Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5334
Peer-review started: May 25, 2020
First decision: September 14, 2020
Revised: September 25, 2020
Accepted: October 19, 2020
Article in press: October 19, 2020
Published online: November 6, 2020
Processing time: 163 Days and 6.1 Hours
Choriocarcinoma is an infrequent entity and the most aggressive subtype of germ-cell tumors. Because of early metastatic spread and rapid disease progression, choriocarcinoma patients display poor prognosis. Although etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) regimen is widely used to treat gestational trophoblastic tumors in females, its role in treating male choriocarcinoma is seldom reported.
A 32-year-old man was diagnosed with burned-out primary germ cell tumors (GCT) with retroperitoneum, liver and lung metastases. Biopsy of the liver revealed pure choriocarcinoma. The patient received bleomycin, etoposide, and cisplatin chemotherapy. After two cycles of treatment, response evaluation revealed the mixed response. EMA-CO regimen was used in the second-line therapy. After eight cycles, the patient showed a potentially resectable state and thus, all residual masses were surgically removed. The patient was completely cured, and 10 years later, he is leading a healthy life without complications.
This paper is the first case of high-risk nonseminomatous GCT in a male patient to be successfully treated with the EMA-CO regimen. The EMA-CO regimen can be used actively in patients with high-risk nonseminomatous GCT.
Core Tip: Choriocarcinoma is an extremely rare germ cell tumor and responds poorly to standard chemotherapy. Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine regimen is widely used to treat gestational trophoblastic tumors in females, however, its role in choriocarcinoma of males is seldom reported. This case report is the first of its kind demonstrating successful treatment using the etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine regimen in a male diagnosed with cisplatin-refractory high-risk nonseminomatous germ cell tumors.