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

Gerl, Arthur; Clemm, C.; Schmeller, N.; Hartenstein, R.; Lamerz, R.; Wilmanns, W.

doi:10.1038/bjc.1995.456

Cited by 49 publications

(17 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These authors identified the following poor prognosis parameters: mediastinal non-seminomatous primary tumour, progressive disease before high-dose chemotherapy, disease refractory to conventional-dose cisplatin, hCG >1000 IU l -1 . Using conventional cisplatin-based salvage chemotherapy Gerl et al (1995), Josefsen et al (1993) and Motzer et al (1991) identified a complete response to induction treatment as an additional positive independent prognostic factor which is confirmed in the present study.…”

Section: Salvage Treatmentsupporting

confidence: 77%

“…This percentage is comparable to other reports (Motzer et al, 1991;Horwich et al, 1993;Josefsen et al, 1993;Gerl et al, 1995). Although about 70% of the cases of progression occurred within the first year after the start of induction treatment, reactivation of the disease was observed in 23% patients after 2 years.…”

Section: Progressive Germ Cell Malignancysupporting

confidence: 75%

“…Few series have been published dealing with prognostic factors in patients with recurrent malignant germ cell tumours, and most are based on the experience of specialized institutions (Motzer et al, 1991;Horwich et al, 1993;Josefsen et al, 1993;Ledermann et al, 1994;Gerl et al, 1995). The aim of the present study was to establish prognostic factors based on a series of patients presenting to unselected oncological units.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours

Fosså

Stenning²,

Gerl³

et al. 1999

Br J Cancer

Self Cite

132

View full text Add to dashboard Cite

The aim of this study was to define prognostic parameters for survival in patients with malignant germ cell tumours progressing after platinum-based induction chemotherapy with or without surgery. A total of 164 progressing patients (testicular: 83%, extragonadal: 17%) were identified out of 795 patients treated with platinum-based induction chemotherapy for metastatic germ cell malignancy with or without surgery. ‘Progressive disease’ included patients who had progressed after a previous partial or complete remission as well as patients who failed primary therapy. Salvage chemotherapy consisted of ‘conventional’ platinum-based chemotherapy. Prognostic factors for survival were assessed by uni- and multivariate analyses. The resulting prognostic model was validated in an independent data set of 66 similar patients. For all 164 patients the median time from start of induction chemotherapy to progression was 10 months (range: 0–99). Thirty-eight (23%) patients relapsed after 2 years. The 5-year survival rate for all progressing patients was 30% (95% confidence interval 23–38%). In the univariate analysis the following factors most importantly predicted a poor prognosis: progression-free interval < 2 years: initial poor prognosis category (MRC criteria), < CR to induction chemotherapy, initial treatment early in the 1980s and treatment given at a ‘small’ centre. Three prognostic factors remained in the multivariate analysis: progression-free interval, response to induction treatment and the level of serum human chronic gonadotrophin (hCG) and alpha fetoprotein (AFP) at relapse. One hundred and twenty-four patients could be classified on the basis of these characteristics, Those patients with progression-free interval < 2 years, < CR to induction chemotherapy and high markers at relapse (AFP >100 kU l −1 or hCG >100 IU l −1 ) formed a poor prognosis group of 30 patients, none of whom survived after 3 years. Patients with at most two of these three risk factors formed a good prognosis group of 94 patients (76%) with a 47% (37–56%) 5-year survival. Thirty-eight patients from the good prognosis group with a progression-free interval of >2 years had a 2-year survival of 74% (60–88%) and 5-year survival of 61%. These prognostic groups were validated in the independent data set, in which 5-year survival rates in the good and poor risk groups were 51% and 0% respectively. One-third of patients progressing during or after platinum-based induction chemotherapy for metastatic germ cell malignancy may be cured by repeated ‘conventional’ platinum-based chemotherapy. Good prognosis parameters are: progression-free interval of > 2 years, CR to induction treatment and normal or low serum markers at relapse (hCG < 100 IU l −1 and AFP < 100 kU l −1 ). The results of high-dose salvage chemotherapy should be interpreted on the background of these prognostic factors. © 1999 Cancer Research Campaign

show abstract

Section: Salvage Treatmentsupporting

confidence: 77%

Section: Progressive Germ Cell Malignancysupporting

confidence: 75%

mentioning

confidence: 99%

See 1 more Smart Citation

Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours

Fosså

Stenning²,

Gerl³

et al. 1999

Br J Cancer

Self Cite

132

View full text Add to dashboard Cite

show abstract

“…A recent population-based study from Scotland also could not confirm the prognostic relevance of age (Hatton et al, 1995). In contrast, we found that age was a prognostic factor in patients with recurrent or refractory germ cell tumours undergoing salvage treatment (Gerl et al, 1995b).…”

Section: Prognostic Factorscontrasting

confidence: 54%

“…Some patients underwent multiple surgical interventions (Gerl et al, 1994b (Gerl et al, 1995a). Few patients with chemorefractory but localised disease that was deemed resectable were also alloted to post-chemotherapy surgery (Gerl et al, 1995b). The type and number of surgical interventions are summarised in Table II. Evaluation of response Complete response 1 (CR1) was defined as total disappearance of clinical, radiological and biochemical signs of disease for at least 4 weeks.…”

Section: Methodsmentioning

confidence: 99%

Advances in the management of metastatic non-seminomatous germ cell tumours during the cisplatin era: a single-institution experience

Gerl¹,

Clemm²,

Schmeller³

et al. 1996

Br J Cancer

Self Cite

View full text Add to dashboard Cite

Summary Long-term outcome was reviewed in 266 consecutive patients with metastatic non-seminomatous germ cell tumours treated at a single institution. The overall 3 year survival was 77%, and 3 year progressionfree survival was 71 %. Multivariate analysis identified the following clinical features as independent prognostic factors: the presence of liver, bone or brain metastasis, serum human chorionic gonadotropin k 10000 U 1 -1 and/or alpha-fetoprotein > 1000 ng ml-1, a mediastinal mass> 5 cm and the presence of 20 or more lung metastases. Age was not of prognostic significance. Patients without any of the above poor-risk factors had a 3-year survival of 91 % regardless of etoposide-or vinblastine-containing chemotherapy compared with 61 % for the remaining patients. However, etoposide-containing protocols led to significantly improved survival in patients with at least one poor risk factor. After 612 patient-years of observation no case of secondary leukaemia was observed among 119 surviving patients who had received etoposide as part of their treatment. With a median follow-up of 93 months, five patients developed a second germ cell tumour, two patients nongerm cell malignancies. Fourteen patients relapsed after a disease-free interval of more than 2 years, and nine patients died more than 5 years after commencement of treatment underscoring the need to report long-term results. There is some evidence that cumulative experience translates into improved survival and cure rates for patients with poor-risk metastatic disease.

show abstract

Cisplatin-based chemotherapy of primary extragonadal germ cell tumors: A single institution experience

Gerl

Clemm²,

Lamerz

et al. 1996

Cancer

View full text Add to dashboard Cite

Mediastinal and retroperitoneal nonseminomas have distinct clinical features. As in other series, clinical outcome is somewhat inferior for mediastinal nonseminomas compared with retroperitoneal nonseminomas. Regardless of the site of presentation, the vast majority of patients with extragonadal seminomas can expect cure. It remains controversial, however, whether retroperitoneal germ cell tumors are metastatic from a primary testicular germ cell tumor.

show abstract

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

Cited by 49 publications

References 30 publications

Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours

Prognostic factors in patients progressing after cisplatin-based chemotherapy for malignant non-seminomatous germ cell tumours

Advances in the management of metastatic non-seminomatous germ cell tumours during the cisplatin era: a single-institution experience

Cisplatin-based chemotherapy of primary extragonadal germ cell tumors: A single institution experience

Contact Info

Product

Resources

About