title: [High-dose chemotherapy and residual tumor resection in male germ cell tumors].
abstract: As a consequence of the unsatisfactory results of conventional dose salvage regimens, in particular for patients with poor prognostic features at the time of relapse or in patients with refractory disease, high-dose chemotherapy (HDCT) was introduced into clinical practice in the late 1980s. The combination of carboplatin and etoposide (CE) still remains the backbone of most high-dose regimens. Multiple modifications with more dose escalations or addition of further drugs have been explored, most often with increased toxicity. With improved expertise in supportive care and the use of peripheral blood stem cells, hematopoetic recovery has been significantly shortened and the initial high treatment-related mortality reduced from more than 10% to about 3%. Since the incorporation of HDCT, even patients with unfavorable prognostic features or patients with second or subsequent relapses can achieve long-term remission. Following HDCT residual tumor resection plays a major role in achieving these long-term results. The proportion of vital residual tumor after HDCT is much higher than in patients after conventional chemotherapy. The role of HDCT remains controversial particularly as a first-line treatment and less so in the first salvage setting. As these patients are rare HDCT and residual tumor resection should only be be provided by high-volume centers with sufficient expertise in performing these complex procedures.
authors.affiliation: Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland. lorcha@med.uni-marburg.de
authors.forename: A
authors.initials: A
authors.lastname: Lorch
authors.forename: P
authors.initials: P
authors.lastname: Albers
authors.forename: C
authors.initials: C
authors.lastname: Winter
authors.forename: J
authors.initials: J
authors.lastname: Beyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D018365:Neoplasm, Residual / Q000188:drug therapy* / Q000601:surgery*; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D016879:Salvage Therapy; D018239:Seminoma / Q000188:drug therapy / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
chemical_list: D005047:Etoposide; D016190:Carboplatin