An attempt to treat pediatric intracranial alphaFP and betaHCG secreting germ cell tumors with chemotherapy alone. SFOP experience with 18 cases. Société Française d'Oncologie Pédiatrique.
OBJECTIVE
Intracranial alphaFP and betaHCG secreting germ cell tumors have a very poor prognosis with local treatment alone. Because of efficacy of chemotherapy in extracranial forms, we tried in the SFOP (Société Française d'Oncologie Pédiatrique) to treat them with chemotherapeutic treatment exclusively.


METHODS
Eighteen patients (10 alphaFP, 2 betaHCG, 6 alphaFP and betaHCG secretion) were enrolled from January 1988 to December 1992. After biological diagnosis patients were to receive 6 cycles of chemotherapy (vinblastine bleomycin - carboplatin or etoposide - carboplatin/ifosfamide - etoposide). After completion of chemotherapy, surgery was to be performed in case of residual tumor. Focal radiation was only to be delivered in case of viable residual tumor.


RESULTS
All patients had biological remission and tumor reduction. Fifteen patients were treated according to the protocol by chemotherapy alone (13) or chemotherapy and radiation of residue (2). Twelve of the 13 non irradiated patients relapsed, 8 in local and/or regional area, 3 in cerebrospinal area and 1 in undeterminated area with mild elevation of markers except in one case. Six patients are alive in second complete remission after chemotherapy and/or surgery and then a consolidation treatment with radiation and/or high dose chemotherapy (5) or craniospinal radiation (1). Three patients received radiation after 2 or 3 cycles of chemotherapy as protocol violations and didn't relapse. Thus, 12 patients out of the 18 patients are alive with a median follow up of 68 months. All but 1 had focal radiation as part of treatment. No toxic death was observed.


CONCLUSIONS
Although survival rate is noteworthy (66%), these tumors were not curable with this conventional chemotherapy alone and focal radiotherapy should be part of the treatment.
Baranzelli
M C
MC
Centre Oscar Lambret, Lille, France.
Patte
C
C
Bouffet
E
E
Portas
M
M
Mechinaud-Lacroix
F
F
Sariban
E
E
Roche
H
H
Kalifa
C
C
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism*; D005260:Female; D018237:Germinoma / Q000188:drug therapy* / Q000378:metabolism*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D016019:Survival Analysis; D013997:Time Factors; D000509:alpha-Fetoproteins / Q000378:metabolism*
D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins