Broun E R, Nichols C R, Gize G, Cornetta K, Hromas R A, Schacht B, Einhorn L H
Section of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, USA.
Cancer. 1997 Apr 15;79(8):1605-10. doi: 10.1002/(sici)1097-0142(19970415)79:8<1605::aid-cncr25>3.0.co;2-0.
The purpose of this study was to evaluate the use of two cycles of high dose chemotherapy with autologous bone marrow transplantation (ABMT) in the treatment of patients having a first relapse of testicular germ cell cancer.
Twenty-five patients whose disease had relapsed after 1 platinum-based regimen received 1-2 cycles of conventional dose salvage therapy, followed by a planned 2 consecutive cycles of carboplatin 2100 mg/m2 and etoposide 2250 mg/m2 with ABMT. Patients were required to have testicular germ cell cancer, adequate organ function, and performance status. The median patient age was 32 years; 3 cisplatin refractory.
Conventional dose salvage therapy consisted of vinblastine, ifosfamide, and cisplatin (for 16 patients); etoposide, cisplatin, and ifosfamide (for 3 patients); cisplatin, vinblastine, and bleomycin (for 2 patients); or none (for 4 patients). Twenty-five patients received high dose therapy; of these, 19 (76%) received two cycles. The median time to an absolute neutrophil count of 500 was 12 days (range, 8-20 days) for the first cycle and and 11 days (range, 8-18 days) for the second. The median time to a platelet count of 20,000/microL, independent of transfusions, was 15 days (range, 8-60 days) for the first cycle and 14 days (range, 8-22 days) for the second. Extramyeloid toxicities were as follows: Grade 3-4 stomatitis in 17 of 25 patients, Grade 3-4 nausea/emesis in 12 of 25 patients, and Grade 3 ototoxicity in 3 of 25 patients. At the completion of therapy, nine patients were in complete remission, six had only teratoma found at resection, one had carcinoma resected, six were in partial remission, two had stable disease, and one had progressive disease. With a median follow-up period of 26 months (range, 14-36 months), 13 of 25 patients (52%) had been continuously progression free at last follow-up, 11 of 25 (44%) progressed, and 1 patient died in treatment.
Salvage treatment incorporating brief conventional dose therapy followed by two cycles of high dose therapy resulted in prolonged disease free survival in a proportion of patients with relapsed testicular germ cell cancer.
本研究的目的是评估两周期高剂量化疗联合自体骨髓移植（ABMT）在治疗首次复发的睾丸生殖细胞癌患者中的应用。
25例在接受1个含铂方案治疗后疾病复发的患者接受了1 - 2周期的常规剂量挽救治疗，随后计划连续2周期给予卡铂2100mg/m²和依托泊苷2250mg/m²并进行ABMT。患者必须患有睾丸生殖细胞癌、具备足够的器官功能和体能状态。患者中位年龄为32岁；3例对顺铂耐药。
常规剂量挽救治疗包括长春花碱、异环磷酰胺和顺铂（16例患者）；依托泊苷、顺铂和异环磷酰胺（3例患者）；顺铂、长春花碱和博来霉素（2例患者）；或未接受任何治疗（4例患者）。25例患者接受了高剂量治疗；其中19例（76%）接受了两周期治疗。第一周期绝对中性粒细胞计数达到500的中位时间为12天（范围8 - 20天），第二周期为11天（范围8 - 18天）。不依赖输血血小板计数达到20,000/μL的中位时间，第一周期为15天（范围8 - 60天），第二周期为14天（范围8 - 22天）。髓外毒性如下：25例患者中有17例发生3 - 4级口腔炎，25例患者中有12例发生3 - 4级恶心/呕吐，25例患者中有3例发生3级耳毒性。治疗结束时，9例患者完全缓解，6例在切除时仅发现畸胎瘤，1例切除了癌组织，6例部分缓解，2例病情稳定，1例病情进展。中位随访期为26个月（范围14 - 36个月），25例患者中有13例（52%）在末次随访时持续无进展，25例中有11例（44%）病情进展，1例患者在治疗中死亡。
挽救性治疗采用简短的常规剂量治疗后再进行两周期高剂量治疗，使一部分复发的睾丸生殖细胞癌患者的无病生存期得以延长。
