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Questions and Answers
What is the primary consensus regarding the use of high-dose chemotherapy (HDC) in first-line treatment for high-risk patients with germ cell tumors?
What chemotherapy regimen has a long-term event-free survival (EFS) rate of 90% for advanced-disease, good-risk patients?
Which factors affect long-term event-free survival rates in patients undergoing first relapse treatment for germ cell tumors?
What technique has been improved in recent studies to support high-dose chemotherapy for relapse patients?
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What is the reported event-free survival (EFS) rate for patients with second relapse who undergo tandem high-dose chemotherapy?
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What is the main salvage regimen for treating germ cell tumor patients who have relapsed and is based on ifosfamide and cisplatin?
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Which method was pioneered for the use of tandem high-dose chemotherapy cycles in treating refractory germ cell tumors?
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What is the typical prognosis for patients classified as poor-risk using the International Germ Cell Consensus Classification (IGCCC)?
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Study Notes
Germ Cell Tumors (GCT)
- Most common malignancy in young men (15-35 years old).
- Standard first-line treatment with cisplatin-based chemotherapy achieves cure rates of 70-80% for metastatic disease.
- Standard regimen bleomycin/etoposide/cisplatin (BEP) results in 90% long-term event-free survival (EFS) rates for advanced-disease, good-risk patients.
- EFS rates decrease to 80% for intermediate-risk patients and 50% for poor-risk patients, according to the International Germ Cell Consensus Classification (IGCCC).
- First relapse patients with standard salvage regimens have 50-60% CR rates and 20-30% long-term EFS.
- Second relapse patients are largely incurable.
High-dose Chemotherapy (HDC) for Refractory/Relapsed NSGCT
- Tandem high-dose cycles of carboplatin/etoposide with autologous hematopoietic progenitor cell support (AHPCS) is used for salvage therapy.
- Nichols et al. pioneered this approach in the 1980s.
- Studies show long-term EFS rates as high as 15% for second-relapse patients and 38% for first-relapse patients.
- Improvements in PBPC techniques and supportive measures have led to higher doses and better results.
- Einhorn et al. found 68% EFS at a 48-month median follow-up in a recent study.
- Outcome is similar in patients with seminoma and non-seminoma histologies.
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Description
This quiz focuses on germ cell tumors (GCT), their prevalence in young men, and the standard treatments including chemotherapy regimens. It highlights the effectiveness of cisplatin-based therapy and the use of high-dose chemotherapy for relapsed cases. Test your knowledge on GCT statistics, treatment outcomes, and clinical classifications.
