title: [High dose chemotherapy with autologous stem-cell support in germ cell tumors: The Instituto Português de Oncologia de Lisboa Francisco Gentil Series].
abstract: BACKGROUND
  High dose chemotherapy with autologous stem cell transplantation (HDCT-ASCT) has been administered to patients with high-risk germ cell tumours (GCT). The role of this treatment for GCT still remains unclear, including the identification of subgroups more likely to benefit from such strategy.
  
  
  METHODS
  A retrospective review was conducted of all male patients with gonadal and extra gonadal GCT treated with HDCT-ASCT between 1996 and 2008 at the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG).
  
  
  RESULTS
  Twenty patients were treated with HDCT-ASCT, 17 with primary testicular tumours, two mediastinal and one retroperitoneal GCT. According to the International Germ Cell Cancer Consensus Group (IGCCCG) classification, at diagnosis three patients had good risk, four intermediate, eight poor but for the patients left the risk group could not be ascertained. In eight patients HDCT-ASCT was used upfront, after induction with first-line conventional chemotherapy, and in the remaining 12 for relapsed GCT. One patient had platinum-resistant and another platinum-refractory disease. Only two patients had Beyer score > 2. All but one patient were treated with ICE (Ifosfamide, Carboplatin, Etoposide). Six patients underwent a second HDCT-ASCT course. The 5-year overall survival and progression free survival were respectively 53% and 44%; both patients with mediastinal GCT are long term survivors.
  
  
  CONCLUSIONS
  Randomized studies to date have failed to indicate a survival advantage for HDCT-ASCT in GCT. This series is small and heterogeneous which prevents us from drawing conclusions regarding the benefit of this treatment for GCT. However, we could confirm the lack of benefit of HDCT-ASCT for platinum-resistant GCT and to question the absolute contraindication to this therapeutic modality in mediastinal GCT. HDCT-ASCT should therefore be performed exclusively in experienced centers and, preferably, in the setting of clinical trials.
authors.affiliation: Serviço de Oncologia Médica, Centro de Transplantação, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Brito
authors.forename: Pedro
authors.initials: P
authors.lastname: Sanchez
authors.forename: Sónia
authors.initials: S
authors.lastname: Velho
authors.forename: Nuno
authors.initials: N
authors.lastname: Miranda
authors.forename: Fernando
authors.initials: F
authors.lastname: Leal da Costa
authors.forename: Isabelina
authors.initials: I
authors.lastname: Ferreira
authors.forename: Gilda
authors.initials: G
authors.lastname: Teixeira
authors.forename: António
authors.initials: A
authors.lastname: Guimarães
authors.forename: Manuel
authors.initials: M
authors.lastname: Abecasis
authors.forename: J L
authors.initials: JL
authors.lastname: Passos Coelho
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000601:surgery*; D011174:Portugal; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents