Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Children's Oncology Group. J Clin Oncol 2014 Feb 10;32(5):465-70
Date
01/08/2014Pubmed ID
24395845Pubmed Central ID
PMC4876316DOI
10.1200/JCO.2013.51.1006Scopus ID
2-s2.0-84897577103 (requires institutional sign-in at Scopus site) 129 CitationsAbstract
PURPOSE: To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection.
PATIENTS AND METHODS: Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m(2) on days 1 to 3, etoposide 167 mg/m(2) on days 1 to 3, bleomycin 15 U/m(2) on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method.
RESULTS: Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52%; 95% CI, 31% to 69%). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96%; 95% CI, 74% to 99%).
CONCLUSION: Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults.
Author List
Billmire DF, Cullen JW, Rescorla FJ, Davis M, Schlatter MG, Olson TA, Malogolowkin MH, Pashankar F, Villaluna D, Krailo M, Egler RA, Rodriguez-Galindo C, Frazier ALMESH terms used to index this publication - Major topics in bold
AdolescentAntineoplastic Combined Chemotherapy Protocols
Bleomycin
Child
Child, Preschool
Cisplatin
Disease-Free Survival
Etoposide
Female
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasm, Residual
Neoplasms, Germ Cell and Embryonal
Ovarian Neoplasms
Radiography
Risk Factors
Salvage Therapy
Time Factors
Treatment Outcome
alpha-Fetoproteins
