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Chemotherapy of metastatic seminoma

机译：转移性精原细胞瘤的化学疗法

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Response to chemotherapy and survival was retrospectively analyzed in 28 patients with bulky retroperitoneal and disseminated seminoma treated between 1977 and 1983. The median age was 41 years (range: 23-52). All patients had histological evidence of pure testicular seminoma, however, 14 patients revealed moderate increases of human beta-chorionic gonadotropin levels. Prior radiotherapy had been given to 9/28 (32%) patients. Treatment consisted of at least four courses of simultaneous or sequentially alternating therapy with cisplatin, vinblastine, bleomycin plus/minus adriamycin (PVB +/- A), administration of ifosfamide or combination therapy with ifosfamide/cisplatin (IFS/DDP) or ifosfamide/etoposide (IFS/ETP). Twenty-five of 28 patients (89%) achieved a complete (CR), and 3/28 patients a partial remission. Relapse occurred in 1/8 CR patients after adjuvant postchemotherapeutic irradiation, and in 1/11 patients without any further radiotherapy. So far, 23/28 patients (82%) are free of disease after a median follow-up of 28+ (14+----82+) months. Marked myelosuppression was observed in previously irradiated patients, mainly after PVB +/- A therapy. In two patients, transient nephrotoxicity developed after PVB and IFS/DDP, respectively. After PVB +/- A chemotherapy, three patients revealed polyneuropathy, paralytic subileus and bleomycin-induced pneumonitis, respectively. In conclusion, the present series suggests a high probability of continuous CR in even bulky retroperitoneal and widespread metastatic seminoma. So far, no definite conclusions can be made on the therapeutic superiority of one of the different chemotherapeutic regimens used. However, this preliminary experience suggests that the combination of ifosfamide and etoposide or cisplatin may prove less toxic than sequentially alternating or simultaneous PVB +/- A chemotherapy.
机译：回顾性分析了1977年至1983年间治疗的28例腹膜后弥漫性播散性精原细胞瘤患者对化疗和生存的反应。中位年龄为41岁（范围：23-52岁）。所有患者均具有纯睾丸精原细胞瘤的组织学证据，但是，有14例患者显示人类β-绒毛膜促性腺激素水平适度增加。 9/28（32％）患者已接受过放疗。治疗包括至少四个疗程的顺铂，长春碱，博来霉素加/减阿霉素（PVB +/- A）同步或交替治疗，给予异环磷酰胺或异环磷酰胺/顺铂（IFS / DDP）或异环磷酰胺/依托泊苷联合治疗（IFS / ETP）。 28名患者中有25名（89％）达到了完全缓解（CR），3/28名患者获得了部分缓解。辅助化疗后放疗后有1/8例CR患者复发，而未经进一步放疗的患者中有1/11例复发。迄今为止，中位随访28+（14 + ---- 82+）个月后，有23/28名患者（82％）没有疾病。在先前接受过放射治疗的患者中观察到明显的骨髓抑制，主要是在PVB +/- A治疗后。在两名患者中，分别在PVB和IFS / DDP后出现短暂的肾毒性。 PVB +/- A化疗后，三名患者分别显示出多发性神经病，麻痹性回肠和博来霉素诱发的肺炎。总之，本系列表明即使在巨大的腹膜后和广泛的转移性精原细胞瘤中，连续CR的可能性也很高。迄今为止，尚不能就所使用的不同化学疗法之一的治疗优势做出明确的结论。但是，这种初步的经验表明，异环磷酰胺和依托泊苷或顺铂的组合可能比顺序或同时进行PVB +/- A化疗具有更低的毒性。

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