First-line high-dose chemotherapy +/- radiation therapy in patients with metastatic germ-cell cancer and brain metastases. |
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| Authors: | C. Kollmannsberger, C. Nichols, M. Bamberg, J. T. Hartmann, N. Schleucher, J. Beyer, P. Schö ffski, G. Derigs, U. Rü ther, I. Bö hlke, H.-J. Schmoll, L. Kanz C. Bokemeyer |
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| Affiliation: | (1) Department of Hematology/Oncology, University of Tübingen Medical Center, Germany;(2) Division of Hematology/Oncology, Oregon Health Science University, Oregon, USA;(3) Department of Radiation Oncology, University of Tübingen Medical Center, Tübingen, Germany;(4) Department of Internal Medicine, West German Cancer Center, Essen, Germany;(5) Departments of Hematology/Oncology, Charite, Campus Virchow, Humboldt University Clinic, Berlin, Germany;(6) Departments of Hematology/Oncology, Hannover University Medical School, Hannover, Germany;(7) Departments of Hematology/Oncology, Mainz University Medical School, Mainz, Germany;(8) Departments of Hematology/Oncology, Katharinenhospital Stuttgart, Stuttgart, Germany;(9) Departments of Hematology/Oncology, University of Halle Medical Center, Halle, Germany |
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| Abstract: | Purpose:To examine the feasibility and efficacy of first-linehigh-dose chemotherapy (HD-CTX) in patients with advanced metastatic germ-celltumors (GCT) and brain metastases.Patients and methods:Twenty-two patients with brain metastasesat initial diagnosis were identified within a cohort of two hundred thirty-oneconsecutive patients with advanced metastatic disease, entered on a Germanmulticenter trial between January 1993 and July 1998. All patients receivedfirst-line HD-CTX with cisplatin–etoposide–ifosfamide (HD-VIP)followed by autologous stem-cell transplantation. Brain irradiation (BRT) with30–50 Gy ± 10 Gy boost was applied in patients with symptomaticCNS disease or as consolidation in case of residual CNS lesions after HD-CTX.Results:A median number of 4 HD-CTX cycles (range 2–5) wereapplied to the 22 patients. Ten patients received HD-CTX alone and twelvepatients were treated with HD-CTX plus BRT. Median duration of WHO grade 4granulocytopenia and thrombocytopenia was seven and five days after eachcycle, respectively. Non-hematologic toxicity consisted mainly ofmucositis/enteritis (WHO grade 3–4 32%). Two early deathsoccurred in twenty-two patients (one CNS-bleeding/one sepsis). Fourteen oftwenty patients achieved a CR/PRm– status. Twenty patients (91%)responded in the brain (55% CR/36% PR). Two-yearprogression-free and overall survival rates were 72% and 81%,respectively. These survival rates are substantially higher compared to theavailable data in the literature.Conclusions:High-dose chemotherapy with autologous stem-cellsupport ± BRT appears to be feasible without increased therapy-relatedmortality in patients with advanced metastatic GCT and brain metastases. Theresults achieved emphasize the high chemosensitivity of CNS metastases fromGCT and suggest a potential role for dose intensification. The dose of BRT inaddition to HD-CTX may be tailored to the presence of clinical symptoms andthe response of CNS metastases to chemotherapy. |
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| Keywords: | brain metastases germ-cell cancer high-dose chemotherapy |
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