Chemotherapy for advanced germ cell tumors.
PURPOSE: Germ cell tumors constitute the most curable of all cancers. Standard treatment of previously untreated and treated patients has evolved on the basis of prospective clinical trials and prognostic factors. This review summarizes the prognostic criteria on which treatment decisions may be bas...
| Publicado en: | Journal of Clinical Oncology Vol. 24; no. 35; pp. 5493 - 5503 |
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| Autores principales: | , |
| Formato: | Journal Article |
| Publicado: |
American Society of Clinical Oncology
12/10/2006
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106020977&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106020977 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0732183X 20D jtl: Journal of Clinical Oncology issn: 0732183X maglogo: N pubinfo: dt: 12/10/2006 vid: 24 iid: 35 pid: 26892 pub: American Society of Clinical Oncology place: Alexandria, Virginia artinfo: ui: 106020977 106020977 2009380388 NLM17158534 106020977 ppf: 5493 ppct: 10 formats: tig: atl: Chemotherapy for advanced germ cell tumors. aug: au: Kondagunta GV Motzer RJ affil: Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center,New York, NY 10021, USA. kondaguv@mskcc.org sug: subj: Antineoplastic Agents, Combined Therapeutic Use Neoplasms, Germ Cell and Embryonal Drug Therapy Antineoplastic Agents, Combined Administration and Dosage Bleomycins Administration and Dosage Cisplatin Administration and Dosage Etoposide Administration and Dosage Neoplasms, Germ Cell and Embryonal Surgery Palliative Care Clinical Trials Salvage Therapy ab: PURPOSE: Germ cell tumors constitute the most curable of all cancers. Standard treatment of previously untreated and treated patients has evolved on the basis of prospective clinical trials and prognostic factors. This review summarizes the prognostic criteria on which treatment decisions may be based, and outlines the current treatment approaches. PATIENTS AND METHODS: Randomized and nonrandomized trials of first-line, salvage, and palliative therapy and the role of surgery after chemotherapy were reviewed. In the treatment of previously untreated patients, emphasis was placed on interpretation of data of trials according to the International Germ Cell Cancer Collaborative Group model, which has evolved into a universally accepted classification algorithm for determining appropriate risk-directed chemotherapy. This system permits treatment choices based on the balance between benefit and toxicity and allows comparison of results across multiple clinical trials. RESULTS: Standard therapy for good-risk patients is four cycles of etoposide plus cisplatin or three cycles of cisplatin, etoposide plus bleomycin (BEP x 3); both approaches cure approximately 90% of patients. After chemotherapy and normalization of markers, patients should generally undergo resection of residual masses. Approximately 75% of intermediate-risk and 45% of poor-risk patients group achieve a durable complete response with BEP x 4. Potentially curative options in the salvage setting include ifosfamide plus cisplatin-containing standard dose therapy and high-dose carboplatin plus stem-cell rescue. Surgery remains an essential component of care. CONCLUSION: Curative therapy exists even in patients with resistant disease, and treatment choices can be based on established clinical criteria. Serum tumor markers and surgery after chemotherapy have essential roles in patient management pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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