TY - JOUR
T1 - The effect of cisplatin dose and surgical resection in children with malignant germ cell tumors at the sacrococcygeal region
T2 - A pediatric intergroup trial (POG 9049/CCG 8882)
AU - Rescorla, Frederick
AU - Billmire, Deborah
AU - Stolar, Charles
AU - Vinocur, Charles
AU - Colombani, Paul
AU - Cullen, John
AU - Giller, Roger
AU - Cushing, Barbara
AU - Lauer, Stephen
AU - Davis, Mary
AU - Hawkins, Edith
AU - Shuster, Jonathan
AU - Krailo, Mark
PY - 2001/1/1
Y1 - 2001/1/1
N2 - Purpose: This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors of the sacrococcygeal region (SCT). Methods: Seventy-four of 317 children presenting to Pediatric Oncology Group (POG)/Children's Cancer Group (CCG) institutions from 1990 through 1996 with malignant germ cell tumors had malignant SCT. There were 62 girls and 12 boys with a median age of 21 months (range, 3 days to 37 months) and median serum alpha-fetoprotein of 35, 500 ng/mL. Twelve had undergone resection of a benign SCT as a newborn. Forty-four (59%) had evidence of metastatic disease at time of diagnosis. Presentation by type (Altman classification) was I, 0; II, 2; III, 30; and IV, 42. The initial procedure was biopsy in 45 and resection in 29. Patients were assigned randomly to receive 4 cycles of chemotherapy with etoposide (E) and bleomycin (B) and either high-dose cisplatin (200 mg/m2 per cycle; HDP) or standard dose cisplatin (100 mg/m2 per cycle; P). After completion of chemotherapy, 42 of 45 initially treated with biopsy underwent resection. Results: Overall 4-year survival rate is 90% (SE = 4%) and 4-year event-free survival (EFS) is 84% (SE = 6%). Event-free survival data for subgroups of interest are as follows: Conclusions: (1) The current survival rate of malignant sacrococcygeal tumors is excellent even with metastases. (2) Delayed surgical resection is not associated with an adverse outcome. (3) In this subset the treatment comparison was inconclusive however, followed the trend in the overall study of more than 300 children in which the high-dose cisplatin group had superior EFS (P <. 05).
AB - Purpose: This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors of the sacrococcygeal region (SCT). Methods: Seventy-four of 317 children presenting to Pediatric Oncology Group (POG)/Children's Cancer Group (CCG) institutions from 1990 through 1996 with malignant germ cell tumors had malignant SCT. There were 62 girls and 12 boys with a median age of 21 months (range, 3 days to 37 months) and median serum alpha-fetoprotein of 35, 500 ng/mL. Twelve had undergone resection of a benign SCT as a newborn. Forty-four (59%) had evidence of metastatic disease at time of diagnosis. Presentation by type (Altman classification) was I, 0; II, 2; III, 30; and IV, 42. The initial procedure was biopsy in 45 and resection in 29. Patients were assigned randomly to receive 4 cycles of chemotherapy with etoposide (E) and bleomycin (B) and either high-dose cisplatin (200 mg/m2 per cycle; HDP) or standard dose cisplatin (100 mg/m2 per cycle; P). After completion of chemotherapy, 42 of 45 initially treated with biopsy underwent resection. Results: Overall 4-year survival rate is 90% (SE = 4%) and 4-year event-free survival (EFS) is 84% (SE = 6%). Event-free survival data for subgroups of interest are as follows: Conclusions: (1) The current survival rate of malignant sacrococcygeal tumors is excellent even with metastases. (2) Delayed surgical resection is not associated with an adverse outcome. (3) In this subset the treatment comparison was inconclusive however, followed the trend in the overall study of more than 300 children in which the high-dose cisplatin group had superior EFS (P <. 05).
KW - Germ cell tumors
KW - Sacrococcygeal tumors
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U2 - 10.1053/jpsu.2001.19993
DO - 10.1053/jpsu.2001.19993
M3 - Article
C2 - 11150431
AN - SCOPUS:0035163240
VL - 36
SP - 12
EP - 17
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 1
ER -