Extragonadal germ cell tumours - results from a single centre

Konference: 2009 34st Congress ESMO a 15th Congress ECCO - účast ČR

Kategorie: Genitourinární nádory

Téma: Poster session II: Genitourinary malignancies - Other

Číslo abstraktu: P-7179

Autoři: Doc. MUDr. Tomáš Büchler, Ph.D.; MUDr. Martin Foldyna; MUDr. Jana Nepomucká, CSc.; MUDr. Zuzana Donátová; MUDr. Martin Kupec; prof. MUDr. Jitka Abrahámová, DrSc.

Background: Primary extragonadal germ cell tumours (EGTs) are an uncommon malignancy accounting for 2–4% of all germ cell neoplasms in adult males. Their prognosis is worse than that for testicular germ cell tumours because of their relative chemoresistance and frequent presentation with widely disseminated metastases.

Patients and Methods: We identified 20 male patients (pts) with unequivocal diagnosis of mediastinal or retroperitoneal EGT who were treated at the Thomayer University Hospital between 1994 and 2008. The median age was 37 years (range: 19–52 years). Information on baseline characteristics, treatments, and outcome were obtained retrospectively from medical records. Radical surgical removal of the tumour was initially attempted in 4/20 patients, and was unsuccessful in all cases. All 20 pts received first-line platinum-based chemotherapy – 19/20 with bleomycin/etoposide/cisplatin (BEP) and 1/20 with cisplatin/vinblastin/etoposide (PVB). Four of 20 pts received additional chemotherapy regimens(s) as a part of the first-line treatment. Fifteen of 20 patients were treated with second-line chemotherapy including 4/20 pts who received high-dose chemotherapy.

Results: Only 2/20 pts (10%) achieved complete response (CR) after the first-line chemotherapy. Five of 20 pts (25%) had marker (M)-negative partial response (PR), 11 pts (55%) M-positive PR, and 2 pts died of disease progression during the first-line chemotherapy. Median overall survival (OS) of our pts is 24.8 months (4.5–98.1 months), with 6/20 (30%) patients surviving long-term, all off-treatment and disease-free. Of the analysed variables (age, constitutional symptoms, mediastinal versus retroperitoneal primary, seminoma versus nonseminoma, LDH elevation, S stage, metastatic site) only histology of seminoma was associated with favourable prognosis (p = 0.036). Significantly longer OS was achieved by patients who had negative positron emission tomography (PET) findings (median OS 50.7 versus 18.5 months, p = 0.004) and who had tumour marker normalisation (median OS 36.0 versus 13.3 months, p = 0.005) after therapy.

Conclusions: Widespread metastatic disease is commonly present in EGT patients at diagnosis. Complete responses are seldom achieved by first-line chemotherapy but long-term survival is achievable after combined-modality treatment. Negative PET findings after chemotherapy predict better OS although relapses did occur even after a negative PET study.

Publikováno v: European Journal of Cancer Supplements, Vol 7 No 2, September 2009, Page 447

Datum přednesení příspěvku: 21. 9. 2009