Prognosis after salvage treatment for unselected male patients with germ cell tumours

• Published in: British journal of cancer Vol. 72; no. 4; pp. 1026 - 1032
• Main Authors: GERL, A, CLEMM, C, SCHMELLER, N, HARTENSTEIN, R, LAMERZ, R, WILMANNS, W
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-10-1995
• Subjects: Adolescent; Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; Germinoma - drug therapy; Germinoma - mortality; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prognosis; Retrospective Studies; Salvage Therapy; Survival Rate; Testicular Neoplasms - drug therapy; Antineoplastic agent; Human; Relapse; Prognosis; Testicle; Salvage therapy; Germ cell tumor; Alkylating agent; Alkaloid; Chemotherapy; Treatment; Extragenital; Nitrogen mustard; Male genital diseases; Negative therapeutic reaction; Testicular diseases; Platinum II Complexes
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.1995.456

Long-term outcome of salvage treatment was reviewed in 67 unselected male patients relapsing during or after their primary cisplatin-based chemotherapy for metastatic germ cell tumours. Seven patients underwent only surgery and/or radiotherapy as curatively intended salvage treatment. Thirty-five patients (52%) had a complete or partial response to salvage treatment, 20 (57%) of whom relapsed again. With a median follow-up of 90 months (range 3-143 months) 20 patients (30%) are alive with no evidence of disease, 15 continuously disease-free and five currently disease-free. The 5 year survival from start of salvage treatment is 37% for the group as a whole. Multivariate analysis identified age < or = 35 years, complete response to primary treatment and a relapse-free interval > 3 months as independent predictors of favourable outcome of salvage treatment. A group of patients with these good-risk factors (42%) had a 5 year survival of 72% compared with the remaining patients (58%) with a 5 year survival of only 11%. Whereas patients with good-risk features may be adequately managed by conventional salvage treatment, the remaining patients carry a very poor prognosis and require innovative and more aggressive approaches.