Salvage chemotherapy in patients with extragonadal nonseminomatous germ cell tumors: the Indiana University experience.
OBJECTIVE
Patients with relapsed extragonadal germ cell tumors (EGCT) are usually treated in an identical fashion as patients with recurrent testicular cancer. However, little is known about the long-term outcome in these patients and whether they have comparable results to patients with a testicular primary tumor. The purpose of this study was to evaluate the effect of salvage chemotherapy on long-term survival in patients with EGCT.


METHODS
We conducted a retrospective review of 73 patients with relapsed extragonadal nonseminomatous germ cell tumors (GCTs) treated at Indiana University between 1976 and 1993. All patients received cisplatin-containing regimens as primary chemotherapy.


RESULTS
Only five of 73 patients (7%) were long-term disease-free survivors after salvage chemotherapy. The remaining 68 patients are either dead of disease or toxicity (n = 63), or alive with progressive disease (PD) (n = 5). Twenty-eight patients received high-dose chemotherapy with autologous bone marrow transplant (ABMT) at some point during their disease, and none of these patients are continuously disease-free.


CONCLUSIONS
Although similar salvage chemotherapy strategies will cure approximately 30% of patients with recurrent testicular cancer, new approaches are needed for EGCT.
Indiana University School of Medicine, Division of Hematology/Oncology, Indianapolis 46202.
S B
SB
Saxman
C R
CR
Nichols
L H
LH
Einhorn
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018237:Germinoma / Q000188:drug therapy*; D006801:Humans; D007196:Indiana; D008479:Mediastinal Neoplasms / Q000188:drug therapy; D008875:Middle Aged; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome