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.
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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)
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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
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