The second important—and promising—message is that the precise role (if any) of high-dose chemotherapy in the more common setting of primary salvage therapy or treatment of untreated, poor-risk disease is undefined. [3] Patients with disease that is absolutely refractory to cisplatin (Platinol), patients with recurrent, primary mediastinal nonseminoma, and patients with persistent or rising high beta–human chorionic gonadotropin (HCG) levels do not benefit from high-dose chemotherapy and should be considered for clinical trials of novel agents. Your doctor will talk to you about the specific risk with the drugs you are having. Margolin K, Doroshow J, Ahn C, et al: Treatment of germ cell cancer with two cycles of high-dose ifosfamide, carboplatin, and etoposide with autologous stem-cell support. The first takeaway message is that a very small proportion of patients who have failed two or more lines of conventional therapy will be cured with the application of carboplatin (Paraplatin)/etoposide–based high-dose chemotherapy. Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. Dr. Srinivas nicely summarizes the last 15 years of clinical data on the use of high-dose chemotherapy in germ-cell tumors. Indiana University has performed a retrospective review of all patients thought to have chemotherapy-refractory disease who were submitted to surgery for attempts at curative resection. So calling them chemo brain may not be accurate. A final point concerns the availability of reasonable predictive prognostic systems that can identify a patient population in which high-dose chemotherapy is futile. Murphy B, Breeden E, Donohue J, et al: Surgical salvage of chemorefractory germ cell tumors. Do children grow out of heart abnormalities? Read our information about coronavirus and cancer. Randomized trials in these settings, however, are nearing completion. About Cancer generously supported by Dangoor Education since 2010. Make sure to talk to your oncologist early about these potential side effects. During high-dose chemotherapy, the patient receives high doses of chemotherapy, and possibly radiation therapy, in order to kill the cancer cells. One of three common treatments for cancer, chemotherapy uses drugs to kill or slow down the progression of cancer cells. Some chemotherapy drugs can cause long term problems with specific body organs. Ten patients (21%) remain free of disease, with follow-up ranging from 31 to 89 months. Beyer J, Kramar A, Mandanas R, et al: High-dose chemotherapy as salvage treatment in germ cell tumors: A multivariate analysis of prognostic variables. Clinical Consult: Assessing the Impact of Tailor X. These factors must be considered when evaluating the literature in this area as well. If I've Just Been Diagnosed with Type 2 Diabetes, What's the First Thing I Should Do. After intensive treatment, you are likely to have a lower resistance to infection for quite a long time. Such patients may require no therapy, depot testosterone, or aggressive surgery rather than high-dose chemotherapy. One underappreciated aspect of care of these patients is the complexity of the usually straightforward process of identifying a true malignant recurrence. But cancer doctors are aware of this. As always, you should consult with your healthcare provider about your specific health needs. Patients with multiple sites of metastasis, although resectable, were not cured. To facilitate the selection of patients for this approach, numerous prognostic factors have been established that can identify subgroups with a very low chance of benefit from high-dose chemotherapy. It's possible that these problems might be due to other cancer treatments. For some people chemotherapy can cause long term changes in the body months or years after treatment. What Can I Expect If I Have Just Been Diagnosed With MS? After cancer treatment, some people notice changes in their memory, concentration and the way they think. Many people feel more tired than usual for a long time after chemotherapy treatment. It's not clear exactly what causes these memory and concentration changes in people with cancer. This will gradually get back to normal, but can take some months. The risk of a second cancer is less of a risk to you than the cancer you are having treatment for. Management of patients with poor-risk germ-cell tumors is challenging for numerous reasons. Call freephone or email us, Get more information on cancer and fertility, Read more about chemo brain, ways to cope and research in this area, how health professionals and people with cancer can best manage the symptoms of cognitive impairment. You will have tests before and during your treatment so your doctor can keep an eye on your reaction to the drug.There may be some chemotherapy drugs your doctor won't use, if you have a heart condition. Different chemotherapy drugs are used for different types of cancers and can be combined with other treatments, like radiation therapy or surgery. Some people call them 'chemo brain' or 'chemo fog'. Most chemotherapy side effects are temporary and disappear once your treatment is over. There are medications to prevent or decrease some of these side effects. In some cases chemotherapy can cause infertility. Acute lymphocytic leukemia (ALL) has also been linked to chemo. The major side effect is bone marrow damage, which causes low blood cell counts. This is called a second cancer. The second important and promising message is that the precise role (if any) of high-dose chemotherapy in the more common setting of primary salvage therapy or treatment of untreated, poor-risk disease is undefined. Randomized trials in these settings, however, are nearing completion. Talking to Your Doctor About Rheumatoid Arthritis, Gynecology, Vascular & Interventional Radiology, When Tina Fey played real-life war correspondent Kim Barker in the movie Whiskey Tango Foxtrot some reviewers thought the script was off-balance. Such decisions and surgeries should be made at centers with significant experience in germ-cell tumor management. © 2020 MJH Life Sciences and Cancer Network. This is because after getting high-dose chemo, the patient receives a transplant of blood-forming stem cells to rebuild the bone marrow. 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