title: Germ cell tumors in children: gonadal and extragonadal.
abstract: Sixty-three pediatric patients with germ cell tumors are presented with details of symptoms, histological findings, staging, serological markers, treatment, and response to therapy. The primary sites were: ovarian 32, testicular 17, presacral 7, mediastinal 3, intraabdominal 2, vaginal 1, and right inguinal canal 1. These patients were treated with T2 (sequential use of dactinomycin, doxorubicin, vincristine, and cyclophosphamide, with or without radiation), T6 (combination chemotherapy with cyclophosphamide, bleomycin, dactinomycin, doxorubicin, methotrexate, vincristine), or VAB treatment protocols (velban, dactinomycin, bleomycin, cisplatin). The cure rate for stage I ovarian and testicular germ cell tumors was 100%; for stage III, all primary sites, 82% and for stage IV, all primary sites, 75%. Histology was prognostic in ovarian tumors of the immature malignant teratoma type; the neural type immature teratoma, grades II and III, had the worst prognosis. Initial debulking surgery in combination with chemotherapy and radiation plays an important role in germ cell tumors. Stages II, III, and IV germ cell tumors require aggressive treatment with surgery, radiation, and chemotherapy. For stage I patients, with primary ovarian malignant tumor, cure with surgery alone can be achieved in 50% of the cases and in testicular tumors in about 70% of the patients. For those with stage I and elevated serological markers, it is feasible to follow these markers and give no treatment until there is evidence of persistent elevation or a rise in titers after an initial fall. In those without elevated serological markers, one should take into consideration the size of the tumor and the histological type before taking the "wait and see" approach. These stage I tumors are highly curable when they first present but, if allowed to recur, chemotherapy may not offer the patient such a favorable response and cure rate.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
authors.forename: N
authors.initials: N
authors.lastname: Wollner
authors.forename: F
authors.initials: F
authors.lastname: Ghavimi
authors.forename: A
authors.initials: A
authors.lastname: Wachtel
authors.forename: E
authors.initials: E
authors.lastname: Luks
authors.forename: P
authors.initials: P
authors.lastname: Exelby
authors.forename: J
authors.initials: J
authors.lastname: Woodruff
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D006063:Chorionic Gonadotropin / Q000032:analysis; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D007813:Laparotomy; D008197:Lymph Node Excision; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009919:Orchiectomy; D011879:Radiotherapy Dosage; D015996:Survival Rate; D014565:Urogenital Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D014747:Vinblastine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase; D002945:Cisplatin; D008727:Methotrexate