Bulky germinal tumors: comparison of different induction regimens and significance of residual disease.
In order to study the efficacy of three different chemotherapy regimens and the prognostic significance of residual disease after chemotherapy, we analyzed 84 patients with bulky germinal tumors. Chemotherapy, consisting of vinblastine, bleomycin/adriamycin, cisplatin (VB/AP) was administered sequentially to 37 patients. 19 patients were treated with the cisplatin, vinblastine, bleomycin (PVB) regimen and 17 patients with cisplatin, vinblastine, bleomycin, ifosfamide (PVBI). The initial complete remission (iCR) was 71% (52 of 73) with a relapse rate of 29% (15 of 52). 10 of 73 (14%) patients achieved partial response and 11 of 73 (15%) showed progression due to multidrug resistance. There was no statistically significant difference in iCR, continuous complete remission (cCR), relapse and survival between the PVB, PVBI and VB/AP regimens. In 50 patients, the residual tumor after chemotherapy was examined histologically. cCR was achieved in 75% (15 of 20) of patients with necrosis or fibrosis, in 50% (5 of 10) with adult teratoma and in 25% (5 of 20) with malignant tumor. Comparison of survival curves according to residual histology revealed statistically significant differences (p = 0.02). Our findings suggest that in patients with germinal bulk disease PVBI-regimen and VB/AD-therapy are not superior to the standard regimen. Residual disease seems to be an important prognosticator.
Kreuser
E D
ED
Jaeger
N
N
Altwein
J E
JE
Egghart
G
G
Hartlapp
J
J
Gaus
W
W
Schreml
W
W
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy / Q000601:surgery; D008297:Male; D009364:Neoplasm Recurrence, Local; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014747:Vinblastine / Q000008:administration & dosage
D001761:Bleomycin; D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide