title: Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Children's Oncology Group.
abstract: OBJECTIVE
  To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection.
  
  
  METHODS
  Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m(2) on days 1 to 3, etoposide 167 mg/m(2) on days 1 to 3, bleomycin 15 U/m(2) on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52%; 95% CI, 31% to 69%). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96%; 95% CI, 74% to 99%).
  
  
  CONCLUSIONS
  Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults.
authors.affiliation: Deborah F. Billmire and Frederick J. Rescorla, Riley Hospital for Children, Indianapolis, IN; John W. Cullen, Rocky Mountain Hospital for Children-Presbyterian St Luke's Medical, Denver, CO; Mary Davis and Marc G. Schlatter, Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; Thomas A. Olson, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; Marcio H. Malogolowkin, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI; Farzana Pashankar, Yale University, New Haven, CT; Doojduen Villaluna, Children's Oncology Group, Monrovia; Mark Krailo, Keck School of Medicine, University of Southern California, Los Angeles, CA; Rachel A. Egler, Rainbow Babies and Children's Hospital, Cleveland, OH; and Carlos Rodriguez-Galindo and A. Lindsay Frazier, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA.
authors.forename: Deborah F
authors.initials: DF
authors.lastname: Billmire
authors.forename: John W
authors.initials: JW
authors.lastname: Cullen
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Rescorla
authors.forename: Mary
authors.initials: M
authors.lastname: Davis
authors.forename: Marc G
authors.initials: MG
authors.lastname: Schlatter
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Olson
authors.forename: Marcio H
authors.initials: MH
authors.lastname: Malogolowkin
authors.forename: Farzana
authors.initials: F
authors.lastname: Pashankar
authors.forename: Doojduen
authors.initials: D
authors.lastname: Villaluna
authors.forename: Mark
authors.initials: M
authors.lastname: Krailo
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Egler
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Galindo
authors.forename: A Lindsay
authors.initials: AL
authors.lastname: Frazier
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D012307:Risk Factors; D016879:Salvage Therapy; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins; D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin