High-dose chemotherapy as the first salvage treatment of relapsed germ cell tumors has been less extensively investigated.115 Unlike patients with multiply recurrent germ cell cancer, patients in first relapse can expect a 50% likelihood of complete remission and a 25% chance of long-term freedom from disease with conventional-dose salvage chemotherapy. The goal, therefore, is not the salvage of otherwise doomed patients but improvement in the efficacy of salvage therapy. Demonstrating efficacy in this setting is thus more challenging.
The typical approach employed to date has included one or two cycles of conventional-dose chemotherapy followed by one or two courses of high-dose chemotherapy with carboplatin/etoposide, with or without an alkylating agent.116119 Less commonly, high-dose therapy has been administered alone, without a prior conventional-dose salvage regimen.120,121 Investigators at Indiana University
Table 16-2. PROGNOSTIC SCORING FOR OVERALL SURVIVAL AND FAILURE-FREE SURVIVAL OF PATIENTS RECEIVING HIGH-DOSE CHEMOTHERAPY FOR RELAPSED OR REFRACTORY GERM CELL TUMORS
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