title: Super-high-risk germ-cell tumors: a clinical entity. Report of eleven cases.
abstract: Among patients suffering from nonseminomatous germ-cell tumor, with a poor prognosis, a subset underwent respiratory failure and died very early in the course of their treatment. Between 1982 and 1989, 11 out of 56 such patients (20%) died within the first 5 weeks of chemotherapy. The clinical, radiological, biological and infectious characteristics of these patients were analyzed. Nine patients had extensive pulmonary metastases and the 2 others presented a bulky mediastinal mass with pleural effusion. All patients experienced acute respiratory distress during chemotherapy and underwent mechanical ventilation. All patients were febrile, and septicemia was documented in 7 cases. WHO grade 4 and grade 1-2 renal toxicities occurred in 3 and 4 patients respectively. There was no tumor lysis syndrome. All patients died within 35 days from the start of therapy; 4 were autopsied. These 11 patients represent a clinical entity, having what we called super-high-risk germ cell tumors. Early death is related to pulmonary distress within the first 5 weeks of therapy. The origin of the pulmonary distress is multifactorial: bulky disease of the chest, infection, and interstitial fibrosis. Immediate full-dose standard chemotherapy in association with intensive supportive care is recommended in the management of these patients.
authors.affiliation: Department of Medicine, Institut Gustave-Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Moran-Ribon
authors.forename: J P
authors.initials: JP
authors.lastname: Droz
authors.forename: J
authors.initials: J
authors.lastname: Kattan
authors.forename: B
authors.initials: B
authors.lastname: Leclercq
authors.forename: M
authors.initials: M
authors.lastname: Ghosn
authors.forename: D
authors.initials: D
authors.lastname: Couanet
authors.forename: M
authors.initials: M
authors.lastname: Ostronoff
authors.forename: S
authors.initials: S
authors.lastname: Culine
authors.forename: B
authors.initials: B
authors.lastname: Misset
authors.forename: B
authors.initials: B
authors.lastname: Escudier
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia; D002302:Cardiac Output / Q000502:physiology; D002423:Cause of Death; D018237:Germinoma / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology / Q000556:secondary; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007964:Leukocytosis / Q000209:etiology; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology / Q000556:secondary; D011379:Prognosis; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000209:etiology; D012074:Remission Induction; D012131:Respiratory Insufficiency / Q000209:etiology*; D012307:Risk Factors; D015996:Survival Rate; D014655:Vascular Resistance / Q000502:physiology