Miller K D, Loehrer P J, Gonin R, Einhorn L H
Department of Medicine, Indiana University Medical Center, Indianapolis 46202, USA.
J Clin Oncol. 1997 Apr;15(4):1427-31. doi: 10.1200/JCO.1997.15.4.1427.
Salvage therapy for disseminated germ cell tumors of all histologic subtypes with vinblastine, ifosfamide, and cisplatin (VeIP) will cure approximately 25% of patients. The purpose of this study was to evaluate the activity of VeIP in patients with recurrent seminoma.
We conducted a retrospective review of 24 patients with recurrent seminoma who were treated at Indiana University with VeIP as second-line chemotherapy. All patients had received cisplatin-containing regimens as primary chemotherapy and seven had also received prior pelvic radiotherapy. All patients received four courses of VeIP.
The minimum follow-up duration was 2 years (range, 2 to 9.1), with a median follow-up time of 7 years. Twenty of 24 patients (83%) achieved a complete remission (CR) following VeIP alone. One additional patient was rendered disease-free (NED) with the resection of residual carcinoma. Eight patients have relapsed. Four of six patients with extragonadal primary tumors and two of four who failed to achieve CR with initial chemotherapy are continuously NED with VeIP. Overall, 13 of 24 (54%) are long-term survivors with VeIP salvage chemotherapy.
VeIP has significant curative potential in patients with recurrent seminoma and appears to produce a higher CR rate and more long-term survivors than is achieved in patients with nonseminomatous disease.
使用长春花碱、异环磷酰胺和顺铂（VeIP）对所有组织学亚型的播散性生殖细胞肿瘤进行挽救性治疗，约25%的患者可获治愈。本研究旨在评估VeIP对复发性精原细胞瘤患者的疗效。
我们对24例在印第安纳大学接受VeIP作为二线化疗的复发性精原细胞瘤患者进行了回顾性分析。所有患者均接受含顺铂方案作为一线化疗，7例患者还曾接受盆腔放疗。所有患者均接受4个疗程的VeIP治疗。
最短随访时间为2年（范围2至9.1年），中位随访时间为7年。24例患者中有20例（83%）仅接受VeIP治疗后即获得完全缓解（CR）。另有1例患者经残余癌切除后达到无病状态（NED）。8例患者复发。6例性腺外原发性肿瘤患者中有4例，4例初始化疗未达CR的患者中有2例，经VeIP治疗后持续处于NED状态。总体而言，24例患者中有13例（54%）经VeIP挽救性化疗后成为长期存活者。
VeIP对复发性精原细胞瘤患者具有显著的治愈潜力，与非精原细胞瘤患者相比，似乎能产生更高的CR率和更多的长期存活者。
