Salvage chemotherapy with high-dose carboplatin plus etoposide and autologous peripheral blood stem cell transplant in male pure choriocarcinoma: a retrospective analysis of 13 cases.
Choriocarcinoma of testes is a very rare tumor with poor prognosis, usually presenting with high serum level of human chorionic gonadotropin (hCG>50,000 mIU/ml) and advanced hematogenous metastases. Data with salvage chemotherapy has been sparse, with few long-term survivors. Between April 1996 and October 2004, 184 patients with germ cell tumor were treated at Indiana University with salvage high-dose chemotherapy (HDCT) with autologous peripheral blood stem cell transplant. Thirteen had pure choriocarcinoma or choriocarcinoma syndrome (normal testes by palpation and ultrasound, normal serum alpha-fetoprotein, advanced hematogenous metastases and high level hCG). All patients had progressed following one or two lines of cisplatin combination therapy. HDCT regimen was carboplatin 700 mg/m(2) and etoposide 750 mg/m(2) intravenously given for 3 consecutive days. A second course was given after hematopoietic recovery, usually 3-4 weeks later. The median survival was 19 months (range 5-90). Six patients (46%) are alive and continuously disease free (cNED) at a median follow-up of 37 months (range 19-75). One additional patient who relapsed after HDCT and was treated with third line chemotherapy followed by two surgical resections of choriocarcinoma is currently alive NED at +90 months from HDCT. Long-term disease-free survival and potential cure is possible with HDCT in choriocarcinoma patients that progressed after standard cisplatin combination therapy.
Papiani
G
G
Department of Hematology and Oncology, Istituto Oncologico Romagnolo, Ravenna City Hospital, Ravenna, Italy. giorgio_papiani@hotmail.it
Einhorn
L H
LH
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D031954:Choriocarcinoma, Non-gestational / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006063:Chorionic Gonadotropin / Q000097:blood; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D019337:Hematologic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014182:Transplantation, Autologous; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D005047:Etoposide; D016190:Carboplatin