The effect of neoadjuvant chemotherapy and surgery in children with malignant germ cell tumors of the genital region: a pediatric intergroup trial.
OBJECTIVE
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 (MGCT) of the genital region.


METHODS
Fourteen of 317 children enrolled in to the Pediatric Oncology Group/Children's Cancer Group intergroup study of MGCT from 1990 through 1996 had genital tumors. Thirteen were eligible for inclusion (12 vaginal, one penile). The initial procedure was biopsy in 11 and subtotal resection in 2. Patients were assigned randomly to receive 4 cycles of etoposide, bleomycin, and either standard or high-dose cisplatin.


RESULTS
Nine children underwent postchemotherapy excision of the residual site, and 2 had subsequent biopsies to confirm a complete response. Two with relapse were saved with additional therapy, and one with progressive disease died. The 4-year event-free survival rate in these patients is 76.2% +/- 13.1%, and 4-year survival rate is 91.7% +/- 8.4%.


CONCLUSIONS
The author conclude that: (1) the current survival rate for genital MGCT is excellent, (2) delayed surgical resection with organ preservation is not associated with an adverse outcome, and (3) the treatment comparison of the effect of cisplatin dose was inconclusive in this small study population.
Rescorla
Frederick
F
Indiana University School of Medicine, Indianapolis, IN, USA.
Billmire
Deborah
D
Vinocur
Charles
C
Colombani
Paul
P
London
Wendy
W
Giller
Roger
R
Cushing
Barbara
B
Lauer
Stephen
S
Cullen
John
J
Davis
Mary
M
Hawkins
Edith
E
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018237:Germinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods*; D009373:Neoplasms, Germ Cell and Embryonal; D010412:Penile Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D014565:Urogenital Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D014625:Vaginal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery
D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin