Abstract
Among patients suffering from nonseminomatous germ-cell tumor, with a poor prognosis, a subset underwent respiratory failure and died very early in the course of their treatment. Between 1982 and 1989, 11 out of 56 such patients (20%) died within the first 5 weeks of chemotherapy. The clinical, radiological, biological and infectious characteristics of these patients were analyzed. Nine patients had extensive pulmonary metastases and the 2 others presented a bulky mediastinal mass with pleural effusion. All patients experienced acute respiratory distress during chemotherapy and underwent mechanical ventilation. All patients were febrile, and septicemia was documented in 7 cases. WHO grade 4 and grade 1–2 renal toxicities occurred in 3 and 4 patients respectively. There was no tumor lysis syndrome. All patients died within 35 days from the start of therapy; 4 were autopsied. These 11 patients represent a clinical entity, having what we called super-high-risk germ cell tumors. Early death is related to pulmonary distress within the first 5 weeks of therapy. The origin of the pulmonary distress is multifactorial: bulky disease of the chest, infection, and interstitial fibrosis. Immediate full-dose standard chemotherapy in association with intensive supportive care is recommended in the management of these patients.
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References
Bendit JO, Farber HW, Wright J, Karavad A (1988) Pulmonary hemorrhage with diffuse alveolar infiltrates in men with high-volume choriocarcinoma. Ann Intern Med 109:674–675
Birch R, Williams SD, Cone A, et al (1986) Prognostic factor for favorable outcome in disseminated germ cell tumors. J Clin Oncol 4:400–407
Bosl GJ, Geller NL, Cirrincione C, et al (1983) Multivariate analysis of prognosis variables in patients with metastatic testicular cancer. Cancer 43:3403–3407
Bosl GJ, Gluckman R, Geller NL, et al (1986) VAB6: an effective chemotherapy regimen for patients with germ-cell tumors. J Clin Oncol 4:1493–1499
Bosl GJ, Geller NL, Bajorin D, et al (1988) A randomized trial with etoposide plus cisplatin versus vinblastine plus bleomycin plus cisplatin plus cyclophosphamide plus dactinomycin in patients with good prognosis germ cell tumors. J Clin Oncol 6:1231–1238
Chong C, Logothetis C, Dexeus F, Sella A (1988) Response directed chemotherapy for high beta HCG producing non-seminomatous germ cell tumours (abstract). Proc Am Assoc Cancer Res 29:204
Droz JP, Ghosn M, Rey A, et al (1987) Treatment of patients with non-seminomatous germ cell tumors with modulated chemotherapy based on prognostic factors. Preliminary results of the good prognosis group (abstract). Proceedings ECCO 5:181
Droz JP, Kramar A, Ghosn M, et al (1988) Prognostic factors in advanced non seminomatous testicular cancer: a multivariate logistic regression analysis. Cancer 62:562–568
Droz JP, Pico JL, Biron P, et al (1992) No evidence of a benefit of early intensified chemotherapy (HDCT) with autologous bone marrow transplantation (ABUT) in first line treatment of poor risk non seminomatous germ cell tumors (NSGCT): preliminary results of a randomized trial (abstract). Proc Am Soc Clin Oncol 11:197
Droz JP, Pico JL, Ghosn M, et al (1992) Phase II trial of early intensive chemotherapy with autologous bone marrow transplantation in the treatment of poor prognosis non seminomatous germ cell tumors. Bull Cancer 79:497–507
Einhorn LH (1990) Treatment of testicular cancer: a new and improved model. J Clin Oncol 8:1777–1781
Kattan J, Culine S, Tavakoli-Razavi T, Kramar A, Droz JP (1994) Acute tumor lysis syndrome in poor-risk germ cell tumors: does-it exist? Support Care Cancer 2:128–131
Le Gall, JR, Loirat P, Alperovith A, et al (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977
Loehrer PJ, Elson P, Johnson DH, et al (1991) A randomized trial of cisplatin plus etoposide with or without bleomycin in favorable prognosis disseminated germ cell tumors: an ECOG study (abstract). Proc Ann Soc Clin Oncol 10:169
Logothetis CJ (1984) Choriocarcinoma syndrome. Cancer Bull 36:118–120
Logothetis C, Samuels ML, Selig DE, et al (1986) Cyclic chemotherapy with cyclophosphamide, doxorubicin and cisplatin plus vinblastine and bleomycin in advanced germinal tumors. Results with 100 patients. Am J Med 81:219–222
Maki DG, Weise CA, Sarafin HW (1977) A semiquantitative culture method for identifying intravenous-catheter-veloted infection. N Engl J Med 296:1305–1309
Medical Research Council Working Party on Testicular Tumour (1985) Prognostic factors in advanced non seminomatous germ cell testicular tumours: results of a multicentric study Lancet I:8–15
Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214
Mostofi FK, Sobin LH (1977) Histological typing of germ tumors, no 16. World Health Organization, Geneva
Motzer RJ, Bosl GJ (1987) Hemorrhage: a complication of metastatic testicular choriocarcinoma. Urology 30:119–121
Newlands ES, Bagshawe KD, Begent RHJ, et al (1986) Current optimum management of anaplastic germ cell tumours of the testis and other sites. Br J Urol 58:307–314
Ozols RF, Ihde DC, Linehan WM, et al (1988) A randomized trial of standard chemotherapy versus a high-dose chemotherapy regimen in the treatment of poor prognosis non-seminomatous germ-cell tumors. J Clin Oncol 6:1031–1041
Phipps J, Madden F, Shaw P (1985) Fatal respiratory failure following chemotherapy of advanced teratoma — a pulmonary tumour lysis syndrome? Lancet I:1505
Zerhouni EA (1984) Principles and techniques in chest computed tomography. In: Nordich DP, Zerhouni EA, Seegelmann SS (eds) Computed tomography of the thorax. Raven Press, New York, pp 1–18
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Moran-Ribon, A., Droz, JP., Kattan, J. et al. Super-high-risk germ-cell tumors: a clinical entity. Support Care Cancer 2, 253–258 (1994). https://doi.org/10.1007/BF00365732
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DOI: https://doi.org/10.1007/BF00365732