Results from the UK Children's Cancer and Leukaemia Group study of extracranial germ cell tumours in children and adolescents (GCIII).

Abstract

BACKGROUND:

For extracranial malignant germ cell tumours (MGCTs) in the UK, the GCII study used carboplatin-based chemotherapy (JEb) and demonstrated equivalent survival to cisplatin-containing protocols. GCIII, a single-arm observational study, used new risk stratification, replaced consolidation chemotherapy with a standard number of cycles and introduced surveillance for all stage I MGCTs. Pure teratomas were registered to understand their natural history.

METHODS:

Patients with MGCTs were stratified to three risk groups - low risk (LR), intermediate risk (IR) and high risk (HR), using stage and prognostic factors. Patients with alpha fetoprotein (AFP) >10,000 kU/L, stage IV disease (except testis <5 years and all germinomas) or stage II-IV mediastinal tumour were classified HR. Stage I tumours (LR) received chemotherapy only if disease progressed. IR and HR patients received 4 and 6 JEB cycles, respectively. Carboplatin dose was calculated using glomerular filtration rate to give an area under the curve of 7.9 ml/m2.min.

RESULTS:

Eighty-six patients with MGCTs were enrolled from 2005 to 2009: 59% female, median age, 5.7 years. Twenty-five patients were LR, 21 IR and 38 HR. Seven LR patients had disease progression; all were successfully treated with chemotherapy. Overall survival (OS) for the whole group was 97%; 5-year event-free survival for JEb-treated patients was 92%, and OS, 95%. JEb was well tolerated with no observed significant hearing or renal side-effects. There was no discernible difference in carboplatin dose whether calculated by body surface area or creatinine clearance. Forty-seven patients with teratoma were managed with surgery and one had malignant transformation.

CONCLUSION:

Carboplatin-based chemotherapy as part of a risk-stratified approach leads to excellent survival in paediatric MGCTs, minimising potential burden of long-term effects.

• Authors: Sarita Depani, Sara Stoneham, Mark Krailo, Caihong Xia, James Nicholson
• Journal: European journal of cancer (Oxford, England : 1990) (Eur J Cancer) Vol. 118 Pg. 49-57 (09 2019) ISSN: 1879-0852 [Electronic] England
• PMID: 31306943 (Publication Type: Comparative Study, Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier Ltd. All rights reserved.

Chemical References

• Carboplatin
• Cisplatin

Topics

• Adolescent
• Age Factors
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Carboplatin (administration & dosage, adverse effects)
• Chemotherapy, Adjuvant
• Child
• Child, Preschool
• Cisplatin (administration & dosage, adverse effects)
• Disease Progression
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Neoplasm Staging
• Neoplasms, Germ Cell and Embryonal (drug therapy, mortality, pathology)
• Orchiectomy
• Ovarian Neoplasms (drug therapy, mortality, pathology)
• Ovariectomy
• Progression-Free Survival
• Risk Assessment
• Risk Factors
• Teratoma (drug therapy, mortality, pathology)
• Testicular Neoplasms (drug therapy, mortality, pathology)
• Time Factors
• United Kingdom