Fizazi K, Culine S, Droz J P, Terrier-Lacombe M J, Théodore C, Wibault P, Rixe O, Ruffié P, Le Chevalier T
Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France.
Eur J Cancer. 1998 Feb;34(3):347-52. doi: 10.1016/s0959-8049(97)10021-1.
Primary mediastinal seminoma is an uncommon neoplasm, the optimal management of which is still debated. Radiotherapy produces a 65% disease-free survival rate. We assess whether these results have been improved with the advent of cisplatin-based chemotherapy. Data from 14 patients treated at the Institut Gustave-Roussy were reviewed. 9 had received cisplatin-based chemotherapy (Group 1): their outcome was compared with that of 5 patients treated with radiotherapy without chemotherapy (Group 2). We also reviewed data from the English literature using strict criteria, and report results concerning patients who received cisplatin-based chemotherapy and those who received radiotherapy. 8 of the 9 patients (89%) in Group 1 are long-term disease-free survivors and only 3 of 5 patients in Group 2. The patient who died in Group 1 was the only one who refused surgical resection of residual masses after chemotherapy. The review of the literature revealed that 59 of 68 (87%) patients initially managed with cisplatin- or carboplatin-based chemotherapy and for whom sufficient data are available, are long-term survivors and free of disease. Some of these patients had also received radiotherapy. Only 64 of 103 (62%) treated with thoracic radiotherapy without chemotherapy were long-term disease-free survivors. The disease-free survival rate of 51 patients who received cisplatin-based chemotherapy (excluding those who received carboplatin) was 86%. The difference in survival between patients administered cisplatin-based chemotherapy and those who underwent radiotherapy is apparently not due to unbalanced prognostic factors, the effect of time or non-specific medical management. We conclude that cisplatin-based chemotherapy allows long-term disease-free survival in approximately 85% of patients. These results seem to be higher than those obtained without cisplatin-based chemotherapy. However, a randomised study is required for definitive conclusions, but it is very unlikely that such a study will be performed due to the rarity of this neoplasm. Another alternative would be a meta-analysis based on individual data.
原发性纵隔精原细胞瘤是一种罕见的肿瘤，其最佳治疗方案仍存在争议。放射治疗可产生65%的无病生存率。我们评估基于顺铂的化疗出现后这些结果是否有所改善。回顾了古斯塔夫 - 鲁西研究所治疗的14例患者的数据。9例接受了基于顺铂的化疗（第1组）：将他们的结果与5例接受放疗但未化疗的患者（第2组）进行比较。我们还使用严格标准回顾了英文文献中的数据，并报告了接受基于顺铂化疗的患者和接受放疗的患者的结果。第1组9例患者中有8例（89%）是长期无病生存者，而第2组5例患者中只有3例。第1组中死亡的患者是唯一在化疗后拒绝手术切除残留肿块的患者。文献回顾显示，68例最初接受基于顺铂或卡铂化疗且有足够数据的患者中有59例（87%）是长期生存且无疾病。这些患者中有些还接受了放疗。仅接受胸部放疗而未化疗的103例患者中有64例（62%）是长期无病生存者。51例接受基于顺铂化疗（不包括接受卡铂化疗的患者）的患者的无病生存率为86%。接受基于顺铂化疗的患者与接受放疗的患者之间的生存差异显然不是由于预后因素不平衡、时间效应或非特异性医疗管理所致。我们得出结论，基于顺铂的化疗可使约85%的患者长期无病生存。这些结果似乎高于未采用基于顺铂化疗所获得的结果。然而，需要进行随机研究才能得出明确结论，但由于这种肿瘤罕见，进行此类研究的可能性非常小。另一种选择是基于个体数据的荟萃分析。
