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Malignant germ cell tumors in 57 children and adolescents
Insights
Disease stage is the key factor in predicting outcomes for malignant germ cell tumors (GCTs) in children. Treatment effectiveness and metastasis patterns suggest GCTs can be viewed as a single group.
Area of Science:
- Pediatric Oncology
- Cancer Research
- Tumor Biology
Background:
- Malignant germ cell tumors (GCTs) are rare in children.
- Understanding prognostic factors is crucial for effective treatment strategies.
Purpose of the Study:
- To evaluate prognostic variables (stage, histology, site, age) in childhood GCTs.
- To assess therapeutic outcomes and metastasis patterns.
- To determine if GCTs can be considered a unified group regardless of primary site.
Main Methods:
- Retrospective analysis of 57 pediatric GCT patients (1962-1979).
- Utilized Cox regression analysis for prognostic factor evaluation.
- Reviewed treatment responses and patterns of metastasis.
Main Results:
- Disease stage emerged as the most significant prognostic indicator.
- Extragonadal GCTs were often diagnosed at advanced stages.
- Tumor site, patient age, and histology did not independently impact prognosis.
- Effective agents included combinations of vincristine, cyclophosphamide, dactinomycin, and vinblastine, bleomycin, cis-platinum.
- Radiation therapy was curative for localized germinomas.
- Common metastasis sites included lungs, liver, CNS, and bone.
Conclusions:
- Disease stage is the primary prognostic factor for pediatric malignant GCTs.
- Similarities in histogenesis, metastasis, and treatment response support treating GCTs as a single entity.
- Extragonadal GCTs typically present with advanced disease.
Abstract:
Fifty-seven patients with malignant germ cell tumors (GCTs) treated at our center between 1962 and 1979 were evaluated to determine 1) the prognostic value of disease stage, tumor histology, primary site, and patient age; 2) results of therapy; and 3) patterns of metastasis. The 35 girls and 22 boys were from 1 week to 18 years old (median 5 yr). Primary sites were ovarian (20), testicular (10), sacrococcygeal (12), retroperitoneal (7), mediastinal (5), and other (3). Cox regression analysis indicated that stage was the most important prognostic variable. Extragonadal tumors were usually advanced at diagnosis, but tumor site did not have prognostic value independent of disease stage. Neither patient age nor tumor histology significantly influenced outcome. Drugs active against malignant GCTs included vincristine, cyclophosphamide, and dactinomycin in combination and vinblastine, bleomycin, and cis-platinum. Radiation alone cured nondisseminated germinomas. The most common sites of metastasis were lungs, liver, central nervous system, and bone; other sites were infrequently involved. We conclude that stage was the most important prognostic variable, extragonadal tumors were usually advanced at diagnosis, and similarities in the histogenesis, metastatic pattern, and response to therapy, regardless of primary site, justify the consideration of childhood malignant GCTs as one group.