While the majority of patients with testicular cancer are curable following standard therapy, some “high-risk” patients have a poor prognosis and a cancer-free survival of approximately 50-60%. Previous clinical studies have demonstrated that patients with recurrent testicular cancer can be cured with high-dose chemotherapy and autologous bone marrow or blood stem cell support. Because of the effectiveness of high-dose chemotherapy in patients with recurrent cancer, many physicians believe that the use of high-dose chemotherapy with autologous stem cell support as part of the initial treatment program for patients with “high-risk” testicular cancer will improve cure rates.
Physicians from centers specializing in the treatment of testicular cancers in Germany and Indiana performed an analysis comparing the outcomes of patients treated with high-dose chemotherapy and stem cell transplant as part of initial therapy to patients treated with conventional chemotherapy. The majority of patients that failed conventional chemotherapy were able to receive high-dose chemotherapy at the time of cancer recurrence. The results of this analysis were reported in the November issue of the
Journal of Clinical Oncology.
In this retrospective analysis the doctors found that the use of early high-dose chemotherapy resulted in a 2-year, 75% cancer-free survival. Patients treated with conventional chemotherapy utilizing high-dose chemotherapy only at the time of cancer recurrence experienced a cancer-free survival of only 59%.
High-dose chemotherapy was associated with greater side effects; 4.1% of patients died from complications of treatment compared to 2.7% of patients treated with conventional chemotherapy. Initial treatment with high-dose chemotherapy and autologous stem cell transplant appears to cure more patients than administering conventional chemotherapy followed by high-dose chemotherapy only at the time of cancer recurrence. Patients with testicular cancer should discuss the relative risks and benefits of high-dose chemotherapy and autologous stem cell transplant with their physician. (
Journal of Clinical Oncology, Vol 17, No 11, pp 3450-3456, 1999)
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