Keywords :
Adult; Antineoplastic Combined Chemotherapy Protocols/administration & dosage; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Bacteremia; Cardiac Output/physiology; Cause of Death; Germinoma/complications; Germinoma/drug therapy; Germinoma/physiopathology; Germinoma/secondary; Humans; Kidney/drug effects; Kidney/physiopathology; Leukocytosis/etiology; Lung Neoplasms/pathology; Lung Neoplasms/secondary; Lymphatic Metastasis; Male; Mediastinal Neoplasms/pathology; Mediastinal Neoplasms/secondary; Prognosis; Prospective Studies; Pulmonary Fibrosis/etiology; Remission Induction; Respiratory Insufficiency/etiology; Risk Factors; Survival Rate; Vascular Resistance/physiology; Bulky mediastinum; Poor-prognosis germ-cell tumors; Pulmonary metastases; Respiratory distress; Supportive care; Oncology
Abstract :
[en] Among patients suffering from nonseminomatous germ-cell tumor, with a poor prognosis, a subset underwent respiratory failure and died very early in the course of their treatment. Between 1982 and 1989, 11 out of 56 such patients (20%) died within the first 5 weeks of chemotherapy. The clinical, radiological, biological and infectious characteristics of these patients were analyzed. Nine patients had extensive pulmonary metastases and the 2 others presented a bulky mediastinal mass with pleural effusion. All patients experienced acute respiratory distress during chemotherapy and underwent mechanical ventilation. All patients were febrile, and septicemia was documented in 7 cases. WHO grade 4 and grade 1-2 renal toxicities occurred in 3 and 4 patients respectively. There was no tumor lysis syndrome. All patients died within 35 days from the start of therapy; 4 were autopsied. These 11 patients represent a clinical entity, having what we called super-high-risk germ cell tumors. Early death is related to pulmonary distress within the first 5 weeks of therapy. The origin of the pulmonary distress is multifactorial: bulky disease of the chest, infection, and interstitial fibrosis. Immediate full-dose standard chemotherapy in association with intensive supportive care is recommended in the management of these patients.
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