COMBINATION OF HIGH-DOSE CHEMOTHERAPY, AUTOLOGOUS BONE MARROW PERIPHERAL BLOOD STEM-CELL TRANSPLANTATION, AND THORACOSCOPIC SURGERY IN REFRACTORY NONGESTATIONAL CHORIOCARCINOMA OF A 45XO/46XY FEMALE - A CASE-REPORT/

A 39-year-old woman having a pure gonadal choriocarcinoma with lung me tastasis was referred to our hospital after hysterectomy and bilateral salpingo-oophorectomy. She was found to have a 45XO/46XY karyotype an d gonadal dysgenesis, The patient's serum beta-hCG was normalized afte r six courses of chemotherapy with cisplatin and etoposide of conventi onal dose (100 mg/m(2), 100 mg/m(2) x 3 days), but began to fluctuate, Thoracoscopic resection of a remaining pleural lesion was negative fo r malignancy, However, the disease relapsed as multiple metastatic nod ules in bilateral lung fields and the mediastinum. After one course of priming chemotherapy with conventional dose (1 g/m(2) cyclophosphamid e, 400 mg/m(2) carboplatin, and 500 mg/m(2) etoposide), high-dose chem otherapy with a total dose of 1500 mg/m(2) carboplatin, 1200 mg/m(2) e toposide, and 5 g/m(2) ifosfamide followed by autologous bone marrow t ransplantation and peripheral stem cell support was given, Thoracoscop ic surgery was performed to resect two residual solitary metastatic lu ng lesions. With these salvage treatments, the patient obtained comple te remission and remained disease free at last follow-up (17 months), Our result suggests that high-dose chemotherapy may be effective in ch emosensitive nongestational choriocarcinoma when first chemotherapy ha s failed. (C) 1997 Academic Press.