Cyclic chemotherapy with cyclophosphamide, doxorubicin, and cisplatin plus vinblastine and bleomycin in advanced germinal tumors. Results with 100 patients

Logothetis, Christopher J.; Samuels, Melvin L.; Selig, D; Ogden, Sheryl; Dexeus, Francisco H.; Swanson, David A.; Johnson, Douglas E.; Eschenbach, Andrew von

doi:10.1016/0002-9343(86)90255-x

Cited by 104 publications

(48 citation statements)

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“…These data suggest osseus metastases may not confer such an adverse prognosis as is commonly believed (Bosl et al, 1986;Einhorn et al, 1985;Logothetis et al, 1986;Williams et al, 1987;Bajorin et al, 1988).…”

Section: Resultsmentioning

confidence: 62%

“…This apparent change in metastatic pattern from the older series may reflect radiotherapy-induced modification of seminoma natural history with retroperitoneal disease controlled but late recurrence occurring in other sites, including bone, and leading to subsequent death. Now, long term remission and cure in non-seminomatous GCT is common due to widespread use of cisplatin-based combination chemotherapy (Bosl et al, 1986;Logothetis et al, 1986;Newlands et al, 1986;Williams et al, 1987). Such chemotherapy has also proved effective first-line management for bulky metastatic seminoma and as salvage treatment for seminoma patients relapsing after radiotherapy (Loehrer et al, 1987;Stanton et al, 1985).…”

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confidence: 99%

“…Bone involvement at presentation with GCT is an adverse prognostic feature equivalent to liver or central nervous system (CNS) metastases according to most authors (Bosl et al, 1986;Logothetis et al, 1986;Williams et al, 1987 GCT in recent textbooks of Oncology or Urology are brief (Barzell & Whitmore, 1979;Einhorn et al, 1985;Garnick et al, 1982;Pugh, 1982) and only anecdotal reports of bony metastases from testicular and extragonadal GCT exist (Collis & Eckert, 1985;Gay et al, 1985;Hermann, 1986;Martini et al, 1974;Richardson et al, 1981;Sagalowsky et al, 1986), mostly referring to seminoma. The incidence of clinically detectable osseous metastases, responsiveness of such metastases to currently available chemotherapy, and long term prognosis in patients with bone involvement from GCT remain poorly defined.…”

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confidence: 99%

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Bone disease in testicular and extragonadal germ cell tumours

Hitchins

Philip²,

Wignall³

et al. 1988

Br J Cancer

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Summary Of 297 patients with metastatic testicular and extragonadal germ cell tumours (GCT), bone involvement was detected clinically in 3% (7/251) of those at first presentation and in 9% (4/46) of relapsed cases. This difference was not statistically significant (95% confidence limits -2%; +14%). Concurrent systemic metastases, commonly involving lung (7/11 cases) and para-aortic lymph nodes (6/11), were present in all patients with bone disease. All affected patients had localized bone pain and lumbar spine was the most frequent site involved (9/11). Spinal cord compression occurred in two patients while a third developed progressive vertebral collapse after chemotherapy and required extensive surgical reconstruction. At median follow-up of 4 years, survival among patients presenting with bone disease (6/7) was similar to overall survival in the whole group (84%) and appeared better than in those with liver (18/26, 69%) or central nervous system (6/9) metastases at presentation.Back pain in metastatic germ cell tumours is often due to retroperitoneal lymphadenopathy but lumbar spine osseus metastases must be recognized early if severe potential complications, such as spinal cord compression, are to be avoided. In this series, bone metastases were not seen in the absence of widespread systemic disease suggesting all solitary bony lesions in GCT patients should be biopsied.Bone is an uncommon site for metastases from testicular and extragonadal germ cell tumours (GCT) (Pugh, 1982). The large study of Dixon & Moore (1953) described metastases seen in 1,000 testicular GCT affecting United States servicemen to January 1948. Autopsy-proven bony metastases were seen in 21% of GCT containing mainly embryonal carcinoma and 36% of those with predominant teratoma but not in other histologic types. Bones of the trunk were involved most commonly. Mostofi (1973) reported 6,000 testicular tumours on the American Registry of Pathology over 25 years and noted a similar distribution of osseus metastases. These pathologic series largely predated the considerable recent advances in treatment of GCT and in methods for demonstrating bone metastases radiologically during life. With optimal radiotherapeutic techniques in seminoma, very high overall cure rates have been possible for over 20 years (Ball et al., 1982;Duncan & Munro, 1987;Hay et al., 1984). Isotope bone scans, computerized tomography (CT) and, most recently, magnetic resonance imaging (MRI) have provided much more sensitive means for diagnosing bone involvement than plain radiographs.Johnson et al. (1976) reported an autopsy series of testicular GCT where 47% of bony metastases were seen among seminoma patients, significantly more than in all other histologic subtypes. Bredael et al. (1982) showed similar results in another postmortem series. This apparent change in metastatic pattern from the older series may reflect radiotherapy-induced modification of seminoma natural history with retroperitoneal disease controlled but late recurrence occurring in other sites, incl...

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Section: Resultsmentioning

confidence: 62%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Bone disease in testicular and extragonadal germ cell tumours

Hitchins

Philip²,

Wignall³

et al. 1988

Br J Cancer

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show abstract

“…Planned initial 'debulking' surgery proved to be of no value in one randomised study (Javadpour et al, 1982), although surgery performed after three cycles of treatment in responding patients has perhaps contributed to the excellent results in one nonrandomised series of patients with advanced disease (Pizzacaro et al, 1985). A similar treatment policy to that described in this paper was pursued by Logothetis et al (1986) in four patients. In the light of our experience we would advocate that teratoma patients with very large masses (particularly abdominal) but small volume disease elsewhere be considered for surgical removal of the largest masses in the specific situation of attentuation of chemotherapy response as judged by serial marker estimations and CT scanning.…”

Section: Discussionmentioning

confidence: 80%

“…In the light of our experience we would advocate that teratoma patients with very large masses (particularly abdominal) but small volume disease elsewhere be considered for surgical removal of the largest masses in the specific situation of attentuation of chemotherapy response as judged by serial marker estimations and CT scanning. However this must be carefully considered as inevitably not all patients will have a successful outcome (Logothetis et al, 1986) and surgical intervention might delay the introduction of alternative (perhaps more effective) chemotherapy.…”

Section: Discussionmentioning

confidence: 99%