title: Chemotherapy in patients with teratoma with malignant transformation.
abstract: OBJECTIVE
  Germ-cell tumours (GCTs) with a non-GCT malignant component are a unique and rare phenomenon called teratoma with malignant transformation (TMT). The only published series of patients with TMT treated with chemotherapy comprised 10 patients. We report here our experience in treating 14 patients with TMT.
  
  
  METHODS
  Sarcoma was identified in 10 of 14 patients, with rhabdomyosarcoma ranking first (n=4). Other histological types included adenocarcinoma (n=3) and bronchoalveolar carcinoma (n=1). Immunohistochemistry was performed to help in identifying the malignant non-GCT component.
  
  
  RESULTS
  Primary treatment consisted of surgery alone in 4 patients. The remaining 10 patients received first-line cisplatin-based chemotherapy with resection of residual masses (n=5): 4 patients had a complete response and 5 had a partial response. Overall, 9 patients developed a relapse with a median time of 84 mo (range: 6-168). At relapse, 8 patients received a chemotherapy regimen directed to the non-GCT component. Four of these patients achieved a partial response. With a median follow-up of 59 mo (range: 3-180), 4 of 14 patients are alive, including 3 who are disease-free.
  
  
  CONCLUSIONS
  To our knowledge, this is by far the largest reported European series of chemotherapy in TMT. Although TMT has a poor prognosis compared to GCT, its management may be improved by adapted chemotherapy associated with surgical resection of residual masses.
authors.affiliation: Department of Medicine, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94800 Villejuif, France.
authors.forename: Omar
authors.initials: O
authors.lastname: El Mesbahi
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Terrier-Lacombe
authors.forename: Christine
authors.initials: C
authors.lastname: Rebischung
authors.forename: Christine
authors.initials: C
authors.lastname: Theodore
authors.forename: Daniel
authors.initials: D
authors.lastname: Vanel
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology; D000328:Adult; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000473:pathology; D012509:Sarcoma / Q000188:drug therapy / Q000473:pathology; D013724:Teratoma / Q000188:drug therapy* / Q000473:pathology; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology