Cisplatin and etoposide in childhood germ cell tumor: brazilian pediatric oncology society protocol GCT-91.
OBJECTIVE
In 1988, we formed a consortium of Brazilian institutions to develop uniform standards for the diagnostic assessment and multidisciplinary treatment of children and adolescents with germ cell tumors. We also implemented the first childhood Brazilian germ cell tumor protocol, GCT-91, evaluating two-agent chemotherapy with cisplatin and etoposide (PE). We now report on the clinical characteristics and survival of children and adolescents with germ cell tumors treated on this protocol.


METHODS
From May 1991 to April 2000, 115 patients (106 assessable patients) were enrolled onto the Brazilian protocol with a diagnosis of germ cell tumor.


RESULTS
Patients were treated with surgery only (n = 35) and chemotherapy (n = 71). Important prognostic factors included stage (P = .025), surgical procedure at diagnosis according to resectability (P < .032), and abnormal lactate dehydrogenase value at diagnosis (P < .001).


CONCLUSIONS
The improvement in survival by the introduction of a standard protocol is an important achievement. This is of particular importance for smaller institutions with previous limited experience in the treatment of childhood germ cell tumors. In addition, the results of a two-agent regimen with PE were favorable (5-year overall survival rate is 83.3% for patients in the high-risk group [n = 36] who received PE v 58.8% for patients in the high-risk patients group who received PE plus ifosfamide, vinblastine, and bleomycin [n = 17; P = .017]). Thus for selected patients, complex three-agent regimens may not be necessary to achieve long-term survival, even for some patients with advanced disease.
Lopes
Luiz Fernando
LF
Brazilian Germ Cell TumourStudy Group of the Sociedade Brasileira de Oncologia Pediátrica, Av Moema, 94 cj 31, Cep 04077-020 São Paulo-SP, Brasil. lf.lopes@yahoo.com
Macedo
Carla Renata Pacheco
CR
Pontes
Elitânia Marinho
EM
Dos Santos Aguiar
Simone
S
Mastellaro
Maria José
MJ
Melaragno
Renato
R
Vianna
Sonia Maria Rossi
SM
Lopes
Paula Azevedo Allemand
PA
Mendonça
Nubia
N
de Assis Almeida
Maria Teresa
MT
Sonaglio
Viviane
V
Ribeiro
Karina B
KB
Santana
Victor M
VM
Schneider
Dominik T
DT
de Camargo
Beatriz
B
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate
D005047:Etoposide; D002945:Cisplatin