Treatment of epidural spinal cord involvement from germ cell tumors with chemotherapy Journal Article


Authors: Grommes, C.; Bosl, G. J.; Deangelis, L. M.
Article Title: Treatment of epidural spinal cord involvement from germ cell tumors with chemotherapy
Abstract: BACKGROUND: Germ cell tumors (GCTs) are chemosensitive, and epidural spinal cord compression (ESCC) from GCT may be amenable to treatment with chemotherapy (CT) only. This retrospective study compares the clinical outcome of GCT patients with ESCC treated with CT or radiotherapy (RT) + CT. METHODS: All patients with a histologic diagnosis of GCT from 1984 to 2009 were included in this study. Patients with ESCC were identified. Age, clinical features, histology, treatment, and outcome were analyzed. RESULTS: The authors identified 1734 patients with GCT, of whom 29 (1.7%) had ESCC. The median age of these 29 patients was 32 years. The ESCC was treated with CT only in 16, RT + CT in 11, and 2 patients received palliative care only. The ESCC was more extensive in the RT + CT than the CT group. Patients who received RT + CT had a higher proportion of failed prior CT regimens, a higher percentage of nonseminomatous GCT, T-spine involvement, multilevel epidural disease, and bony vertebral metastases. Median overall survival after diagnosis of ESCC was not reached for those treated with CT alone versus 15 months for those receiving RT + CT (P =.02). There was also a significant difference in survival in patients receiving first-line therapy (n = 15), where median overall survival was not reached in the CT group (n = 11), compared with 22 months in the RT group (n = 4) (P =.04). CONCLUSIONS: GCTs rarely involve the epidural compartment. Patients with ESCC who are likely to have chemosensitive disease can receive CT alone as definitive treatment. Cancer 2011;117:1911-1916. © 2010 American Cancer Society.
Keywords: adolescent; adult; cancer chemotherapy; cancer survival; controlled study; major clinical study; overall survival; clinical feature; disease course; histopathology; cisplatin; doxorubicin; fluorouracil; sunitinib; bone metastasis; paclitaxel; cancer radiotherapy; chemotherapy; temozolomide; nuclear magnetic resonance imaging; outcome assessment; cancer palliative therapy; etoposide; cyclophosphamide; vincristine; retrospective study; ifosfamide; backache; lung metastasis; folinic acid; spinal cord compression; spinal cord tumor; bleomycin; radiation therapy; visceral metastasis; platinum complex; sensory dysfunction; motor dysfunction; oxaliplatin; germ cell tumor; seminoma; spine metastasis; mediastinum metastasis; incontinence; epidural cord compression; nonseminomatous germ cell tumors; mobilization; reflex disorder
Journal Title: Cancer
Volume: 117
Issue: 9
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2011-05-01
Start Page: 1911
End Page: 1916
Language: English
DOI: 10.1002/cncr.25693
PROVIDER: scopus
PUBMED: 21509768
DOI/URL:
Notes: --- - "Export Date: 23 June 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Christian Grommes
    52 Grommes
  2. George Bosl
    255 Bosl