title: Cisplatin and etoposide in childhood germ cell tumor: brazilian pediatric oncology society protocol GCT-91.
abstract: 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.
authors.affiliation: 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
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Lopes
authors.forename: Carla Renata Pacheco
authors.initials: CR
authors.lastname: Macedo
authors.forename: Elitânia Marinho
authors.initials: EM
authors.lastname: Pontes
authors.forename: Simone
authors.initials: S
authors.lastname: Dos Santos Aguiar
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Mastellaro
authors.forename: Renato
authors.initials: R
authors.lastname: Melaragno
authors.forename: Sonia Maria Rossi
authors.initials: SM
authors.lastname: Vianna
authors.forename: Paula Azevedo Allemand
authors.initials: PA
authors.lastname: Lopes
authors.forename: Nubia
authors.initials: N
authors.lastname: Mendonça
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: de Assis Almeida
authors.forename: Viviane
authors.initials: V
authors.lastname: Sonaglio
authors.forename: Karina B
authors.initials: KB
authors.lastname: Ribeiro
authors.forename: Victor M
authors.initials: VM
authors.lastname: Santana
authors.forename: Dominik T
authors.initials: DT
authors.lastname: Schneider
authors.forename: Beatriz
authors.initials: B
authors.lastname: de Camargo
mesh_terms: 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
chemical_list: D005047:Etoposide; D002945:Cisplatin