Vierfach-Kombination beim nichtseminomatösen Hodentumor mit ungünstiger Prognose

  • C. Clemm
  • R. Hartenstein
  • W. Mair
  • M. Wiesel
  • G. Ledderose
Conference paper

Zusammenfassung

Obwohl mit PVB und PEB Chemotherapie gute Resultate beim nichtseminomatösen Hodentumor erzielt werden, sind die Erfolge beim “bulky” Tumor noch keineswegs befriedigend. Da eine spätere Intensivierung der Therapie zu keiner Ergebnisverbesserung führt, behandelten wir solche Patienten initial mit einem Vierer-Schema (ECBC) bestehend aus Etoposid 120 mg/m2, Cisplatin 30 mg/m2, Cyclophosphamid 300 mg/m2 und Bleomycin 12 mg/m2 Tag 1–4, sowie 15 mg Bleomycin Tag 1. Von den 28 Patienten befanden sich 15 im Stadium IV mit Lungenmetastasen > 5 cm oder abdomino-pulmonalen Manifestationen, 4 mit Leber- und 2 mit ZNS-Metastasen. 4 Patienten hatten ein Stadium III mit mediastinalen Lymphknoten > 10 cm, 3 ein Stadium HC mit abdominellen Lymphknoten > 10 cm. In 22 Fällen waren die Tumormarker stark erhöht: AFP > 1000 ng/ml, HCG > 10000 U/l.

Von den 28 Patienten werden 5 noch therapiert und sind nicht auswertbar. Von den 23 auswertbaren Patienten verstarb 1 Patient im ersten Zyklus an Lungen- und Leberversagen aufgrund großer Metastasen, 2 weitere Patienten waren initial progredient, einer erreichte eine partielle Remission mit erhöhten Tumormarkern — insgesamt 17%. Von den übrigen 19 Patienten war bei 9 eine komplette Remission durch Chemotherapie erzielbar (39%), bei 8 NED durch zusätzliche Chirurgie (35%), und in 2 Fällen eine partielle Remission (9%) mit Markernegativität — insgesamt 83%.

Von diesen 19 Patienten haben 3 ein Rezidiv erlitten, woran 2 verstarben, 1 Patient erreichte eine erneute Remission (NED). Derzeit leben noch 17/23 Patienten (73%), die Remissionsdauer liegt zwischen 3+ und 51+ Monaten (Median 11 + Monate). Die Knochenmarktoxizität war erheblich mit Leuko- und/oder Thrombopenie Grad 3 und 4 (WHO) bei allen Patienten.

Trotz der hohen Toxizität sind die Ergebnisse mit ECBC sehr vielversprechend für diese Hochrisiko Patientengruppe mit bisher schlechter Prognose.

Abstract

In spite of good results with PVB and PEB chemotherapy in NSGCT (nonseminomatous germ cell tumor), the remission rate in “bulky” NSGCT is too low. Late intensification of treatment does not improve the cure rate. We therefore treated patients with bulky NSGCT initially with a four-drug regimen (ECBC) consisting of etoposide 120 mg/m2, cisplatin 30 mg/m2, bleomycin 12 mg/m2, and cyclophosphamide 300 mg/m2, on days 1–4 and 15 mg bleomycin push injection on day 1.

Up until now 28 patients have been treated; 15 had stage IV disease with lung metastases exceeding 5 cm or large abdominopulmonary manifestations, four with liver, and two with CNS-metastases. Four patients had stage III disease with mediastinal lymph nodes and three had stage IIC disease with abdominal lymph nodes exceeding 10 cm. In 22 cases tumor marker levels were extremely elevated: AFP > 1000 ng/ml, HCG > 10000 U/l.

Five patients are still being treated. Of 23 evaluable patients, one died during the first cycle due to pulmonary and hepatic failure caused by metastases. Two patients initially had progressive disease, and one reached PR (partial remission) with elevated tumor markers; in total four of 23 patients, or 17%. Of the remaining 19 patients, nine reached CR (complete remission) through chemotherapy alone (39%); eight, NED (no evidence of disease) with surgery (35%); and two, PR with marker normalization (9%; total 83%). Three of these 19 had relapses; two died and one reached NED status for a second time. At present 17 of 23 (73%) currently reveal NED, the remission duration being 3 to 51 months (median 11). Bone marrow toxicity is remarkable with leuko- and/or thrombopenia of WHO grade 3 and 4 in all cases.

In spite of the high toxicity, the results with ECBC are encouraging for these patients, who have an extremely poor prognosis.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • C. Clemm
  • R. Hartenstein
  • W. Mair
  • M. Wiesel
  • G. Ledderose

There are no affiliations available

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