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Improvement in the outcome of children with germ cell tumors
Luiz Fernando Lopes1, Viviane Sonaglio, Karina C B Ribeiro
1Department of Pediatrics-Centro de Tratamento e Pesquisa Hospital do Cancer, A.C. Camargo, Sao Paulo, Brazil. lf.lopes@yahoo.com
Insights
Survival rates for pediatric germ cell tumors improved significantly with updated chemotherapy protocols. The latest TCG-91 protocol, using a simplified regimen, demonstrated superior outcomes in children and adolescents.
Area of Science:
- Pediatric Oncology
- Medical Oncology
- Clinical Research
Background:
- Germ cell tumors (GCTs) are a significant concern in pediatric oncology.
- Effective treatment strategies are crucial for improving survival rates in children and adolescents.
- Cisplatin-based chemotherapy has been a cornerstone in GCT management.
Purpose of the Study:
- To evaluate clinical characteristics and survival outcomes of pediatric GCT patients.
- To compare the efficacy of three different cisplatin-based chemotherapy protocols.
- To identify prognostic factors influencing treatment success in young GCT patients.
Main Methods:
- Retrospective review of 106 pediatric GCT patients treated between 1983-1997.
- Analysis of clinical, histopathological data, and treatment protocols (VAB-6, EPO/VAC, TCG-91).
- Evaluation of prognostic factors including stage, metastatic status, and surgical intervention.
Main Results:
- Improved 5-year overall survival (OS) observed across treatment periods: 42.9% (Period I), 53.9% (Period II), and 80.6% (Period III).
- Stage, metastatic status, and initial surgery were significant prognostic factors (P < 0.001).
- The TCG-91 protocol showed a trend towards better outcomes (P = 0.070).
Conclusions:
- The TCG-91 protocol demonstrated improved survival for pediatric germ cell tumors.
- A risk-adapted approach with cisplatin and etoposide proved effective.
- Complex multi-agent regimens may not be essential for long-term survival in select GCT cases.
Purpose:
To describe the clinical characteristics and estimate the survival of children and adolescents with germ cell tumors treated with cisplatin-based combination chemotherapy according to three different protocols in Brazil.
Methods:
From 1983 to 1997, 106 patients were treated at the Hospital do Cancer, Sao Paulo for a diagnosis of germ cell tumor. We performed a retrospective review of the clinical and histopathological data to identify prognostic factors and evaluate their outcome.
Results:
Patients were treated with only surgery (n = 32), surgery and radiotherapy (n = 1) and chemotherapy (n = 73). From 1983 to 1986 (period I), there were 30 patients and 21 received chemotherapy according to the modified VAB-6 protocol. Twenty-two of 35 patients registered between 1987 and 1991 (period II) were treated with EPO/VAC combination chemotherapy. From 1991 to 1997 (period III), there were 41 patients and 31 received chemotherapy according to the Brazilian TCG-91 protocol. Important prognostic factors included stage (P < 0.001), metastatic status (P < 0.001) and surgical procedure at diagnosis (P < 0.001). An incremental improvement in outcomes was noted across the periods of treatment (P = 0.070). Five-year OS was respectively 42.9 +/- 10.8%, 53.9 +/- 11.4% and 80.6 +/- 7.1% for periods I, II, and III for the patients who received chemotherapy.
Conclusion:
An improvement in the survival of children with germ cell tumors was achieved in the most recent trial (TCG-91) with a risk adapted approach incorporating only cisplatin and etoposide. These results indicate that in selected patients complex three-agent regimens may not be necessary to achieve long term survival.
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