High-dose chemotherapy as initial salvage chemotherapy in patients with relapsed testicular cancer

Purpose: To assess the role of high-dose chemotherapy as initial salvage ch emotherapy in patients with relapsed testicular cancer. Patients and Methods: From August 1992 to April 1998, 65 patients with test icular cancer were treated with high-dose carboplatin and etoposide followe d by peripheral-blood stem-cell transplantation or autologous bone marrow t ransplantation rescue as initial salvage chemotherapy at Indiana University . An identical course was given after hematopoietic reconstitution. Postche motherapy resection of residual disease was performed in selected patients with incomplete radiographic response associated with normalization of mark ers. The median follow-up was 39 months [range, 16 to 91 months). Results: Thirty-seven (57%) of the 65 patients are continuously disease-fre e. Three additional patients are disease-free with subsequent surgery. High -dose chemotherapy was associated with significant morbidity but no treatme nt-related mortality. Conclusion: High-dose chemotherapy as initial salvage chemotherapy achieved impressive long-term survival with acceptable toxicity in patients with re lapsed testicular cancer. J Clin Oncol 18:3346-3351. (C) 2000 by American S ociety of Clinical Oncology.