title: Second-line high-dose chemotherapy in patients with mediastinal and retroperitoneal primary non-seminomatous germ cell tumors: the EBMT experience.
abstract: BACKGROUND
  Results of second-line chemotherapy in patients with extragonadal non-seminomatous germ cell tumor (NSGCT) appear inferior to results in testicular NSGCT. Patients with retroperitoneal NSGCT achieve a comparable long-term survival rate of 30%, but the salvage rates of patients with mediastinal primary are less than 10%. We conducted a retrospective analysis on patients with mediastinal and retroperitoneal NSGCT treated with second-line high-dose chemotherapy (HDCT) registered with the European Group for Blood and Marrow Transplantation (EBMT).
  
  
  METHODS
  Between 1987 and 1999, 59 registered patients with retroperitoneal (n=37) and mediastinal (n=22) primary NSGCT, median age 28 years (range 18-60), were treated with second-line HDCT. All had received cisplatin-containing chemotherapy as first-line treatment.
  
  
  RESULTS
  Toxic death occurred in three cases (5%). With a median follow-up of 58 months (range 14-114), 18/59 patients (30%) continue to be disease-free. Of three patients who had a disease recurrence after HDCT, one patient achieved a disease-free status with further chemotherapy and surgery. In total, 19 patients (32%) are currently disease-free. Sixteen of 37 patients (43%) with retroperitoneal NSGCT, and three of 22 patients (14%) with mediastinal NSGCT are currently alive and disease-free.
  
  
  CONCLUSIONS
  Second-line HDCT might represent a possible option for patients with retroperitoneal primary NSGCT. New salvage strategies are needed for patients with mediastinal NSGCT.
authors.affiliation: Istituto Oncologico Romagnolo-Santa Maria delle Croci Hospital, Ravenna, Italy. ugo_degiorgi@yahoo.com
authors.forename: U
authors.initials: U
authors.lastname: De Giorgi
authors.forename: T
authors.initials: T
authors.lastname: Demirer
authors.forename: H
authors.initials: H
authors.lastname: Wandt
authors.forename: C
authors.initials: C
authors.lastname: Taverna
authors.forename: W
authors.initials: W
authors.lastname: Siegert
authors.forename: M
authors.initials: M
authors.lastname: Bornhauser
authors.forename: T
authors.initials: T
authors.lastname: Kozak
authors.forename: G
authors.initials: G
authors.lastname: Papiani
authors.forename: M
authors.initials: M
authors.lastname: Ballardini
authors.forename: G
authors.initials: G
authors.lastname: Rosti
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016879:Salvage Therapy
chemical_list: D002945:Cisplatin