Treatment of recurrent malignant sacrococcygeal germ cell tumors:: Analysis of 22 patients registered in the German protocols MAKEI 83/86, 89, and 96
Treatment of recurrent malignant sacrococcygeal germ cell tumors:: Analysis of 22 patients registered in the German protocols MAKEI 83/86, 89, and 96
复制标题
DOI：
10.1200/jco.2001.19.7.1951
复制
发表时间：
2001-04-01
影响因子：
45.3
通讯作者：
Göbel, U
中科院分区：
文献类型：
--
作者：
Schneider, DT;Wessalowski, R;Göbel, U
目的：探讨以顺铂为基础的三药一线化疗和肿瘤切除术后复发性骶尾蚴恶性生殖细胞瘤（GCT）的治疗方案。患者和方法：22例患者分为第一次复发22例，第二次复发14例，第三次复发5例，第四次复发2例。1例单纯畸胎瘤复发的患者被排除在辅助治疗分析之外。结果：局部孤立复发17例，远处复发2例，局部和远处合并复发3例。12例患者术后完全缓解（CR） （n = 12），辅助铂化疗（In = 10）。其中7例患者仍处于持续CR， 5例患者复发，所有仅部分缓解的患者均出现第二次复发。14名患者中有3名在第二次（或进一步）复发后可以治愈。总共有10名患者无病存活，12名患者因肿瘤进展（n = 11）或治疗相关并发症（n = 1）而死亡。抢救手术的完成程度和首次抢救治疗后的临床缓解情况是最重要的预后参数。此外，首次或第二次复发的局部晚期或肿瘤反应不良的患者受益于术前化疗联合局部热疗（RHT），在一些显微镜下不完全切除的患者中，剂量为bb0 - 45 Gy的照射有助于获得良好的结果。结论：局部复发的完全切除是挽救性治疗的基石。术前以铂类化疗为主，部分患者联合RHT可促进肿瘤完全切除，对于显微镜下肿瘤切除不完全的患者应保留放疗。由于治愈的机会随着进一步的复发而减少，重要的是建立一个严格的治疗策略，以避免显著的治疗延误，最重要的是，局部治疗不足。(C) 2001年美国临床肿瘤学会。
Purpose: To evaluate therapeutic options for recurrent malignant sacrococcygeal germ cell tumors (GCT) following three-agent, cisplatinum-based, first-line chemotherapy and tumor resection.Patients and Methods: Twenty-two patients were evaluated in 22 first-, 14 second-, five third-, and two fourth-relapse situations. One patient, who relapsed with pure teratoma, was excluded from the analysis of adjuvant treatment.Results: Seventeen patients presented with an isolated local recurrence, two patients showed a distant relapse, and three patients suffered from a combined local and distant recurrence. Twelve patients achieved complete remission (CR) after surgery (n = 12) and adjuvant platinum chemotherapy In = 10). Seven of these patients remain in continuous CR, and five patients relapsed, All patients who achieved only a partial remission developed a second relapse. Three of 14 patients could be cured after a second (or further) relapse. Altogether, 10 patients survived disease free, and 12 patients died as a result of tumor progression (n = 11) or therapy-related complications (n = 1). The completeness of salvage surgery and clinical remission status after first salvage treatment were the most important prognostic parameters. In addition, patients in first or second relapse with locally advanced or poorly responding tumors benefited from preoperative chemotherapy in combination with regional hyperthermia (RHT), In some patients after microscopically incomplete resection, irradiation at doses > 45 Gy contributed to a favorable outcome.Conclusion: The complete resection of the local recurrence represents the cornerstone of salvage treatment. preoperative platinum-based chemotherapy, combined with RHT in some patients, facilitates complete tumor resection, Radiotherapy should be reserved for those patients with microscopically incomplete tumor resection. As the chance of cure decreases with further relapses, it is important to establish a stringent therapeutic strategy to avoid significant treatment delays and, most importantly, insufficient local therapy. (C) 2001 by American Society of Clinical Oncology.