High-dose chemotherapy in germ cell tumours: a large single centre experience

High-dose chemotherapy (HDCT) has evolved as a strategy to improve the trea tment outcome in patients with relapsed and/or refractory germ cell tumours . Between August 1989 and September 1995, 150 consecutive patients with rel apsed and/or refractory germ cell tumours were treated with conventional-do se salvage chemotherapy followed by one cycle of HDCT with carboplatin 1500 -2000 mg/m(2), etoposide 1200-2400mg/m(2) and ifosfamide 0-10 g/m(2) and we re retrospectively analysed. With a median follow-up time of 55 months (ran ge 21-88 months) 51/150 (34%) patients are alive and disease fi ee. The pro jected event-free and overall survival are 29% (confidence interval 22-37%) and 39% (confidence interval 31-47%) respectively. The relevance of progno stic variables for long-term survival after HDCT were prospectively confirm ed. Persisting toxicities occurred in approximately one third of the long-t erm survivors. Treatment intensification with HDCT resulted in a significan t proportion of long-term survivors in patients with relapsed and/or refrac tory germ cell tumours. Trials to prospectively evaluate HDCT as an early i ntervention in these patients seem justified. (C) 1998 Elsevier Science Ltd . All rights reserved.