[PMID]: | 28463397 |
[Au] Autor: | Murray MJ; Bailey S; Heinemann K; Mann J; Göbel UK; Saran F; Hale JP; Calaminus G; Nicholson JC |
[Ad] Endereço: | Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom. |
[Ti] Título: | Treatment and outcomes of UK and German patients with relapsed intracranial germ cell tumors following uniform first-line therapy. |
[So] Source: | Int J Cancer;141(3):621-635, 2017 08 01. |
[Is] ISSN: | 1097-0215 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | We aimed to retrospectively assess treatments/outcomes, including the value of high-dose-chemotherapy and autologous-stem-cell-rescue (HDC + AuSCR) and re-irradiation, in a large, European patient-cohort with relapsed intracranial germ-cell-tumors (GCTs) receiving uniform first-line therapy, including radiotherapy as standard-of-care. Fifty-eight UK/German patients (48 male/10 female) with relapsed intracranial-GCTs [13 germinoma/45 non-germinomatous GCT (NGGCT)] treated 1996-2010 as per the SIOP-CNS-GCT-96 protocol were evaluated. For germinoma, six patients relapsed with germinoma and five with NGGCT (one palliative, one teratoma patient excluded). Five-year overall-survival (OS) for the whole-group (n = 11) was 55%. Four of six germinoma relapses and two of five relapsing with NGGCT were salvaged; patients were salvaged with either standard-dose-chemotherapy (SDC) and re-irradiation or HDC + AuSCR with/without re-irradiation. Of 45 relapsed NGGCT patients, 13 were excluded (three non-protocol adherence, five teratoma, five palliation). Five-year OS for the remaining 32 relapsed malignant NGGCT patients treated with curative intent was 9% (95%CI: 2-26%). By treatment received, 5-year OS for the 10 patients receiving SDC and 22 patients treated with intention for HDC + AuSCR was 0% (0-0%) and 14% (3-36%), respectively. The three relapsed NGGCT survivors had raised HCG markers alone; two received additional irradiation. Patients with relapsed germinoma had better 5-year OS than those with relapsed NGGCT (55 vs. 9%; p = 0.007). Patients with relapsed germinoma were salvaged both with SDC and re-irradiation or HDC + AuSCR with/without re-irradiation; both represent valid treatment options. Outcomes for malignant relapse following initial diagnosis of NGGCT were exceptionally poor; the few survivors received thiotepa-based HDC + AuSCR, which is a treatment option at first malignant relapse for such patients, with further surgery/irradiation where feasible. |
[Mh] Termos MeSH primário: |
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico Neoplasias Encefálicas/terapia Germinoma/terapia Recidiva Local de Neoplasia/terapia Neoplasias Embrionárias de Células Germinativas/terapia
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[Mh] Termos MeSH secundário: |
Adolescente Adulto Neoplasias Encefálicas/patologia Criança Pré-Escolar Terapia Combinada Feminino Seguimentos Alemanha Germinoma/patologia Seres Humanos Lactente Masculino Recidiva Local de Neoplasia/patologia Estadiamento de Neoplasias Neoplasias Embrionárias de Células Germinativas/patologia Prognóstico Estudos Retrospectivos Taxa de Sobrevida Reino Unido Adulto Jovem
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[Pt] Tipo de publicação: | JOURNAL ARTICLE |
[Em] Mês de entrada: | 1710 |
[Cu] Atualização por classe: | 180208 |
[Lr] Data última revisão:
| 180208 |
[Sb] Subgrupo de revista: | IM |
[Da] Data de entrada para processamento: | 170503 |
[St] Status: | MEDLINE |
[do] DOI: | 10.1002/ijc.30755 |
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