Clinical outcomes of male choriocarcinoma: A case series

Abstract

16128 Background: Pure choriocarcinoma is a very rare entity and is the most aggressive subtype of nonseminomatous germ cell tumor. Extensive metastatic disease, marked HCG elevations, and rapid disease progression and death are commonly seen. There is limited published data regarding specific treatment outcomes in this group of patients (pts). Methods: We identified 14 cases of pure choriocarcinoma treated by a single primary oncologist between 1998 and 2007. Retrospective chart review with descriptive statistical analysis was performed. Results: The median age was 28 years (range 12–51). Six pts had testis pure choriocarcinoma and eight pts had choriocarcinoma syndrome. According to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification system, ten pts were poor prognosis at diagnosis and four pts were intermediate prognosis. Four pts who underwent standard initial chemotherapy followed by surgical resection of all residual masses are alive at +3, +6, +7, and +120 months. Three pts with choriocarcinoma syndrome and one pt with primary testis choriocarcinoma were absolute cisplatin refractory and died within 3–6 months of diagnosis. Two pts underwent high dose chemotherapy with stem cell transplant (HDCT) as 2nd line treatment and four pts received HDCT as 3rd line treatment. Four of the six pts died of disease at a median of 10.5 months after transplant (range 3–16). Of three pts with cisplatin refractory disease prior to HDCT all died within 11 months of transplant. One pt is currently alive with disease, and one pt has received the first of planned tandem cycles. With a median follow-up of 8 months (range 4–192), five pts are alive without disease, one is alive with disease, and eight pts have died. Conclusions: Choriocarcinoma remains a significant therapeutic challenge. In our series, HDCT did not benefit patients with cisplatin refractory disease. Patients who are able to undergo complete resection of residual masses after standard chemotherapy appear to have better outcomes although follow up is brief thus far. Novel strategies are needed in this high risk, often cisplatin refractory population. No significant financial relationships to disclose.