title: Clinical stage I nonseminomatous germ cell tumors of the testis in childhood and adolescence: an analysis of 31 cases.
abstract: A 20-year single-institution experience of clinical stage I nonseminomatous germ cell tumors of the testis (NSGCTT) in childhood and adolescents was reviewed in relation to clinical characteristics, treatment modalities, and survival. Thirty-one patients with clinical stage I NSGCTT were seen between 1980 and 2000: 14 children and 17 adolescents. Yolk sac tumors and/or teratomas occurred in the children, whereas mixed histologies, including embryonal carcinoma, were predominant in the adolescents. After orchiectomy, the children were assigned to surveillance and the adolescents to active treatment: 16 underwent retroperitoneal lymph node dissection (RPLND) and 1 had adjuvant cisplatin-based chemotherapy because of a high-risk histology. Three of the 14 children (21.4%) relapsed 3, 7, and 8 months after orchiectomy: all 3 had yolk sac tumors and presented with increased alpha-fetoprotein levels. No patients had retroperitoneal relapse; two recurred locally and one in the lung. All three children were treated with cisplatin-based chemotherapy with or without surgery. Among the 16 adolescents undergoing RPLND, 4 (25%) had nodal metastases. Three of the 12 patients (25%) who had negative nodes at RPLND relapsed in the lung 3, 7, and 8 months after RPLND. All were treated with cisplatin-based chemotherapy with or without surgery. Five-year relapse-free and overall survival rates for the whole series were 80.6% and 100%, respectively. This series enabled the authors to pinpoint several important aspects of stage I NSGCTT in children and adolescents. In particular, almost all the childhood cases had the same yolk sac tumor histology, the children tended to have localized disease, and an increased alpha-fetoprotein level had a very high predictive value, suggesting that follow-up should include AFP measurements. A conservative approach is the best option in children, while adolescent NSGCTT behaves like the adult disease and management must include similar treatment strategies.
authors.affiliation: Pediatric Oncology Unit, Istituto Nazionale Tumori, Milan, Italy. mterenziani@hotmail.com
authors.forename: Monica
authors.initials: M
authors.lastname: Terenziani
authors.forename: Luigi
authors.initials: L
authors.lastname: Piva
authors.forename: Filippo
authors.initials: F
authors.lastname: Spreafico
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvioni
authors.forename: Maura
authors.initials: M
authors.lastname: Massimino
authors.forename: Roberto
authors.initials: R
authors.lastname: Luksch
authors.forename: Graziella
authors.initials: G
authors.lastname: Cefalo
authors.forename: Michela
authors.initials: M
authors.lastname: Casanova
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.forename: Daniela
authors.initials: D
authors.lastname: Polastri
authors.forename: Elena
authors.initials: E
authors.lastname: Mazza
authors.forename: Franca Fossati
authors.initials: FF
authors.lastname: Bellani
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018240:Endodermal Sinus Tumor / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005500:Follow-Up Studies; D018237:Germinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007223:Infant; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D009919:Orchiectomy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013724:Teratoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D000509:alpha-Fetoproteins; D002945:Cisplatin