Salvage therapy for refractory or recurrent pediatric germ cell tumors: the French SFCE experience.

Abstract

PURPOSE:

Some children with extracranial germ cell tumors (GCT) relapse after or do not respond to first-line treatment combining chemotherapy and surgery, of whom very few experience long-term survival despite multimodal salvage treatment.

METHODS:

This prospective study, part of the French TGM95 Protocol for non-seminomatous GCT (NSGCT), included 19 (7%) children with malignant refractory or recurrent extracranial NSGCT who were studied to identify prognostic factors and determine the best salvage treatment.

RESULTS:

At the end of the first-line treatment, 10 and 9 children were in complete and incomplete remission, respectively. Events occurred within 2 years (5-23 months) after initial diagnosis. A progression was observed in 13 patients at least in one site initially involved. Two patients had a purely biological relapse (increase in isolated markers), and four patients had a purely metastatic relapse (brain location in three cases). After salvage treatment combining surgery and various types of chemotherapy (including high-dose chemotherapy (HDCT) in 10 cases), the 5-year event-free survival and overall survival rates were of 26% (95%CI: 9.6-46.8%) and 32% (95%CI: 12.9-52.2%), respectively. Patients who underwent complete surgery (or without any detectable tumor) had higher survival rate than patients who underwent partial surgery or for whom surgery was not feasible (P = 0.0003) at first relapse while this rate was similar between patients treated or not with HDCT.

CONCLUSION:

In pediatric recurrent or refractory NSGCT, complete excision of the tumor appears essential. The role of HDCT remains debated.

• Authors: Cecile Faure-Conter, Daniel Orbach, Claire Cropet, Marie Christine Baranzelli, Hélène Martelli, Estelle Thebaud, Cecile Vérité, Angelique Rome, Sylvie Fasola, Nadège Corradini, Nathalie Rocourt, Didier Frappaz, Nicolas Kalfa, Catherine Patte
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 61 Issue 2 Pg. 253-9 (Feb 2014) ISSN: 1545-5017 [Electronic] United States
• PMID: 23940114 (Publication Type: Journal Article)
• Copyright: © 2013 Wiley Periodicals, Inc.

Chemical References

• Bleomycin
• Vinblastine
• Etoposide
• Cisplatin
• Ifosfamide

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bleomycin (administration & dosage)
• Child
• Cisplatin (administration & dosage)
• Drug Resistance, Neoplasm
• Etoposide (administration & dosage)
• Female
• Follow-Up Studies
• Humans
• Ifosfamide (administration & dosage)
• Infant
• Lymphatic Metastasis
• Male
• Neoplasm Recurrence, Local (drug therapy, pathology)
• Neoplasm Staging
• Neoplasms, Germ Cell and Embryonal (drug therapy, pathology)
• Prognosis
• Prospective Studies
• Salvage Therapy
• Survival Rate
• Testicular Neoplasms
• Vinblastine (administration & dosage)
• Young Adult