title: Is surgical resection and observation sufficient for stage I and II sacrococcygeal germ cell tumors? A case series and review.
abstract: Sacrococcygeal teratoma (SCT) is the most common germ cell tumor (GCT) of infancy. Up to 35% of infants may have malignant elements. The standard of care for SCT with malignant elements (SCT-ME) has been surgery and chemotherapy. However, cases where low-stage SCT-ME have been successfully observed following resection have been reported.
  
  
  
  To better understand the outcomes of low-stage SCT-ME that do not receive chemotherapy, we reviewed SCT pathology reports from five children's hospitals from 1999 to 2009. Information regarding staging workup, tumor markers, treatment, and outcome was collected for patients with stage I or II SCT-ME. An English language literature review was also performed.
  
  
  
  Seventy-four SCT were identified: 51 stage I and 23 stage II; 13 (18%) were SCT-ME: 5 stage I and 8 stage II; four stage I and four stage II tumors were not treated with chemotherapy. No stage I tumors recurred; all of the stage II tumors recurred and were successfully salvaged, two had no ME at recurrence. We identified another 10 stage I SCT-ME in the literature managed with active surveillance-two recurred and were successfully treated with surgery and chemotherapy.
  
  
  
  Overall, of the 14 cases of stage I SCT-ME, 12 survived with no recurrence and the two who did recur were successfully treated with platinum-based chemotherapy (EFS = 86%, overall survival [OS] = 100%); this suggests that patients with stage I SCT-ME could be observed after surgery and treated only upon recurrence. Stage II SCT-ME require further study in a clinical trial setting.
authors: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors: Rachel A
authors: RA
authors: Egler
authors: Division of Hematology, Oncology & Transplantation, Robert Lurie Comprehensive Cancer Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Yasmin
authors: Y
authors: Gosiengfiao
authors: Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors: Heidi
authors: H
authors: Russell
authors: Division of Pediatric Hematology-Oncology, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Jonathan E
authors: JE
authors: Wickiser
authors: Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts.
authors: A Lindsay
authors: AL
authors: Frazier
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012445:Sacrococcygeal Region / Q000473:pathology* / Q000601:surgery; D013724:Teratoma / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor
keywords: germ cell tumor; sacrococcygeal teratoma; surveillance