consisting of carboplatin (1500-2000 mg/m2), etoposide (1200-2400 mg/m2), and ifosfamide (0-10 g/m2). In September 1995 all patients were reevaluated to determine overall response, late toxicities, and survival.
Two patients died from treatment-related toxicity shortly after HDCT, and 47 had recurrence or progression of disease after a median of 3 months (range, 1-44 months). Of these latter patients, three were living continuously disease free at the conclusion of this study after a second HDCT regimen, salvage surgery, or chronic oral etoposide treatment. The results were an overall survival of 38% (95% confidence interval, 27-50%) and a failure free survival of 31% (95% confidence interval, 21-43%) at 5 years. There were no long-term survivors among patients whose disease progressed while they were receiving conventional doses of cisplatin before HDCT. Late toxicities consisted mainly or renal impairment (in 21% of patients), paresthesias (in 29%), and ototoxicity (in 18%).
HDCT can be curative for patients with germ cell tumors who do not become disease free after conventional dose chemotherapy but respond to this treatment.
复发性或难治性生殖细胞肿瘤患者的最佳治疗方案仍是一个有争议的话题。高剂量化疗（HDCT）联合自体干细胞救援（ASCR）可能有望强化初次或后续挽救治疗。然而，这种方法的长期结果仍 largely unknown。
1989年8月至1992年9月，74例复发性和/或难治性生殖细胞肿瘤患者在一项I/II期试验中接受了由卡铂（1500 - 2000mg/m²）、依托泊苷（1200 - 2400mg/m²）和异环磷酰胺（0 - 10g/m²）组成的HDCT治疗。1995年9月对所有患者进行重新评估，以确定总体反应、晚期毒性和生存率。
两名患者在HDCT后不久死于治疗相关毒性，47例患者在中位3个月（范围1 - 44个月）后出现疾病复发或进展。在这些患者中，三名患者在接受第二次HDCT方案、挽救性手术或长期口服依托泊苷治疗后，在本研究结束时持续无病生存。结果显示，5年时总体生存率为38%（95%置信区间，27 - 50%），无失败生存率为31%（95%置信区间，21 - 43%）。在接受HDCT前接受常规剂量顺铂治疗时疾病进展的患者中，没有长期存活者。晚期毒性主要包括肾功能损害（21%的患者）、感觉异常（29%）和耳毒性（18%）。
对于那些在常规剂量化疗后未达到无病状态但对HDCT治疗有反应的生殖细胞肿瘤患者，HDCT可能具有治愈性。
