[Results of the German studies (MAHO) for treatment of testicular germ cell tumors in children--an update].
BACKGROUND
The MAHO studies for treatment of testicular germ cell tumors in childhood and adolescence registered between 1982 and 1/2001 260 patients (pts.). Aims of the studies were: 1. Delay of chemotherapy in YST of stage I A. 2. Delay of modified lymphadenectomy for staging in I A tumors. 3. Stepwise reduction of therapy in low stage tumors but increasing therapy in tumors of metastatic pattern. Standard therapy consisted of 4 courses of vinblastine, bleomycin and cisplatin. In stage II C or higher chemotherapy included cisplatin, VP 16 and bleomycin. As salvage therapy VP16, ifosfamide and cisplatin was given.


RESULTS
According to histology and stage only 75/260 pts. needed chemotherapy. Out of 140 pts. with YST 139 survived disease free according to a "watch and wait" policy. 16 of these patients (13 %) needed a delayed standard chemotherapy 6 - 60 weeks after orchiectomy. Patients with mature (40 pts.) and immature (19 pts.) teratoma were cured by orchiectomy alone. 59 pts. suffered from other malignant non-seminomatous tumors (EC, chorio, mixed tumors). 20 of these had a clinical stage I including 5 with a pathologic stage I A. 15 received adjuvant chemotherapy and all 20 pts. survived relapse-free. 22 pts. had stage II, 8 of these received salvage therapy in addition to standard chemotherapy, 21 of 22 pts. survived. 17 pts. had stage III or IV, 5 of these died despite receiving salvage therapy, 9 pts. survived in complete remission, 3 pts. had partial remission. Both patients with a seminoma (stage I) survived. In summary, the probability of disease free survival of 260 pts. is 97 % after a median observation time of 60 months.


CONCLUSIONS
In alpha-fetoprotein producing YST tumors of clinical stage I A after semincastratio the "watch and wait" surveillance strategy is found to be optimal. Only about 13 % of these patients had to be treated by chemotherapy at a later time point and thus could be cured. For YST pts. of stages greater than stage I A and all other malignant testicular tumors in childhood effective chemotherapy exists with an overall cure rate of about 95 %. Local irradiation or staging lymphadenectomy is unnecessary.
Schmidt
P
P
Universitäts-Kinderklinik, München, Germany. Piroska.Schmidt@helios.med.uni-muenchen.de
Haas
R J
RJ
Göbel
U
U
Calaminus
G
G
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009919:Orchiectomy; D016879:Salvage Therapy; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery