Second-line high-dose chemotherapy in patients with mediastinal and retroperitoneal primary non-seminomatous germ cell tumors: the EBMT experience.
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.
De Giorgi
U
U
Istituto Oncologico Romagnolo-Santa Maria delle Croci Hospital, Ravenna, Italy. ugo_degiorgi@yahoo.com
Demirer
T
T
Wandt
H
H
Taverna
C
C
Siegert
W
W
Bornhauser
M
M
Kozak
T
T
Papiani
G
G
Ballardini
M
M
Rosti
G
G
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
D002945:Cisplatin