ISSN:
1569-8041
Keywords:
brain metastases
;
germ-cell cancer
;
high-dose chemotherapy
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
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.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1008388328809
