title: Multimodality treatment of germ cell cancer patients who had progression or relapse after high dose chemotherapy and autologous bone marrow transplantation.
abstract: OBJECTIVE
  When a patient with germ cell tumor (GCT) fails to be cured with high dose chemotherapy (HDC) and autologous haematopoietic stem cell transplantation (auto- BMT) the overall prognosis is very poor and any further treatment has only palliative character. A question requiring answer is how intense should this kind of treatment be, and what can be expected from it.
  
  
  METHODS
  Of 44 patients with GCT who were transplanted after HDC in our centre between 1999- 2005, 17 experienced treatment failure. Amongst them 14 had marker-positive relapse or confirmed germ cell histology. Another 3 had second primary neoplasms. Of the 17 patients 14 received further treatment that consisted of surgery alone in 2, chemotherapy in 2, radiotherapy in 1, combined surgery + chemotherapy in 5, chemotherapy +surgery + radiotherapy in 3 and chemotherapy + radiotherapy in 1 patient.
  
  
  RESULTS
  The median survival from the time of relapse was 3 months in all patients, and 6 months in the 14 patients who received further treatment. In 6 patients with relapse confined to a single site the median survival was 11 months. Three patients in this group are alive with overall survival (OS) of 37.4+, 24.3+ and 6.2+ months (all had multimodal treatment: chemotherapy + surgery or radiotherapy, and all achieved durable complete response/CR).
  
  
  CONCLUSIONS
  Our results suggest that GCT patients who have relapsed/ progressed after HDC may benefit from further treatment. Best chances for long term survival have those who experience relapse confined to one metastatic site and receive combined treatment (surgery or radiotherapy plus systemic therapy).
authors.affiliation: Department of Oncology, Bone Marrow Transplantation Unit, Military Institute of Health Services, Warsaw, Poland.
authors.forename: T
authors.initials: T
authors.lastname: Sarosiek
authors.forename: P
authors.initials: P
authors.lastname: Rzepecki
authors.forename: P
authors.initials: P
authors.lastname: Langiewicz
authors.forename: J
authors.initials: J
authors.lastname: Zolnierek
authors.forename: J
authors.initials: J
authors.lastname: Barzal
authors.forename: C
authors.initials: C
authors.lastname: Szczylik
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis