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[High dose chemotherapy with autologous stem-cell support in germ cell tumors: The Instituto Português de Oncologia de Lisboa Francisco Gentil Series].
- Source :
-
Acta medica portuguesa [Acta Med Port] 2011 Jul-Aug; Vol. 24 (4), pp. 533-44. Date of Electronic Publication: 2011 Dec 12. - Publication Year :
- 2011
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Abstract
- Background: High dose chemotherapy with autologous stem cell transplantation (HDCT-ASCT) has been administered to patients with high-risk germ cell tumours (GCT). The role of this treatment for GCT still remains unclear, including the identification of subgroups more likely to benefit from such strategy.<br />Methods: A retrospective review was conducted of all male patients with gonadal and extra gonadal GCT treated with HDCT-ASCT between 1996 and 2008 at the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG).<br />Results: Twenty patients were treated with HDCT-ASCT, 17 with primary testicular tumours, two mediastinal and one retroperitoneal GCT. According to the International Germ Cell Cancer Consensus Group (IGCCCG) classification, at diagnosis three patients had good risk, four intermediate, eight poor but for the patients left the risk group could not be ascertained. In eight patients HDCT-ASCT was used upfront, after induction with first-line conventional chemotherapy, and in the remaining 12 for relapsed GCT. One patient had platinum-resistant and another platinum-refractory disease. Only two patients had Beyer score > 2. All but one patient were treated with ICE (Ifosfamide, Carboplatin, Etoposide). Six patients underwent a second HDCT-ASCT course. The 5-year overall survival and progression free survival were respectively 53% and 44%; both patients with mediastinal GCT are long term survivors.<br />Conclusion: Randomized studies to date have failed to indicate a survival advantage for HDCT-ASCT in GCT. This series is small and heterogeneous which prevents us from drawing conclusions regarding the benefit of this treatment for GCT. However, we could confirm the lack of benefit of HDCT-ASCT for platinum-resistant GCT and to question the absolute contraindication to this therapeutic modality in mediastinal GCT. HDCT-ASCT should therefore be performed exclusively in experienced centers and, preferably, in the setting of clinical trials.
- Subjects :
- Adolescent
Adult
Child
Child, Preschool
Combined Modality Therapy
Humans
Male
Middle Aged
Portugal
Retrospective Studies
Young Adult
Antineoplastic Agents administration & dosage
Neoplasms, Germ Cell and Embryonal drug therapy
Neoplasms, Germ Cell and Embryonal surgery
Stem Cell Transplantation
Testicular Neoplasms drug therapy
Testicular Neoplasms surgery
Subjects
Details
- Language :
- Portuguese
- ISSN :
- 1646-0758
- Volume :
- 24
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Acta medica portuguesa
- Publication Type :
- Academic Journal
- Accession number :
- 22521011