SURGICAL SALVAGE OF CHEMOREFRACTORY GERM-CELL TUMORS

被引:173
作者
MURPHY, BR
BREEDEN, ES
DONOHUE, JP
MESSEMER, J
WALSH, W
ROTH, BJ
EINHORN, LH
机构
[1] INDIANA UNIV,SCH MED,DEPT MED,DIV HEMATOL & ONCOL,INDIANAPOLIS,IN 46202
[2] INDIANA UNIV,SCH MED,DEPT UROL,INDIANAPOLIS,IN 46202
[3] METHODIST HOSP,MEMPHIS,TN 38104
关键词
D O I
10.1200/JCO.1993.11.2.324
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Patients with disseminated germ cell tumors who relapse after salvage chemotherapy, or who progress during cisplatin-based therapy, have chemorefractory disease and a very poor prognosis. A subset of these patients will have chemorefractory but resectable disease. We have therefore evaluated the role of salvage surgery in this patient population. Patients and Methods: We performed a retrospective review of all patients with disseminated germ cell tumors who were felt to have chemorefractory disease and underwent salvage surgery from 1977 to 1990 at Indiana University. All patients had elevated serum markers or other signs of progressive carcinoma. A total of 48 patients underwent surgery (33 retroperitoneal lymph node dissections [RPLNDs], six thoracotomies, three thoracoabdominal resections, and multiple asynchronous procedures in six patients). Results: Thirty-eight of 48 patients (79%) were rendered grossly free of disease and 29 (60%) obtained a serologic remission. Ten patients (21%) remain continuously disease-free with no postoperative treatment with a median follow-up of 46 months (range, 31 to 89). Six additional patients who relapsed after salvage surgery are currently disease-free with further treatment (four with repeat surgery and two with high-dose chemotherapy and autologous bone marrow transplantation [ABMT]). Conclusion: Selected patients with chemorefractory but resectable germ cell tumors have definite potential for cure with salvage surgery.
引用
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页码:324 / 329
页数:6
相关论文
共 15 条
  • [1] BAJORIN DF, 1992, SEMIN ONCOL, V19, P148
  • [2] Donohue J P, 1977, Urol Clin North Am, V4, P509
  • [3] CYTOREDUCTIVE SURGERY FOR METASTATIC TESTIS CANCER - TISSUE-ANALYSIS OF RETROPERITONEAL MASSES AFTER CHEMOTHERAPY
    DONOHUE, JP
    ROTH, LM
    ZACHARY, JM
    ROWLAND, RG
    EINHORN, LH
    WILLIAMS, SG
    RICHIE, JP
    [J]. JOURNAL OF UROLOGY, 1982, 127 (06) : 1111 - 1114
  • [4] Einhorn L.H., 1992, P AN M AM SOC CLIN, V11, P196
  • [5] A PROSPECTIVE-STUDY OF CISPLATIN-BASED COMBINATION CHEMOTHERAPY IN ADVANCED GERM-CELL MALIGNANCY - ROLE OF MAINTENANCE AND LONG-TERM FOLLOW-UP
    LEVI, JA
    THOMSON, D
    SANDEMAN, T
    TATTERSALL, M
    RAGHAVAN, D
    BYRNE, M
    GILL, G
    HARVEY, V
    BURNS, I
    SNYDER, R
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 1988, 6 (07) : 1154 - 1160
  • [6] SALVAGE THERAPY IN RECURRENT GERM-CELL CANCER - IFOSFAMIDE AND CISPLATIN PLUS EITHER VINBLASTINE OR ETOPOSIDE
    LOEHRER, PJ
    LAUER, R
    ROTH, BJ
    WILLIAMS, SD
    KALASINSKI, LA
    EINHORN, LH
    [J]. ANNALS OF INTERNAL MEDICINE, 1988, 109 (07) : 540 - 546
  • [7] MILLER JC, 1990, SEMIN ONCOL, V17, P36
  • [8] MOTZER RJ, 1991, CANCER-AM CANCER SOC, V67, P1305, DOI 10.1002/1097-0142(19910301)67:5<1305::AID-CNCR2820670506>3.0.CO
  • [9] 2-J
  • [10] HIGH-DOSE CARBOPLATIN AND ETOPOSIDE WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN REFRACTORY GERM-CELL CANCER - AN EASTERN COOPERATIVE ONCOLOGY GROUP PROTOCOL
    NICHOLS, CR
    ANDERSEN, J
    LAZARUS, HM
    FISHER, H
    GREER, J
    STADTMAUER, EA
    LOEHRER, PJ
    TRUMP, DL
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 1992, 10 (04) : 558 - 563