Extragonadal germ-cell tumors: treatment experience in nine patients

Background We treated nine patients with uncommon and high-risk extragonadal germ-cell tumors (EGCTs) between 1982 and 1991. Methods Anterior mediastinal lesions were located in five patients, retroperitoneal tumors in three patients, and in one patient both mediastinal and retroperitoneal tumors were found. Chemotherapeutic regimens consisted of cisplatin, vincristine, bleomycin and actinomycin D (PVcBA); cisplatin, vinblastine and bleomycin (PVB); vinblastine, actinomycin D, cyclophosphamide, bleomycin and cisplatin (VAB-6); and bleomycin, etoposide and two doses of cisplatin (high-dose BEP). Results Two patients receiving PVcBA and second-line chemotherapy showed partial responses. Six patients; one treated with PVB, two with VAB-6, and three others with high-dose BEP with or without additional chemotherapy, underwent surgical resection of residual tumors. Histologic examinations showed either necrotic debris or necrosis including mature teratoma (complete response). In one patient, whose tumor marker was negative, unresectable residual tumors continued to shrink and disappeared with no maintenance therapy following administration of high-dose BEP. Overall, 7 of 9 patients (77.8%) achieved a complete response to either chemotherapy alone or a combination of chemotherapy and surgery. One patient, who suffered a relapse from an apparent CR, was also treated successfully. These patients remain disease free. Conclusion Patients with EGCTs are curable, even if the tumors in question are in highly advanced stages, as long as appropriate chemotherapy and surgical resection are undertaken in a timely fashion.     

High-dose chemotherapy as primary treatment for poor-risk germ-cell tumors: the Memorial Sloan-Kettering experience (1988-1999)

Although the majority of patients with poor-risk germ-cell tumors (GCTs) will achieve a durable complete remission (CR) with standard first-line therapy, 20% to 30% of them will either relapse or fail to achieve an initial CR and eventually die. For this reason, the strategy of using high-dose (HD) chemotherapy with autologous stem-cell support has been investigated to improve the chances of cure attainable in the salvage setting, but at a cost of significant morbidity and mortality. Treatment using HD therapy in the first-line setting offers the promise of reducing morbidity and mortality while increasing efficacy. At Memorial Sloan-Kettering Cancer Center (MSKCC), trials were conducted to test this hypothesis. Patients at high risk of relapse following conventional therapy were identified, based on post-treatment serum marker concentrations that failed to appropriately decline by predicted half-life after several cycles of standard treatment. These patients received first-line HD treatment. Patients received a 2-drug HD regimen in one trial and an intensified 3-drug regimen in another, each with autologous bone marrow transplantation. These patients had improved overall and event-free survival rates (p = 0.001 and 0.003, respectively) compared with historical controls who underwent standard first-line treatment, with a lower incidence of treatment-related mortality than patients who received HD therapy in the salvage setting. Randomized trials are under way to prospectively verify these results.     

Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases

Objective

Ovarian granulosa cell tumors are rare malignancies with a relatively favorable prognosis. However, patients still suffer from disease-related mortality. Therefore, the prognostic factors should be clarified. The purpose of this study was to investigate the clinical and pathologic characteristics related with disease recurrence and mortality in adult type ovarian granulosa cell tumors.

Methods

Eighty surgically staged patients with granulosa cell ovarian tumor treated at the Hacettepe University Hospital between 1982 and 2006 were retrospectively reviewed. Clinical and pathological characteristics were analyzed.

Results

Granulosa cell ovarian tumors accounted for 4.3% of malignant ovarian neoplasms. Mean age was 47.6 years. The most common presenting symptom was abnormal uterine bleeding (53.7%). Endometrial pathology was detected in 51.2% of patients preoperatively. Seventy percent of patients were diagnosed at stage I, and 53.8% of patients received adjuvant treatment. Mean follow-up was 67.5 months. Overall 5-year and 10-year survival was 91% and 86%, respectively. Mean survival was 147.1 months. Recurrence rate was 11.2%. In univariate analysis, advanced stage, advanced age, residual disease after surgery, and need for adjuvant treatment were associated with disease-related mortality and advanced stage disease and absence of initial staging surgery were associated with disease recurrence. However, in multivariate analysis, only initial stage was found to be a significant prognostic factor.

Conclusion

Initial stage seems to be the single most important prognostic factor in ovarian granulosa cell tumors. Therefore, a comprehensive staging surgery should be attempted to document the real extent of disease and to estimate the oncologic outcome more accurately.     

High-dose chemotherapy with transplantation of autologous stem cells in advanced germ-cell poor-risk testicular tumors

Testicular tumors illustrate curable cancer, but 25% patients are resistant to standard therapy. High-dose chemotherapy (HDC) is promising therapy for germ-cell tumors with poor prognosis. HDC and transplantation of autologous stem cells were performed in 13 patients with germ-cell testicular tumors (GTT). In 6 patients of group 1 HDC was first-line treatment in poor prognosis, in 7 patients (group 2) it was a salvage treatment after recurrences. Patients of group 1 had longer mean survival than those of group 2 (31.3 and 11 months, respectively; p = 0.136). Two patients died of HDC complications. Neurological, hematological and other complications occurred. In spite of 50-90% remission after HDC, multicenter prospective randomized trials will give final conclusion on effectiveness of HDC which must be performed in special clinics having many specialists in their staff (urologists, oncologists, chemotherapists, etc.).     

Prognostic factors for outcomes after whole-brain irradiation of brain metastases from relatively radioresistant tumors: a retrospective analysis

Background  

This study investigated potential prognostic factors in patients treated with whole-brain irradiation (WBI) alone for brain metastases from relatively radioresistant tumors such as malignant melanoma, renal cell carcinoma, and colorectal cancer. Additionally, a potential benefit from escalating the radiation dose was investigated.     

Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors.

BACKGROUND: This investigation evaluates prognostic variables in patients with seminomatous and non-seminomatous extragonadal germ-cell tumors (EGCT) in order to identify relevant factors for long-term outcome following cisplatin-based chemotherapy. PATIENTS AND METHODS: Patients from six countries treated at 11 centers in Europe and the USA from 1975 to 1996 were evaluated retrospectively. Uni- and multivariate analyses of prognostic variables for survival and for response to chemotherapy were performed. RESULTS: Data were available for 635 EGCT patients, 104 with seminomatous and 524 with non-seminomatous EGCT (n = 7 not specified). For non-seminomatous EGCT the following independent adverse factors were identified: presence of either liver, lung or central nervous system metastases, primary mediastinal tumor or elevation of pretreatment beta-human gonadotropin; for extragonadal seminoma (only univariate) adverse factors were: presence of liver metastases, two or greater metastatic sites or International Germ Cell Cancer Collaborative Group (IGCCCG) grouping (intermediate versus good). Integration of these variables produced the following prognostic risk groupings: 'excellent prognosis', all seminomatous EGCT (89% 5-year survival rate); 'intermediate low', 'intermediate high' and 'poor', all non-seminomatous EGCT with a 69, 55 and 17% 5-year survival rate, respectively. The decreased survival among the different groups was due to a lower rate of favorable objective remissions and a higher rate of relapses. Classification and regression tree (CART) modeling confirmed histology and location of primary tumor as the major prognosticators. For the subgroup of patients with mediastinal non-seminoma, the 2-year survival rate ranged from 34 to 84%. Multivariate testing for the probability to respond to chemotherapy revealed non-seminomatous histology, primary mediastinal tumor site, and the presence of liver, lung or CNS metastases as independent adverse factors. CONCLUSIONS: In EGCT, prognostic variables for the outcome and for the response to chemotherapy could be identified, which in part differ from gonadal GCT. The proposed model might help to better understand the specific prognosis of EGCT and to tailor risk-adapted treatment strategies. In addition, CART analysis demonstrated the heterogenous prognosis of patients with mediastinal non-seminoma.     

Prognostic factors of gastrointestinal stromal tumors: A single institutional retrospective experience with surgical management over 20 years

Objective  

To analyze the pathological features and prognosis factors of gastrointestinal stromal tumor (GIST) after primary resection.     

Prognostic factors in HIV-positive patients with non-Hodgkin lymphoma: a Peruvian experience

Background

Non-Hodgkin lymphoma (NHL) is the most common cancer in people with HIV. Although 95% of HIV patients are in developing countries like Peru, the majority of these studies have been conducted in developed countries. In this study we aim to evaluate prognostic factors associated with outcomes in HIV positive patients undergoing systemic therapy for treatment of NHL.

Methods

This retrospective study includes patients with NHL seen in the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 2004 to 2014. Patients were divided into two groups: antiretroviral therapy (ART) -naïve (n?=?34) and those previously treated, ART-exposed (n?=?13), at the time of diagnosis. All patients received chemotherapy and ART. The medical records were reviewed. Data were analyzed using t-test and chi-square test. Survival curves were estimated by the Kaplan-Meier method and comparison was done by log-rank test. Multivariate analysis for overall survival (OS) was performed with the Cox proportional hazard regression model.

Results

All ART-exposed patients were from the capital city (p?=?0.039); they had significantly lower hemoglobin levels compared to ART-naïve patients (p?=?0.026). The median OS was 47.7 months with a 5-yr OS of 36.1%. The median OS for ART naïve patients was significantly higher than that for ART-exposed patients (57.05 and 21.09 months, respectively; p?=?0.018). Advanced stage and low serum albumin were associated with lower OS in both groups. Age?>?60 was associated with worse outcomes in the ART-naïve cohort.

Conclusions

Advanced stage, low serum albumin and previous ART treatment were the primary prognostic factors associated with poorer outcomes in patients with NHL and HIV infection. In ART-naïve patients, age?>?60 was associated with worse outcomes but in this cohort, older patients still had better overall outcomes than ART-exposed patients.

     

Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort

Objective

Concurrent chemoradiotherapy (CCRT) is the primary treatment for locally advanced cervical cancer. We studied prognostic factors for patients treated with CCRT.

Methods

We retrospectively reviewed records of 85 consecutive patients with cervical cancer who were treated with CCRT between 2002 and 2011, with external beam radiation therapy, intracavitary brachytherapy, and platinum-based chemotherapy. Survival data were analyzed with Kaplan-Meier methods and Cox proportional hazard models.

Results

Of the 85 patients, 69 patients (81%) had International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease; 25 patients (29%) had pelvic lymph node enlargement (based on magnetic resonance imaging), and 64 patients (75%) achieved clinical remission following treatment. Median maximum tumor diameter was 5.5 cm. The 3- and 5-year overall survival rates were 60.3% and 55.5%, respectively. Cox regression analysis showed tumor diameter >6 cm (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.2 to 4.6), pelvic lymph node enlargement (HR, 2.2; 95% CI, 1.1 to 4.5), and distant metastasis (HR, 10.0; 95% CI, 3.7 to 27.0) were significantly and independently related to poor outcomes.

Conclusion

New treatment strategies should be considered for locally advanced cervical cancers with tumors >6 cm and radiologically enlarged pelvic lymph nodes.     

Ovarian and extragonadal malignant germ-cell tumors in females: A single-institution experience with 43 patients

From 1978 to 1992, 276 patients (pts) with MGCT were treatedin our institution. Forty-three of the pts were female (15,5%).Median age at diagnosis was 20 years (newborn-70). Histologywas dysgerminoma (D) in 14 pts (including 2 anaplastic D), endodermalsinus tumor (EST) in 9 pts, immature teratoma in 10 pts andmixed tumors in 10 pts. Primary locations were as follows: ovary(O) 33 pts and extragonadal (EG) 10 pts (pineal in 4 cases,mediastinum in 3, sacrum in 2 and pharynx in 1). Stage: I in20 (16 0 , 4 EG), U in 7 (5 O, 2 EG), IE in 12 (10 O, 2 EG)and IV in 4 (2 O, 2 EG). Serum AFP was elevated in 20/22 non-dysgerminomapts, HCG in only 5 pts and LDH in 15/36 pts. TREATMENT RESULTS:OVARIAN TUMORS: all but one pt (biopsy only) underwent surgery: unilateral oophorectomywas performed in 15 pts and bilateral oophorectomy (+/–hysterectomy, + / – others) in 17 pts. Fourteen pts wererendered disease-free, 8 pts had residua] tumor (RT) ±2cm and 11 RT >2 cm. Chemotherapy (PVB or BEP) was given to28 pts, radiotherapy to 2 pts and no additional treatment to3. Finally, 30 pts achieved complete response (CR) and nonehave relapsed at a median follow-up of 43 months. EG tumors:None of the pts underwent radical surgery. Radiotherapy wasapplied to 4 pineal tumors and BEP or PVB were given to all10 pts. To date 6 pts are disease-free, 1 is alive with matureteratoma, 2 are alive with disease and 1 died of toxic effects.The projected overall survival of the series as a whole is 89%at 10 years, and it is significantly higher for pts withoutEST (p ± 0.02) and for pts with AFp ±1000 (p ±0.01) and age ± 22 years at diagnosis (p ± 0.01).The projected event-free survival at 10 years is 80.4% (87.7%for ovarian rumors vs. 54% for extragonadal, p = 0.05). No eventswere recorded after 28 months. CONCLUSIONS: The present results reflect the dramatic effectiveness of cisplatin-basedchemotherapy for ovarian MGCT and confirm that unilateral oophorectomycan preserve fertility without compromising cure. Age >22years, histology (EST) and serum AFP > 1000 ng/ml are possibleprognostic factors (univariate analysis) to be tested in anindependent body of data on cisplatin-treated patients. germ-cell tumors, ovary, extragonadal, females, cisplatin, toxicity, prognosis     

Management of postchemotherapy residual mass in patients with advanced seminoma: Indiana University experience

Thirty-six patients with advanced seminoma treated with cisplatin combination chemotherapy were evaluated to assess the significance of postchemotherapy residual radiographic mass. All patients had a minimum follow-up of 2 years. Of the 36 patients 21 had an evaluable residual radiographic mass after completion of chemotherapy. Twelve of these patients had a less than 3 cm maximal transverse diameter residual mass, and nine had a greater than 3 cm persistent mass postchemotherapy. Only three of these 21 patients underwent postchemotherapy retroperitoneal lymph node dissection, and the histopathology revealed only necrotic fibrous tissue. The remaining patients were followed by close observation including repeat abdominal computed tomography (CT) every 3 months the first year and every 6 months the second year (or until normal); further therapeutic intervention was given only on evidence of progressive disease. Nineteen of these 21 patients have no evidence of disease, including eight of nine with greater than 3 cm persistent radiographic abnormality. The optimal management for advanced seminoma patients with a persistent radiographic mass postchemotherapy remains unresolved. However, based on this small series, we feel that observation is a viable option, reserving radiotherapy or chemotherapy for those patients who subsequently develop progressive disease.     

Prognostic factors for renal cell carcinoma: Trakya University experience from Turkey

YURUT‐CALOGLU V., CALOGLU M., KAPLAN M., OZ‐PUYAN F., KARAGOL H., IBIS K., COSAR‐ALAS R, KOCAK Z. & INCI O. (2010) European Journal of Cancer Care 19 , 656–663 Prognostic factors for renal cell carcinoma: Trakya University experience from Turkey The purpose of the present study is to evaluate the prognostic factors of patients with renal cell carcinoma. The treatment results such as distant metastasis‐free survival and overall survival of 59 previously untreated patients were retrospectively analysed. Median follow‐up was 17.5 months (3.8–88.5 months). Overall survival was 22.4 months (3–87 months). Distant metastasis developed in 35 (59%) patients. The Eastern Cooperative Oncology Group (ECOG) performance status (P= 0.022), tumour size (P= 0.025) and lymphatic invasion (P < 0.0001) were significantly effective prognostic factors for distant metastasis‐free survival on multivariate analysis. Related to overall survival, gender (P= 0.025), ECOG performance status (P= 0.027), nuclear grade (P= 0.002), tumour size (P= 0.029), T stage (P= 0.044), nodal involvement (P= 0.003), surgical margin (P= 0.046), renal sinus invasion (P < 0.0001), perineural growth (P= 0.001) and lymphatic invasion (P < 0.0001) were significant prognostic factors on univariate analysis. Gender (P= 0.008), ECOG performance status (P= 0.027), tumour size (P= 0.025) and lymphatic invasion (P < 0.0001) retained their significance on multivariate analysis. We concluded that the most important prognostic factors for patients with renal cell carcinomas are ECOG performance status, tumour size and lymphatic invasion.     

Prognostic factors in elderly patients with non-small cell lung cancer: a two-center experience

Non-small cell lung cancer (NSCLC) is usually at advanced stage when it is diagnosed. There is no consensus about the standard treatment in elderly patients with advanced NSCLC. Generally, data regarding elderly patients with NSCLC are withdrawn from general NSCLC studies based on subgroup analyses and suggestions. We evaluated prognostic factors in elderly patients with advanced NSCLC. We reviewed retrospectively 338 patients from August 2005 to July 2009 in two centers in Turkey. Medical records of the patients ≥65 years with advanced NSCLC were collected. Collected data included demographic informations, clinical assessments and information on treatment, toxicities and outcomes. Survival was estimated by using Kaplan–Meier method and prognostic factors were evaluated with log-rank and Cox regression tests. The median overall survival (OS) for the entire group was 15.4 months (95% CI: 12.7–18.0). In univariate analysis, weight loss, stage, combination therapy, second-line chemotherapy and tumor response (P < 0.01) and performance status significantly affected OS (P < 0.05). The median progression-free survival (PFS) was 10 months (95% CI: 8.4–11.6). In univariate analysis, there was only a significant association between tumor response and PFS (14.6 vs. 8.5 months; P < 0.001). Multivariate analysis showed that only response to therapy was an important prognostic factor for OS (P < 0.001). Survival of elderly patients with advanced NSCLC is significantly influenced by performance status, weight loss, stage, combination therapy, second-line chemotherapy and response to therapy. Not only age but also these factors may be kept in mind in the treatment planning of the elderly patients with NSCLC. These results may be of benefit in changing clinical practice in elderly patients with NSCLC who are often undertreated.     

Letter to the editors regarding the paper: Prognostic factors in HIV-positive patients with non-Hodgkin lymphoma: a Peruvian experience

Non-Hodgkin Lymphoma (NHL) is a neoplasm associated with a group of malignancies called AIDs-Defining Malignancies (ADMs) in Human-Immunodeficiency Virus (HIV) -patients. Similar to the case of NHL in Latin America, particularly in Peru, the amount of research done on others ADMs is limited, especially in the case of Kaposi’s Sarcoma (KS). Prior investigations have talked about the great potential risk that represents this illness in latin american population, but topics as prognosis factors are yet to be well defined. In this letter, we address the importance of investigation in this area and include previously reported data that may enlighten the current national standpoint.     

Prognostic factors and clinical outcomes in patients with leptomeningeal metastasis from solid tumors

Background Leptomeningeal metastasis (LM) occurs in 4–15% of patients with solid tumors. Although the clinical outcomes in cancer patients have been improving recently, no standard treatment for LM has been established as yet. The purpose of this study was to identify the prognostic factors in patients with solid tumors with cytologically proven LM. Methods We retrospectively analyzed a series of 85 consecutive patients with cytologically proven LM who were treated between 1997 and 2005. Results The primary diseases were as follows; lung cancer (n = 36), breast cancer (n = 33), gastric cancer (n = 8), and others (n = 8). Forty-nine patients had brain metastasis at the time of diagnosis of the LM, and in 51 patients, MRI revealed meningeal dissemination in the brain or spine. The performance status (PS) was 0–1 in 26 patients and 2–4 in 59 patients. Thirty-one patients, including 19 with breast cancer, four with lung cancer, five with gastric cancer and three with other cancers, were treated by intrathecal (IT) chemotherapy. The response rate to the IT was 52% (95% confidence interval (CI): 41.4–62.6%). The median survival was 51 days (range, 3–759 days). A univariate analysis identified breast cancer, good PS (0–1), time to development of the LM (>1 year), and treatment by IT chemotherapy as being associated with a good prognosis, and multivariate analysis identified poor PS (HR: 1.72 (95% CI, 1.04–2.86) P = 0.04) and MRI-proven LM (HR: 1.82 (95% CI, 1.11–2.98) P = 0.02) as being associated with a poor prognosis. Conclusion In patients with poor prognostic factors, such as poor PS or MRI-proven LM, palliative therapy might be the most suitable treatment strategy.     

Primary intracranial germ-cell tumors. A retrospective analysis with special reference to long-term results of treatment and the behavior of rare types of tumors

Thirty cases of primary intracranial germ-cell tumors were reviewed with reference to the effect of treatment. Histologically, there were 23 pure germinomas, while the remaining tumors had more unusual histology; 3 of these were teratomas, and 4 germ-cell tumors with the admixture of yolk sac tumor (YST) or embryonal carcinoma (EMC). Three of these rare cases are presented. The performed surgery and radiotherapy, seemed adequate for pure germinomas, and all these cases lived tumor-free after an observation time of 13 to 139 months although 4 patients developed intellectual retardation or cerebral dullness after radiotherapy. Four cases with YST and EMC elements, indicated by the elevation of AFP and HCG values in serum, were resistant to radio- and chemotherapy and developed, despite surgically total removal of the tumor, intra- or extracranial metastases. A review of the literature is included.     

１５６０例非小细胞肺癌患者多因素预后分析

目的：综合治疗模式是提高非小细胞肺癌（ＮＳＣＬＣ）患者生存预后的主要手段,本研究结合临床资料对１５６０例大样本ＮＳＣＬＣ预后行多因素分析,建立具有临床实用价值的预后模型,为肺癌防治提供科学依据。方法：对１９９８年１月１日～２００４年１月１日期间我院收治的具有明确组织病理学诊断和临床分期的１５６０例ＮＳＣＬＣ患者资料,经病历查阅及严格随访,回顾性分析可能影响ＮＳＣＬＣ患者预后的相关因素。结果：共随访１５６０例ＮＳＣＬＣ患者,失随访７０例,有效病例１４９０例,失访率为４.５％。Ｃｏｘ单因素及多因素分析表明：ＴＮＭ分期、手术方式、化疗方案是否含铂类药物、ＫＰＳ评分是独立的影响ＮＳＣＬＣ患者预后的相关因素。该组病例１、３、５年生存率分别为６０.６％、４５.７％、２５.７％。结论：ＴＮＭ分期、手术方式、化疗方案是否含铂类药物、ＫＰＳ评分是影响ＮＳＣＬＣ患者的独立预后因素。     

Prognostic factors and survival in patients with neuroendocrine tumors of the pancreas

Pancreatic neuroendocrine tumors (PNETs) are uncommon malignancies. The purpose of this study was to identify the prognostic factors of pancreatic neuroendocrine tumors at a single center in China. Clinical data of 27 patients with PNETs treated at the Sun Yat-sen University Cancer Center between January 1995 and December 2010 were retrospectively reviewed. Survival was estimated with the Kaplan–Meier methodology. Twenty-three patients (85.2%) had nonfunctional tumors and four patients (14.8%) had functional tumors. The majority of PNETs located in the body and/or tail of the pancreas in 20 patients (74.1%). All Patients with functional tumors cause syndromes related to hormone overproduction. Anorexia, nausea, vomiting, obstructive jaundice, weight loss, and incidental mass were more common in patients with nonfunctional tumors. The median follow-up time was 40 months. The overall 1-, 2-, and 5-year accumulative survival rates were 91%, 81%, and 81%, respectively. In univariate analysis, factors associating with significantly better survival included macroscopically radical resection of the primary tumor, tumor–node–metastasis (TNM) staging, World Health Organization (WHO) classification, and palliative chemotherapy. Macroscopically radical resection of the primary tumor, TNM staging, WHO classification, and palliative chemotherapy were prognostic variables which may emerge as a practical clinical tool to predict survival.     

High-dose versus conventional-dose chemotherapy as first-salvage treatment in patients with non-seminomatous germ-cell tumors: a matched-pair analysis.

BACKGROUND: The purpose of this study was to compare high-dose chemotherapy (HDCT) with conventional-dose chemotherapy (CDCT) as first-salvage treatment in patients with relapsed or refractory non-seminomatous germ-cell tumors (NSGCT). PATIENTS AND METHODS: One hundred and ninety-three patients with relapsed or refractory NSGCT, between 1981 and 1995, were identified from two large databases. In 74 of these, intensification of first-salvage treatment by HDCT was planned. Patients were matched based on primary tumor location, response to first-line treatment, duration of this response and serum levels of the tumor markers, human chorionic gonadotrophin (HCG) and alpha-fetoprotein (AFP). Multivariate analyses were performed using event-free survival and overall survival as primary endpoints. RESULTS: Full matches on all five factors were found for 38 pairs of patients; for a further 17 pairs, matches on at least four factors could be identified. Hazard ratios in favor of HDCT were obtained between 0.72 and 0.84 [confidence interval (CI) 0.59-1.01] for event-free survival and between 0.77 and 0.83 (CI 0.60-0.99) for overall survival, depending on the type of analysis. CONCLUSIONS: The current analysis suggests a benefit from HDCT, with an estimated absolute improvement in event-free survival of between 6 and 12% and in overall survival of between 9 and 11% at 2 years. This benefit is lower than expected from previous phase I/II studies.     

Salvage high-dose chemotherapy in female patients with relapsed/refractory germ-cell tumors: a retrospective analysis of the European Group for Blood and Marrow Transplantation (EBMT)

BackgroundHigh-dose chemotherapy (HDC) with hematopoietic progenitor cell transplantation is a standard option for relapsed/refractory testicular germ-cell tumor (GCT), but only few data have been reported in female patients with GCT. We conducted a retrospective analysis of female patients with GCT treated with HDC and registered with the European Society for Blood and Marrow Transplantation.Patients and methodsBetween 1985 and 2013, 60 registered female patients with GCT, median age 27 years (range 15–48), were treated with salvage HDC. Forty patients (67%) had primary ovarian GCT, 8 (13%) mediastinal, 7 (12%) retroperitoneal and 5 (8%) other primary sites/unknown. Twenty-two patients (37%) received HDC as second-line therapy, 29 (48%) as third-line, and 9 (15%) as fourth- to sixth-line. Nine of 60 patients (15%) received HDC as late-intensification with no evidence of metastasis before HDC. The conditioning HDC regimens comprised carboplatin in 51 of 60 cases (85%), and consisted of a single HDC cycle in 31 cases (52%), a multi-cycle HDC regimen in 29 (48%).ResultsNine cases who underwent late intensification HDC were not evaluable for response. Of the other 51 assessable patients, 17 (33%) achieved a complete response (CR), 8 (16%) a marker-negative partial remission (PRm−), 5 (10%) a marker-positive partial remission, 5 (10%) stable disease, and 13 (25%) progressive disease. There were 3 toxic deaths (6%). With an overall median follow-up of 14 months (range 1–219), 7 of 9 (78%) patients with late intensification and 18 of the 25 patients (72%) achieving a CR/PRm− following HDC were free of relapse/progression. In total, 25 of 60 patients (42%) were progression-free following HDC at a median follow-up of 87 months (range 3–219 months).ConclusionsSalvage HDC based on carboplatin represents a therapeutic option for female patients with relapsed/refractory GCT.