title: Clinical features, presentation, and tolerance of platinum-based chemotherapy in germ cell tumor patients 50 years of age and older.
abstract: BACKGROUND
  Germ cell tumors (GCTs) primarily affect adolescent and young adult men. Detailed clinical and treatment characteristics in older men are lacking.
  
  
  METHODS
  Patients with GCT seen over a 20-year period at Memorial Sloan-Kettering Cancer Center were identified. Primary tumor site and histology were compared for patients aged ≥  50 years at diagnosis versus younger men. For patients aged ≥  50, individual chart review was performed and treatment delays, changes, and toxicities were recorded for those treated with first-line chemotherapy.
  
  
  RESULTS
  Of 4235 diagnoses of GCT, 3999 (94.4%) were made at age  <  50 versus 236 (5.6%) at age  ≥  50. Compared with patients diagnosed before age 50, older men more frequently had seminoma (62.7% versus 36.7%) and less frequently, nonseminoma (34.7% versus 63.2%) (P  < .0001). Predominant histology switched from nonseminoma to seminoma around age 35. Distribution of primary sites also differed for older versus younger men (testis: 89.4% versus 92.9%; retroperitoneal: 3.8% versus 0.7%; CNS 0% versus 1.7%) except for mediastinal primary tumors, which remained constant across age groups. Fifty patients age  ≥  50 received first-line platinum-based chemotherapy; 30 experienced complications leading to treatment discontinuation, delay  ≥  7 days, or regimen change. Twenty-two (44%) patients experienced neutropenic fever, 6 despite prophylactic growth factor support. Estimated 5-year survival for chemotherapy-treated patients was 84.9%.
  
  
  CONCLUSIONS
  Men aged ≥ 50 years comprise less than 10% of GCT diagnoses and have distinct clinical and histological characteristics as compared with younger patients. Although complications from chemotherapy occur frequently in older men, prognosis remains excellent when risk-directed treatment is administered with curative intent.
authors.affiliation: Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. feldmand@mskcc.org
authors.forename: Darren R
authors.initials: DR
authors.lastname: Feldman
authors.forename: Martin H
authors.initials: MH
authors.lastname: Voss
authors.forename: Erin P
authors.initials: EP
authors.lastname: Jacobsen
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Jia
authors.forename: J Andres
authors.initials: JA
authors.lastname: Suarez
authors.forename: Stefan
authors.initials: S
authors.lastname: Turkula
authors.forename: Joel
authors.initials: J
authors.lastname: Sheinfeld
authors.forename: George J
authors.initials: GJ
authors.lastname: Bosl
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Motzer
authors.forename: Sujata
authors.initials: S
authors.lastname: Patil
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000556:secondary; D009503:Neutropenia / Q000139:chemically induced; D017671:Platinum Compounds / Q000008:administration & dosage; D011159:Population Surveillance; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018239:Seminoma / Q000175:diagnosis / Q000188:drug therapy; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D017671:Platinum Compounds
keywords: age over 50; cisplatin; epidemiology; germ cell tumors; histology; primary site; testicular cancer