Testicular germ cell tumors. Results of the GPO MAHO studies -82, -88, -92

The MAHO studies 82, 88 and 92 were cooperative studies for the treatment of testicular germ cell tumors in childhood. Between 1992 and 1993 137 Patients were registered: 76 suffered from yolk sac tumors (YST), 30 from differentiated teratomas (TD), 29 from malignant teratomas of either intermediate (MTI), undifferentiated (MTU) or trophoblastic type (MTT) and 2 from seminoma. All patients received semicastratio. Chemotherapy was administered to 53 patients based on stage and histology. Standard therapy consisted of four courses of vinblastine, bleomycin and cisplatinum. However, if viable tumor was suspected after two courses delayed laparotomy was performed (7 patients). If there was then complete tumor regression, standard therapy was continued (4 pts). If there was incomplete tumor response, the patients received a salvage therapy with 3 courses of VP 16, ifosfamide and cisplatinum (3 pts). Results YST: 73 patients had stage I, 3 patients higher stages. 56 were followed according to "watch and wait" policy. 9 of these needed a delayed standard chemotherapy, one died. The disease free survival of all 76 patients is 98%. TD: 30 patients had stage I. The disease free survival is 100%. Malignant teratomas (MTI, MTU, MTT): 13 patients had stage I. 8 received adjuvant chemotherapy and 5 lymphadenectomy without chemotherapy. All patients survived disease free. 10 patients had stage II and received chemotherapy. All patients survived disease free. 6 patients had stage III. 3 died. Altogether 26 of 29 patients survived disease free. In summary, the probability of disease free survival of all 137 patients suffering from testicular germ cell tumors is 97% after a median observation time of 60 months.