Salvage therapy for refractory or recurrent pediatric germ cell tumors: the French SFCE experience.
OBJECTIVE
Some children with extracranial germ cell tumors (GCT) relapse after or do not respond to first-line treatment combining chemotherapy and surgery, of whom very few experience long-term survival despite multimodal salvage treatment.


METHODS
This prospective study, part of the French TGM95 Protocol for non-seminomatous GCT (NSGCT), included 19 (7%) children with malignant refractory or recurrent extracranial NSGCT who were studied to identify prognostic factors and determine the best salvage treatment.


RESULTS
At the end of the first-line treatment, 10 and 9 children were in complete and incomplete remission, respectively. Events occurred within 2 years (5-23 months) after initial diagnosis. A progression was observed in 13 patients at least in one site initially involved. Two patients had a purely biological relapse (increase in isolated markers), and four patients had a purely metastatic relapse (brain location in three cases). After salvage treatment combining surgery and various types of chemotherapy (including high-dose chemotherapy (HDCT) in 10 cases), the 5-year event-free survival and overall survival rates were of 26% (95%CI: 9.6-46.8%) and 32% (95%CI: 12.9-52.2%), respectively. Patients who underwent complete surgery (or without any detectable tumor) had higher survival rate than patients who underwent partial surgery or for whom surgery was not feasible (P = 0.0003) at first relapse while this rate was similar between patients treated or not with HDCT.


CONCLUSIONS
In pediatric recurrent or refractory NSGCT, complete excision of the tumor appears essential. The role of HDCT remains debated.
Department of Pediatrics, Institut d'Hemato-oncologie Pediatrique, Lyon, France.
Cecile
C
Faure-Conter
Daniel
D
Orbach
Claire
C
Cropet
Marie Christine
MC
Baranzelli
Hélène
H
Martelli
Estelle
E
Thebaud
Cecile
C
Vérité
Angelique
A
Rome
Sylvie
S
Fasola
Nadège
N
Corradini
Nathalie
N
Rocourt
Didier
D
Frappaz
Nicolas
N
Kalfa
Catherine
C
Patte
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007223:Infant; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D013736:Testicular Neoplasms; D014747:Vinblastine / Q000008:administration & dosage; D055815:Young Adult
D001761:Bleomycin; D014747:Vinblastine; D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide
chemotherapy; germ cell tumors; pediatric oncology