title: The management and survival of patients with advanced germ-cell tumours: improving outcome in intermediate and poor prognosis patients.
abstract: OBJECTIVE
  The survival of germ-cell tumours (GCT) was transformed after the introduction of cisplatin-based therapy. Previous trials have indicated BEP (bleomycin, etoposide and cisplatin) as the optimum treatment, although some centres including our own advocate the use of the alternating regimen POMB-ACE (cisplatin, vincristine, methotrexate, bleomycin and dactinomycin, cyclophosphamide and etoposide) for men with intermediate or poor prognosis disease. We analysed the survival and management of GCT patients treated at a specialist cancer centre in relation to internationally recognised prognostic groupings.
  
  
  METHODS
  We retrieved patient information using the Trent Testicular Tumour Registry and supplemented it with information from patient notes. This included all patients with Royal Marsden Hospital Stage II, III and IV disease and patients with stage I disease at diagnosis with raised markers or subsequent relapse. We compared the efficacy and toxicity of the BEP and POMB-ACE chemotherapy regimens, and assessed relapse-free and overall survival.
  
  
  RESULTS
  We identified 178 non-seminomatous germ cell tumours (NSGCT) and 71 seminoma patients. Overall survival was similar to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification for the good (95% vs 92%) and intermediate groups (82% vs 80%). The outcome for the poor prognosis group was better than expected in our series (57% vs 48%). There was a higher proportion of both immediate and late side-effects with POMB-ACE.
  
  
  CONCLUSIONS
  Survival and disease progression rates at this single institution were at least as good as reported by the IGCCCG and somewhat better for the poor-prognosis group. This may reflect use of the POMB-ACE chemotherapy regimen as opposed to standard BEP regimen. However, a randomised comparison of BEP and POMB-ACE would be required to validate this.
authors.affiliation: Academic Unit of Clinical Oncology, Cancer Research Centre, Weston Park Hospital, Sheffield, UK.
authors.forename: N
authors.initials: N
authors.lastname: Bhala
authors.forename: J M
authors.initials: JM
authors.lastname: Coleman
authors.forename: C R
authors.initials: CR
authors.lastname: Radstone
authors.forename: J M
authors.initials: JM
authors.lastname: Horsman
authors.forename: J
authors.initials: J
authors.lastname: George
authors.forename: B W
authors.initials: BW
authors.lastname: Hancock
authors.forename: M Q
authors.initials: MQ
authors.lastname: Hatton
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide; D016208:Databases, Factual; D018572:Disease-Free Survival; D004317:Doxorubicin; D005047:Etoposide / Q000008:administration & dosage; D018237:Germinoma / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D002955:Leucovorin; D008297:Male; D008727:Methotrexate; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D001761:Bleomycin; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D002955:Leucovorin; D011241:Prednisone; D008727:Methotrexate