Salvage therapy for refractory or recurrent pediatric germ cell tumors: The french SFCE experience. Issue 2 (12th August 2013)

• Record Type: Journal Article
• Authors: Faure‐Conter, Cecile; Orbach, Daniel; Cropet, Claire; Baranzelli, Marie Christine; Martelli, Hélène; Thebaud, Estelle; Vérité, Cecile; Rome, Angelique; Fasola, Sylvie; Corradini, Nadège; Rocourt, Nathalie; Frappaz, Didier; Kalfa, Nicolas; Patte, Catherine
• Is Part Of: Pediatric blood & cancer. Volume 61:Issue 2(2014:Feb.)
• Page Start: 253
• Page End: 259
• Publication Date: 2013-08-12
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.24730
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="pbc24730-sec-0001" sec-type="section"> <title>Purpose</title> <p>Some children with extracranial germ cell tumors (GCT) relapse after or do not respond to first‐line treatment combining chemotherapy and surgery, of whom very few experience long‐term survival despite multimodal salvage treatment.</p> </sec> <sec id="pbc24730-sec-0002" sec-type="section"> <title>Methods</title> <p>This prospective study, part of the French TGM95 Protocol for non‐seminomatous GCT (NSGCT), included 19 (7%) children with malignant refractory or recurrent extracranial NSGCT who were studied to identify prognostic factors and determine the best salvage treatment.</p> </sec> <sec id="pbc24730-sec-0003" sec-type="section"> <title>Results</title> <p>At the end of the first‐line treatment, 10 and 9 children were in complete and incomplete remission, respectively. Events occurred within 2 years (5–23 months) after initial diagnosis. A progression was observed in 13 patients at least in one site initially involved. Two patients had a purely biological relapse (increase in isolated markers), and four patients had a purely metastatic relapse (brain location in three cases). After salvage treatment combining surgery and various types of chemotherapy (including high‐dose chemotherapy (HDCT) in 10 cases), the 5‐year event‐free survival and overall survival rates were of 26% (95%CI: 9.6–46.8%) and 32% (95%CI: 12.9–52.2%), respectively. Patients who underwent complete surgery (or without any detectable tumor) had higher survival rate than patients who underwent partial surgery or for whom surgery was not feasible (<italic>P</italic> = 0.0003) at first relapse while this rate was similar between patients treated or not with HDCT.</p> </sec> <sec id="pbc24730-sec-0004" sec-type="section"> <title>Conclusion</title> <p>In pediatric recurrent or refractory NSGCT, complete excision of the tumor appears essential. The role of HDCT remains debated. Pediatr Blood Cancer 2014;61:253–259. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>