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DOI: 10.1055/a-2364-4213
Konventionell dosierte oder Hochdosis-Salvagetherapie bei rezidivierten Hodentumoren
Conventional versus high-dose salvage chemotherapy for relapsed testicular germ cell tumours
Zusammenfassung
Patienten mit metastasierter Keimzelltumorerkrankung haben seit Einführung Cisplatin-basierter Kombinationschemotherapieregime sehr gute Heilungsaussichten von >80%. Trotzdem erleiden knapp 30% der Patienten nach der Erstlinientherapie ein Rezidiv ihrer Erkrankung. Knapp die Hälfte dieser Patienten kann durch platin-basierte Salvagechemotherapie und ggf. anschließende Residualtumorresektion geheilt werden. Für die Salvagechemotherapie kommen entweder erneut konventionell dosierte Cisplatin-basierte Kombinationstherapien oder eine Hochdosischemotherapie mit Carboplatin und Etoposid und nachfolgender autologer Stammzelltransplantation zum Einsatz. Bislang gibt es keine höhergradige Evidenz aus randomisierten Studien, die einen Vorteil für die Hochdosischemotherapie zeigen konnte, jedoch beschreibt eine internationale retrospektive Registerstudie mit knapp 1600 Patienten ein ca. 15% höheres Gesamtüberleben für Patienten, die dosisintensiviert behandelt wurden. Im vorliegenden Übersichtsartikel wird die Datenlage zu den unterschiedlichen Salvagetherapiestrategien zusammengefasst und unter Einbezug aktueller Leitlinienempfehlungen diskutiert.
Abstract
Since the introduction of cisplatin-based combination chemotherapy, patients with metastatic germ cell tumours achieve very high cure rates of >80%. Nevertheless, about 30% of patients relapse despite guideline-endorsed first-line treatment. Of these, again about 50% of patients can still achieve cure with platinum-based salvage chemotherapy and eventually post-chemotherapy residual mass resection.
Salvage chemotherapy generally involves platinum-based combination chemotherapy, either as conventional dose cisplatin-based combinations again or as high-dose chemotherapy with subsequent autologous stem cell transplantation.
To date, high level evidence from randomised trials supporting the use of salvage high-dose chemotherapy for all patients relapsing after first-line treatment remains lacking, but a large international retrospective registry study had shown a 15% overall survival benefit for patients undergoing salvage high-dose chemotherapy.
In this article, we summarise the available literature on the different salvage treatment approaches and discuss these in the light of current treatment guideline recommendations for the management of testicular cancer.
Keywords
Testicular cancer - germ cell tumour - relapse - salvage chemotherapy - high-dose chemotherapyPublikationsverlauf
Eingereicht: 21. Mai 2024
Angenommen nach Revision: 08. Juli 2024
Artikel online veröffentlicht:
06. August 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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