Site of metastases does not influence the clinical outcome of children with metastatic Germ Cell Tumors (GCT). A report from the Children's Oncology Group (COG)

English

Reviewer: Charles Wood, MD
Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 4 de junio del 2006

Presenter: Malogolowkin MH et al.
Presenter's Affiliation: Children's Oncology Group, Arcadia, CA
Type of Session: Scientific

Background

A previous protocol had randomized patients with either extragonadal GCT or high-risk gonadal GCT to high-dose versus standard-dose cisplatin/etoposide/bleomycin combination chemotherapy (PEB)
This study sought to evaluate the outcome of patients with metastatic GCT (Stage IV) at diagnosis based on the site(s) of metastasis

Materials and Methods

299 patients with either extragonadal GCT or high-risk gonadal GCT were treated between March 1990 and February 1996 on a Pediatric Intergroup Trial consisting of randomization between high- and standard-dose chemotherapy arms
Patients received 4 courses of PEB followed by a second-look surgery and an additional 2 courses of PEB for residual disease or persistently elevated tumor markers
Out of this cohort, all patients with Stage IV disease at diagnosis were retrospectively evaluated for outcome based on site(s) of metastasis

Results

133 of the 299 patients were identified to have Stage IV disease at diagnosis
the median age was 2.6 years (range 3 days – 19.3 years), and the majority were female (70)
the most common sites of disease were ovarian, testicular, and extragonadal
the most common histologies were pure yolk sac tumors and mixed germ cell tumors
no significant differences in 5-year event-free survival (EFS) or overall survival (OS) were detected based on site of metastasis

Author's Conclusions

outcome for Stage IV GCT patients is excellent with cisplatin-based chemotherapeutic regimens and is independent of the site(s) of metastasis

Clinical/Scientific Implications

metastatic GCT are one of the uncommon malignancies which can have excellent outcomes with contemporary treatment regimens
sites of metastases do not seem to play a large role in determining outcome in these patients
Agressive management with chemotherapy remains warranted in all patients presenting with metastatic disease regardless of pattern of spread