Abstract
Long-term outcome of salvage treatment was reviewed in 67 unselected male patients relapsing during or after their primary cisplatin-based chemotherapy for metastatic germ cell tumours. Seven patients underwent only surgery and/or radiotherapy as curatively intended salvage treatment. Thirty-five patients (52%) had a complete or partial response to salvage treatment, 20 (57%) of whom relapsed again. With a median follow-up of 90 months (range 3-143 months) 20 patients (30%) are alive with no evidence of disease, 15 continuously disease-free and five currently disease-free. The 5 year survival from start of salvage treatment is 37% for the group as a whole. Multivariate analysis identified age < or = 35 years, complete response to primary treatment and a relapse-free interval > 3 months as independent predictors of favourable outcome of salvage treatment. A group of patients with these good-risk factors (42%) had a 5 year survival of 72% compared with the remaining patients (58%) with a 5 year survival of only 11%. Whereas patients with good-risk features may be adequately managed by conventional salvage treatment, the remaining patients carry a very poor prognosis and require innovative and more aggressive approaches.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aass N., Klepp O., Cavallin-Stahl E., Dahl O., Wicklund H., Unsgaard B., Baldetorp L., Ahlström S., Fosså S. D. Prognostic factors in unselected patients with nonseminomatous metastatic testicular cancer: a multicenter experience. J Clin Oncol. 1991 May;9(5):818–826. doi: 10.1200/JCO.1991.9.5.818. [DOI] [PubMed] [Google Scholar]
- Barnett M. J., Coppin C. M., Murray N., Nevill T. J., Reece D. E., Klingemann H. G., Shepherd J. D., Nantel S. H., Sutherland H. J., Phillips G. L. High-dose chemotherapy and autologous bone marrow transplantation for patients with poor prognosis nonseminomatous germ cell tumours. Br J Cancer. 1993 Sep;68(3):594–598. doi: 10.1038/bjc.1993.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Broun E. R., Nichols C. R., Turns M., Williams S. D., Loehrer P. J., Roth B. J., Lazarus H. M., Einhorn L. H. Early salvage therapy for germ cell cancer using high dose chemotherapy with autologous bone marrow support. Cancer. 1994 Mar 15;73(6):1716–1720. doi: 10.1002/1097-0142(19940315)73:6<1716::aid-cncr2820730627>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
- Cassidy J., Lewis C. R., Kaye S. B., Kirk D. The changing role of surgery in metastatic non-seminomatous germ cell tumour. Br J Cancer. 1992 Jan;65(1):127–129. doi: 10.1038/bjc.1992.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Clemm C., Hartenstein R., Wilmanns W. The value of ifosfamide in the polychemotherapy of metastasized testicular cancer pretreated with chemotherapy. Arzneimittelforschung. 1982;32(12):1557–1560. [PubMed] [Google Scholar]
- Einhorn L. H., Donohue J. Cis-diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med. 1977 Sep;87(3):293–298. doi: 10.7326/0003-4819-87-3-293. [DOI] [PubMed] [Google Scholar]
- Einhorn L. H. Salvage therapy for germ cell tumors. Semin Oncol. 1994 Aug;21(4 Suppl 7):47–51. [PubMed] [Google Scholar]
- Einhorn L. H., Williams S. D., Loehrer P. J., Birch R., Drasga R., Omura G., Greco F. A. Evaluation of optimal duration of chemotherapy in favorable-prognosis disseminated germ cell tumors: a Southeastern Cancer Study Group protocol. J Clin Oncol. 1989 Mar;7(3):387–391. doi: 10.1200/JCO.1989.7.3.387. [DOI] [PubMed] [Google Scholar]
- Fox E. P., Weathers T. D., Williams S. D., Loehrer P. J., Ulbright T. M., Donohue J. P., Einhorn L. H. Outcome analysis for patients with persistent nonteratomatous germ cell tumor in postchemotherapy retroperitoneal lymph node dissections. J Clin Oncol. 1993 Jul;11(7):1294–1299. doi: 10.1200/JCO.1993.11.7.1294. [DOI] [PubMed] [Google Scholar]
- Gerl A., Clemm C., Hentrich M., Hartenstein R., Wilmanns W. Etoposide, cisplatin, bleomycin, and cyclophosphamide (ECBC) as first-line chemotherapy for poor-risk non-seminomatous germ cell tumors. Acta Oncol. 1993;32(5):541–546. doi: 10.3109/02841869309096115. [DOI] [PubMed] [Google Scholar]
- Gerl A., Clemm C., Kohl P., Schalhorn A., Wilmanns W. Central nervous system as sanctuary site of relapse in patients treated with chemotherapy for metastatic testicular cancer. Clin Exp Metastasis. 1994 May;12(3):226–230. doi: 10.1007/BF01753890. [DOI] [PubMed] [Google Scholar]
- Gerl A., Clemm C., Lamerz R., Mann K., Wilmanns W. Prognostic implications of tumour marker analysis in non-seminomatous germ cell tumours with poor prognosis metastatic disease. Eur J Cancer. 1993;29A(7):961–965. doi: 10.1016/s0959-8049(05)80202-3. [DOI] [PubMed] [Google Scholar]
- Gerl A., Clemm C., Schmeller N., Dienemann H., Lamerz R., Kriegmair M., Wilmanns W. Outcome analysis after post-chemotherapy surgery in patients with non-seminomatous germ cell tumours. Ann Oncol. 1995 May;6(5):483–488. doi: 10.1093/oxfordjournals.annonc.a059219. [DOI] [PubMed] [Google Scholar]
- Harstrick A., Schmoll H. J., Wilke H., Köhne-Wömpner C. H., Stahl M., Schöber C., Casper J., Bruderek L., Schmoll E., Bokemeyer C. Cisplatin, etoposide, and ifosfamide salvage therapy for refractory or relapsing germ cell carcinoma. J Clin Oncol. 1991 Sep;9(9):1549–1555. doi: 10.1200/JCO.1991.9.9.1549. [DOI] [PubMed] [Google Scholar]
- Hitchins R. N., Newlands E. S., Smith D. B., Begent R. H., Rustin G. J., Bagshawe K. D. Long-term outcome in patients with germ cell tumours treated with POMB/ACE chemotherapy: comparison of commonly used classification systems of good and poor prognosis. Br J Cancer. 1989 Feb;59(2):236–242. doi: 10.1038/bjc.1989.48. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jansen R. L., Sylvester R., Sleyfer D. T., ten Bokkel Huinink W. W., Kaye S. B., Jones W. G., Keizer J., van Oosterom A. T., Meyer S., Vendrik C. P. Long-term follow-up of non-seminomatous testicular cancer patients with mature teratoma or carcinoma at postchemotherapy surgery. EORTC Genitourinary Tract Cancer Cooperative Group (EORTC GU Group) Eur J Cancer. 1991;27(6):695–698. doi: 10.1016/0277-5379(91)90168-d. [DOI] [PubMed] [Google Scholar]
- Josefsen D., Ous S., Høie J., Stenwig A. E., Fosså S. D. Salvage treatment in male patients with germ cell tumours. Br J Cancer. 1993 Mar;67(3):568–572. doi: 10.1038/bjc.1993.104. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ledermann J. A., Holden L., Newlands E. S., Begent R. H., Rustin G. J., Bagshawe K. D., Brampton M. The long-term outcome of patients who relapse after chemotherapy for non-seminomatous germ cell tumours. Br J Urol. 1994 Aug;74(2):225–230. doi: 10.1111/j.1464-410x.1994.tb16591.x. [DOI] [PubMed] [Google Scholar]
- Loehrer P. J., Sr, Lauer R., Roth B. J., Williams S. D., Kalasinski L. A., Einhorn L. H. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med. 1988 Oct 1;109(7):540–546. doi: 10.7326/0003-4819-109-7-540. [DOI] [PubMed] [Google Scholar]
- Longo D. L., Duffey P. L., DeVita V. T., Jr, Wesley M. N., Hubbard S. M., Young R. C. The calculation of actual or received dose intensity: a comparison of published methods. J Clin Oncol. 1991 Nov;9(11):2042–2051. doi: 10.1200/JCO.1991.9.11.2042. [DOI] [PubMed] [Google Scholar]
- Mead G. M., Stenning S. P., Parkinson M. C., Horwich A., Fossa S. D., Wilkinson P. M., Kaye S. B., Newlands E. S., Cook P. A. The Second Medical Research Council study of prognostic factors in nonseminomatous germ cell tumors. Medical Research Council Testicular Tumour Working Party. J Clin Oncol. 1992 Jan;10(1):85–94. doi: 10.1200/JCO.1992.10.1.85. [DOI] [PubMed] [Google Scholar]
- Motzer R. J., Geller N. L., Tan C. C., Herr H., Morse M., Fair W., Sheinfeld J., Sogani P., Russo P., Bosl G. J. Salvage chemotherapy for patients with germ cell tumors. The Memorial Sloan-Kettering Cancer Center experience (1979-1989). Cancer. 1991 Mar 1;67(5):1305–1310. doi: 10.1002/1097-0142(19910301)67:5<1305::aid-cncr2820670506>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
- Motzer R. J., Gulati S. C., Crown J. P., Weisen S., Doherty M., Herr H., Fair W., Sheinfeld J., Sogani P., Russo P. High-dose chemotherapy and autologous bone marrow rescue for patients with refractory germ cell tumors. Early intervention is better tolerated. Cancer. 1992 Jan 15;69(2):550–556. doi: 10.1002/1097-0142(19920115)69:2<550::aid-cncr2820690245>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
- Murphy B. R., Breeden E. S., Donohue J. P., Messemer J., Walsh W., Roth B. J., Einhorn L. H. Surgical salvage of chemorefractory germ cell tumors. J Clin Oncol. 1993 Feb;11(2):324–329. doi: 10.1200/JCO.1993.11.2.324. [DOI] [PubMed] [Google Scholar]
- Pizzocaro G., Salvioni R., Piva L., Faustini M., Nicolai N., Gianni L. Modified cisplatin, etoposide (or vinblastine) and ifosfamide salvage therapy for male germ-cell tumors. Long-term results. Ann Oncol. 1992 Mar;3(3):211–216. doi: 10.1093/oxfordjournals.annonc.a058154. [DOI] [PubMed] [Google Scholar]
- Saxman S. B., Nichols C. R., Einhorn L. H. Salvage chemotherapy in patients with extragonadal nonseminomatous germ cell tumors: the Indiana University experience. J Clin Oncol. 1994 Jul;12(7):1390–1393. doi: 10.1200/JCO.1994.12.7.1390. [DOI] [PubMed] [Google Scholar]
- Siegert W., Beyer J., Strohscheer I., Baurmann H., Oettle H., Zingsem J., Zimmermann R., Bokemeyer C., Schmoll H. J., Huhn D. High-dose treatment with carboplatin, etoposide, and ifosfamide followed by autologous stem-cell transplantation in relapsed or refractory germ cell cancer: a phase I/II study. The German Testicular Cancer Cooperative Study Group. J Clin Oncol. 1994 Jun;12(6):1223–1231. doi: 10.1200/JCO.1994.12.6.1223. [DOI] [PubMed] [Google Scholar]
- Simon R., Altman D. G. Statistical aspects of prognostic factor studies in oncology. Br J Cancer. 1994 Jun;69(6):979–985. doi: 10.1038/bjc.1994.192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stevens M. J., Norman A. R., Dearnaley D. P., Horwich A. Prognostic significance of early serum tumor marker half-life in metastatic testicular teratoma. J Clin Oncol. 1995 Jan;13(1):87–92. doi: 10.1200/JCO.1995.13.1.87. [DOI] [PubMed] [Google Scholar]
- Steyerberg E. W., Keizer H. J., Zwartendijk J., Van Rijk G. L., Van Groeningen C. J., Habbema J. D., Stoter G. Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis. Br J Cancer. 1993 Jul;68(1):195–200. doi: 10.1038/bjc.1993.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Williams S. D., Birch R., Einhorn L. H., Irwin L., Greco F. A., Loehrer P. J. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987 Jun 4;316(23):1435–1440. doi: 10.1056/NEJM198706043162302. [DOI] [PubMed] [Google Scholar]