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Saliyeva S, Boranbayeva R, Bulegenova M, Zhumadullayev B, Nurzhanova G, Manzhuova L. Outcomes of pediatric extracranial germ cell tumors: A single center experience in a developing country. Rare Tumors 2024; 16:20363613231216567. [PMID: 38566825 PMCID: PMC10986168 DOI: 10.1177/20363613231216567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 11/08/2023] [Indexed: 04/04/2024] Open
Abstract
The purpose of this study was to analyze the outcomes of extracranial GCT in children in a developing country and to assess prognostic factors. The data on 141 children (<18 years old) with extracranial GCT, confirmed histopathologically, collected over the past 9 years (from February 2013 to June 2022) were retrospectively studied. The patients underwent the same therapy with platinum-containing chemotherapy regimens. In the malignant GCT group, OS and EFS were 81.0 ± 4% and 73 ± 5%, respectively. OS and EFS in the teratoma group were 90 ± 5% and 85 ± 6%. In univariate analysis, parameters like stage of disease, tumor localization, AFP level ≥10,000 ng/mL, serum AFP kinetics and resection status were found to be statistically significant prognostic factors. In the multivariate analysis, the significant adverse factors were the resection status, initial AFP level ≥10,000 ng/mL and serum AFP kinetics slow down (p = .000). Good survival rates can be achieved in developing countries with adequate compliance with treatment protocols. The analysis demonstrates high efficacy of platinum-containing chemotherapy regimens. In our opinion, the protocol used in high-income countries can be implemented in low-income countries with the financial support from the government. The qualification of specialists is also important.
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Affiliation(s)
- Symbat Saliyeva
- Oncology/hematology Department, Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
- Department of Children's Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Riza Boranbayeva
- Oncology/hematology Department, Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
- Department of Children's Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Minira Bulegenova
- Oncology/hematology Department, Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
- Department of Children's Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Bakhram Zhumadullayev
- Oncology/hematology Department, Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
| | - Gaukhar Nurzhanova
- Oncology/hematology Department, Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
| | - Lyazat Manzhuova
- Oncology/hematology Department, Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
- Department of Children's Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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2
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Coppin R, Martelli H, Chargari C, Sudour-Bonnange H, Orbach D, Vérité C, Pasquet M, Saumet L, Piguet C, Patte C, Guérin F, Faure-Conter C, Fresneau B. Outcome and late effects of patients treated for childhood vaginal malignant germ cell tumors. Pediatr Blood Cancer 2023; 70:e30697. [PMID: 37798818 DOI: 10.1002/pbc.30697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Vaginal malignant germ cell tumors (MGCT) are rare, occurring in children less than 2 years old and raise the question of the optimal local treatment. METHODS We included children treated for vaginal MGCT according to the French TGM-95/2013 regimen. Patients were classified as standard risk (SR: localized disease and alpha-fetoprotein (AFP) < 10,000 ng/mL) or high risk (HiR: metastatic and/or AFP > 10,000 ng/mL) and were treated, respectively, with three to five VBP (vinblastine-bleomycin-cisplatin) or four to six VIP (etoposide-ifosfamide-cisplatin), followed by conservative surgery and/or brachytherapy in case of post-chemotherapy residuum. RESULTS Fourteen patients were included (median age = 12 months), of which six (43%) were classified as HiR. AFP levels were normalized after first-line chemotherapy in all cases but one. A vaginal post-chemotherapy residuum (median size = 8 mm, range: 1-24 mm) was observed in 13/14 patients, treated by complete resection in seven of 13 (viable cells in three of seven), incomplete resection in four of 13 (viable cells in two of four), with adjuvant brachytherapy in two of 13, and exclusive brachytherapy in two of 13 (viable cells in one of six). Among the six patients with viable disease, four patients received adjuvant chemotherapy. One patient (SR) experienced immediate postoperative relapse despite presenting no viable residual cells and was treated with four VIP cycles and brachytherapy. At last follow-up (median = 4.6 years, range: 0.5-16), all patients were alive in complete remission. Five patients suffered from vaginal sequelae with synechiae and/or stenosis (of whom four had undergone brachytherapy). CONCLUSION Childhood vaginal MGCTs show a highly favorable prognosis with risk-adapted chemotherapy and local treatment of post-chemotherapy residuum (preferably by conservative surgery with partial vaginectomy). Brachytherapy could be an alternative when conservative surgery is not deemed possible or in cases of incomplete resection with residual viable cells.
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Affiliation(s)
- Robin Coppin
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Helene Martelli
- Department of Pediatric Surgery, Bicêtre Hospital - Assistance Publique-Hôpitaux de Paris - Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Cyrus Chargari
- Department of Radiation Therapy, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | | | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer) Institut Curie, PSL University, Paris, France
| | - Cecile Vérité
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Bordeaux, France
| | - Marlene Pasquet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Toulouse, France
| | - Laure Saumet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Montpellier, France
| | - Christophe Piguet
- Department of Pediatric Onco-Hematology, Centre Hospitalier Universitaire, Limoges, France
| | - Catherine Patte
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital - Assistance Publique-Hôpitaux de Paris - Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Cecile Faure-Conter
- Department of Pediatric Oncology, Institut d'Hemato-Oncologie Pediatrique, Lyon, France
| | - Brice Fresneau
- Department of Children and Adolescents Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
- Paris-Saclay University, Paris-Sud University, Epidemiology of Radiation, CESP, INSERM, Villejuif, France
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3
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Jiang S, Dong K, Li K, Liu J, Du X, Huang C, Jiao Y, Han Y, Yang J, Liao X, Li Y, Zhang T, Li S, Lv Z, Gao Y. Extracranial Germ Cell Tumors in Children: Ten Years of Experience in Three Children's Medical Centers in Shanghai. Cancers (Basel) 2023; 15:5412. [PMID: 38001671 PMCID: PMC10670163 DOI: 10.3390/cancers15225412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The aim was to describe the clinical features of extracranial germ cell tumors (GCTs) in pediatrics and study the clinical risk factors related to survival for malignant germ cell tumors (MGCTs) in order to optimize therapeutic options. METHODS The clinical data of children with extracranial GCTs in three children's medical centers in Shanghai were retrospectively analyzed. RESULTS In total, 1007 cases of extracranial GCTs diagnosed between 2010 and 2019 were included in this study, including teratomas (TERs) 706 (70.11%) and MGCTs 301 (29.89%). There were twice as many TER cases as MGCT cases. Approximately 50% of children with GCTs were <3 years old (43.39% for TERs, 67.13% for MGCTs). GCTs in children of different ages show differences in tumor anatomical locations and pathological subtypes. The 5-year event-free survival (EFS) and overall survival (OS) of all patients with MGCTs were 82.33% (95% CI, 77.32%, 86.62%) and 94.13% (95% CI, 90.02%, 96.69%), respectively. The multivariate Cox regression analysis identified a primary site in the mediastinum and alpha fetoprotein (AFP) levels ≥10,000 ng/mL as independent adverse prognostic factors (p < 0.0.0001, χ2 = 23.6638, p = 0.0225, χ2 = 5.2072.). There were no significant differences in OS among children receiving various chemotherapy regimens, such as the BEP, PEB, JEB and other regimens (VBP/VIP and AVCP/IEV) (p < 0.05). CONCLUSIONS The clinical features of GCTs in Chinese pediatrics are similar to those reported in children in Europe and America. The age distribution of pathological types and primary sites in GCTs reflect the developmental origin of type I and type II GCTs transformed from mismigration primordial germ cells (PGCs). Optimizing the current platinum-based chemotherapy regimens and exploring the treatment strategies for MGCTs of the mediastinum are future research directions.
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Affiliation(s)
- Shayi Jiang
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Kuiran Dong
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai 201102, China; (K.D.); (K.L.)
| | - Kai Li
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, Shanghai 201102, China; (K.D.); (K.L.)
| | - Jiangbin Liu
- Department of Pediatric Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China;
| | - Xin Du
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Can Huang
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Yangyang Jiao
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Yali Han
- Department of Hematology and Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai 200127, China;
| | - Jingwei Yang
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Xuelian Liao
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Yanhua Li
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Ting Zhang
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Shanshan Li
- Department of Hematology and Oncology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China; (S.J.); (X.D.); (C.H.); (Y.J.); (J.Y.); (X.L.); (Y.L.); (T.Z.); (S.L.)
| | - Zhibao Lv
- Department of Pediatric Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai 200061, China;
| | - Yijin Gao
- Department of Hematology and Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai 200127, China;
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Wood GE, Bunting CP, Veli M, Arora R, Berney DM, Alifrangis C, MacDonald ND, Miller RE, Shamash J, Stoneham S, Lockley M. Seminoma and dysgerminoma: evidence for alignment of clinical trials and de-escalation of systemic chemotherapy. Front Oncol 2023; 13:1271647. [PMID: 37954076 PMCID: PMC10634240 DOI: 10.3389/fonc.2023.1271647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/18/2023] [Indexed: 11/14/2023] Open
Abstract
Malignant germ cell tumours are a group of rare cancers whose incidence peaks in late adolescence and early adulthood. Dysgerminomas of the ovary and seminomas of the testis are analogous diseases, but seminomas have a 10-fold higher incidence. The two tumours are morphologically identical and are only differentiated by surrounding organ-specific tissue or testicular germ cell neoplasia in situ. They share genetic features including KIT and RAS mutations, amplification of chromosome 12p, and expression of pluripotency markers (NANOG (Nanog homeobox), OCT3/4 (Octamer-binding transcription factor 3/4), and SAL4 (Spalt-like trascription factor 4)). Both histologies are exquisitely sensitive to platinum chemotherapy, and the combination of bleomycin, etoposide, and cisplatin (BEP) yields survival rates greater than 90%. However, BEP causes significant, lifelong toxicity (cardiovascular, renal, respiratory, and neurological) in these young patients with an expectation of cure. Here, we comprehensively review the biological features of dysgerminoma and seminoma to demonstrate that they are biologically analogous diseases. We present available clinical trial data supporting de-escalation of chemotherapy treatment. Finally, we propose that future trials should enrol men, women, and children to benefit all patients regardless of age or sex.
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Affiliation(s)
- Georgina E. Wood
- Medical Oncology, University College London Hospital, London, United Kingdom
| | - Christopher P. Bunting
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mesel Veli
- Medical Oncology, University College London Hospital, London, United Kingdom
| | - Rupali Arora
- Histopathology, University College London Hospital, London, United Kingdom
| | | | | | - Nicola D. MacDonald
- Department of Gynaecology, University College London Hospital, London, United Kingdom
| | - Rowan E. Miller
- Medical Oncology, University College London Hospital, London, United Kingdom
- Medical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Jonathan Shamash
- Medical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Sara Stoneham
- Paediatric Oncology, University College London Hospital, London, United Kingdom
| | - Michelle Lockley
- Medical Oncology, University College London Hospital, London, United Kingdom
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Huang TH, Hung GY, Weng TF, Wang FM, Lee CY, Lin DT, Chen BW, Lin KH, Wu KH, Liu HC, Chen JS, Jou ST, Hou JY, Yang YL, Chen SH, Chang HH, Chiou SS, Lin PC, Chen RL, Hsiao CC, Yen HJ, Yang CP, Chang TK, Lu MY, Cheng CN, Sheen JM, Liao YM, Su MY, Yeh TC. Surgical treatment confers prognostic significance in pediatric malignant mediastinal germ cell tumors. Cancer 2022; 128:4139-4149. [PMID: 36223226 DOI: 10.1002/cncr.34494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Primary malignant mediastinal germ cell tumors (GCTs) are rare pediatric tumors that have a poorer prognosis compared to GCTs occurring elsewhere in the body. The current study aimed to assess the prognostic factors and treatment outcomes of children with primary malignant mediastinal GCT in Taiwan. METHODS The authors retrospectively reviewed children 0-18 years old who were newly diagnosed with primary malignant mediastinal GCT between January 1, 2005 and December 31, 2019 and were registered in the Taiwan Pediatric Oncology Group patient registry. The impact of presenting characteristics, including sex, age, tumor stage, histology subtype, surgical treatment, and chemotherapy regimens of the patients were analyzed. RESULTS This study enrolled 52 children with malignant mediastinal GCT who had a median age of 16.0 (range, 6.0-17.9) years at diagnosis. The most common histological subtypes were mixed GCTs (n = 20) and yolk sac tumors (n = 15). Advanced disease stage and choriocarcinoma histology subtype were associated inferior outcomes. Children who received surgical treatment exhibited better outcomes compared to those who did not (5-year overall survival, 78% vs. 7%, p < .001). After comparing patients who received first-line cisplatin- and carboplatin-based chemotherapy, no difference in treatment outcomes was observed. Multivariate analysis showed that surgical management was the only independent predictor for superior OS. CONCLUSIONS Surgical treatment is recommended for mediastinal GCT. Cisplatin-based chemotherapy was not superior to carboplatin-based chemotherapy as first-line treatment and may be avoided due to toxicity concerns.
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Affiliation(s)
- Ting-Huan Huang
- Division of Pediatric Hematology/Oncology, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Giun-Yi Hung
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Te-Fu Weng
- Division of Pediatric Hematology/Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Fu-Mien Wang
- Division of Pediatric Hematology/Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Ying Lee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Dong-Tsamn Lin
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Bow-Wen Chen
- Department of Pediatrics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Kai-Hsin Lin
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Kang-Hsi Wu
- Division of Pediatric Hematology/Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsi-Che Liu
- Division of Pediatric Hematology/Oncology and Mackay Medical College, MacKay Children's Hospital, Taipei, Taiwan
| | - Jiann-Shiuh Chen
- Division of Pediatric Hematology/Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shiann-Tarng Jou
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Jen-Yin Hou
- Division of Pediatric Hematology/Oncology and Mackay Medical College, MacKay Children's Hospital, Taipei, Taiwan
| | - Yung-Li Yang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Hao Chang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Shyh-Shin Chiou
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chin Lin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Rong-Long Chen
- Department of Pediatrics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chih-Cheng Hsiao
- Division of Pediatric Hematology/Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsiu-Ju Yen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chao-Ping Yang
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Te-Kau Chang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Meng-Yao Lu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Chao-Neng Cheng
- Division of Pediatric Hematology/Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jiunn-Ming Sheen
- Division of Pediatric Hematology/Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Mei Liao
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Min-Yu Su
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Ting-Chi Yeh
- Division of Pediatric Hematology/Oncology and Mackay Medical College, MacKay Children's Hospital, Taipei, Taiwan
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Watson L, Gavens E, Pachl M, Singh M, Soccorso G, McCarthy L, Arul GS. Controlled aspiration of large paediatric ovarian cystic tumours. J Pediatr Surg 2022; 57:711-714. [PMID: 34348845 DOI: 10.1016/j.jpedsurg.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 01/27/2023]
Abstract
AIM Cystic ovarian masses in children may be physiological or neoplastic. It is mandatory that suspected neoplastic lesions are resected without tumour spillage. However, a large midline incision is cosmetically unappealing incision to young women. Here we describe our experience of using controlled drainage without spillage that allows a cosmetic pfannenstiel approach without compromising oncological principles. METHOD All girls treated with large ovarian cystic masses since 2008 in our centre were identified and data was collected prospectively. A small pfannenstiel incision was performed followed by peritoneal washings; tissue glue was used to stick an Opsite™ dressing to the cyst surface and fluid drained so there was no leakage back into the patient. Once aspirated the cyst was delivered and an ovarian preserving cystectomy was performed where possible. RESULTS Twenty-three girls (median age 14.5 years (8.1 to 16.5 years) were included. Pre-operative MRI scan showed a complex lesions with median volume of 1169 ml (range 252-7077 ml). At surgery 22/23 cysts were intact and removed without spillage. HISTOLOGY mature teratoma (11), serous cyst (3), mucinous cyst adenocarcinoma (2), mucinous cystadenoma (5), Sertoli-Leydig tumour, sclerosing stromal tumour. One girl with pre-operative rupture of a mucinous adenocarcinoma subsequently died. Ovarian sparing cystectomy was performed in 17/23 girls. All other patients are well without evidence of recurrence. CONCLUSION This is the largest series in children and adolescents using controlled drainage of cystic ovarian tumours. Though there were a range of diagnoses we have shown that these can be removed safely with a cosmetic pfannenstiel approach while following oncological principles.
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Affiliation(s)
- Lucy Watson
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Elizabeth Gavens
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Max Pachl
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Mike Singh
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Giampiero Soccorso
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Liam McCarthy
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - G Suren Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
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7
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Jain R, Menon P, Bansal D, Kakkar N, Radhika S, Rao KLN, Trehan A. Outcome of pediatric germ cell tumor with comparison of carboplatin and cisplatin based regimens: A 10-year analysis. Pediatr Hematol Oncol 2022; 39:267-277. [PMID: 34665989 DOI: 10.1080/08880018.2021.1980164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Carboplatin is being advocated more frequently for treatment of childhood germ cell tumors (GCT), due to less long-term toxicity, and demonstrable equivalence in outcome as compared to cisplatin. This analysis presents the survival of GCT in a low middle-income country and compares two different chemotherapeutic regimens. A retrospective analysis of patient case records was carried out over 10-years (January 2007-December 2016). Chemotherapy regimen used was bleomycin, etoposide, and cisplatin (PEb) for initial 6-½ years and carboplatin, etoposide, and bleomycin (CEb) subsequently. Ninety patients with GCT were treated over 10-years. Malignant GCT was diagnosed in 69 (77%) patients, with 21(23%) having teratoma. The chemotherapy protocol was PEb in 38 (42%), CEb in 28 (31%) patients, while 24 patients were treated with surgery only. Stage 4 tumor was observed in 19 (21%) patients. Relapse or disease progression was seen in 11(12%). Overall and event-free survival at 5-years for the entire cohort was 77% and 73%, being similar with PEb (OS:77%; EFS:72.5%) vs. CEb (OS:69%; EFS: 69%). Significantly better overall survival was noted for patients with gonadal GCT) and non-stage 4 disease, while event-free survival was significantly better in patients with non-stage 4 disease. The chemotherapeutic regimen (PEb vs. CEb), very high AFP (value ≥10,000 IU/L), and risk stratification (low, intermediate, or high-risk disease) did not affect survival significantly. Carboplatin-based strategy was equivalent in our cohort to cisplatin-based strategy, and could be used safely in the LMIC set-up. The overall survival is suboptimal, with delayed presentation, abandonment, and relapse being barriers to survival.
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Affiliation(s)
- Richa Jain
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Prema Menon
- Pediatric Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepak Bansal
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Nandita Kakkar
- Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Srinivasan Radhika
- Cytopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - K L N Rao
- Pediatric Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Alifrangis C, Sharma A, Chowdhury S, Duncan S, Milic M, Gogbashian A, Agarwal S, Sahdev A, Wilson P, Harland S, Stoneham S, Lockley M, Rustin G, Oliver T, Berney D, Shamash J. Single-agent carboplatin AUC10 in metastatic seminoma: A multi-centre UK study of 216 patients. Eur J Cancer 2022; 164:105-113. [PMID: 33041185 DOI: 10.1016/j.ejca.2020.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/10/2020] [Accepted: 08/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiotherapy and cisplatin-based combination chemotherapy are accepted standard-of-care treatments for metastatic seminoma with excellent survival outcomes but with established short- and long-term morbidity. Carboplatin monotherapy may be a less toxic alternative; however early historic studies at AUC7 showed inferior outcomes. OBJECTIVES To evaluate multi-institutional data on and toxicity and longer-term survival for metastatic seminoma patients treated with the single-agent carboplatin AUC10. METHODS We undertook a multi-institutional analysis incorporating all men with the International Germ Cell Cancer Collaborative Group good-prognosis metastatic seminoma treated until 2018. Carboplatin AUC10 was given every 21 days. Toxicity, progression-free survival (PFS), disease-specific survival (DSS) and overall survival were noted. Variables predictive of progression were identified. RESULTS AND LIMITATIONS 216 patients were treated. The three-year PFS rate was 96.5%, and five-year DSS was 98.3%. There were seven relapses, of which 5 were successfully salvaged with further chemotherapy ± surgery, and three non-seminoma-related deaths. There were no treatment-related deaths. Of 148/216 evaluable patients for toxicity, 37% and 27% suffered >/ = grade III neutropenia and thrombocytopenia, respectively. Twelve percent of patients needed a platelet or blood transfusion (or both). The incidence of febrile neutropenia was 5%. CONCLUSION For metastatic seminoma, carboplatin AUC10 harbours a similar oncological efficacy to established therapies, with a low failure risk. The major acute toxicity was myelosuppression. Our study establishes carboplatin AUC10 as another standard-of-care treatment option for good-prognosis metastatic seminoma, with a potentially lower toxicity profile than other therapies.
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Affiliation(s)
- Constantine Alifrangis
- University College London Hospitals NHS Trust, NW1 2BU, UK; Department of Medical Oncology, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | - Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, HA6 2RN, UK
| | - Shafi Chowdhury
- Department of Medical Oncology, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | - Sarah Duncan
- Department of Medical Oncology, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | - Marina Milic
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, HA6 2RN, UK
| | - Andrew Gogbashian
- Department of Radiology, Mount Vernon Cancer Centre, Paul Strickland Scanner Centre, Northwood, HA6 2RN, UK
| | - Samita Agarwal
- Department of Histopathology, East and North Herts NHS Trust, Lister Hospital Stevenage, SG1 4AB, UK
| | - Anju Sahdev
- Department of Radiology, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | - Peter Wilson
- Department of Medical Oncology, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | | | - Sara Stoneham
- University College London Hospitals NHS Trust, NW1 2BU, UK
| | - Michelle Lockley
- University College London Hospitals NHS Trust, NW1 2BU, UK; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, UK
| | - Gordon Rustin
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, HA6 2RN, UK
| | - Timothy Oliver
- Department of Medical Oncology, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | - Daniel Berney
- Department of Histopathology, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | - Jonathan Shamash
- Department of Medical Oncology, St Bartholomew's Hospital, London, EC1A 7BE, UK.
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9
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Shaikh F, Stark D, Fonseca A, Dang H, Xia C, Krailo M, Pashankar F, Rodriguez-Galindo C, Olson TA, Nicholson JC, Murray MJ, Amatruda JF, Billmire D, Stoneham S, Frazier AL. Outcomes of adolescent males with extracranial metastatic germ cell tumors: A report from the Malignant Germ Cell Tumor International Consortium. Cancer 2020; 127:193-202. [PMID: 33079404 DOI: 10.1002/cncr.33273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescents with extracranial metastatic germ cell tumors (GCTs) are often treated with regimens developed for children, but their clinical characteristics more closely resemble those of young adult patients. This study was designed to determine event-free survival (EFS) for adolescents with GCTs and compared them with children and young adults. METHODS An individual patient database of 11 GCT trials was assembled: 8 conducted by pediatric cooperative groups and 3 conducted by an adult group. Male patients aged 0 to 30 years with metastatic, nonseminomatous, malignant GCTs of the testis, retroperitoneum, or mediastinum who were treated with platinum-based chemotherapy were included. The age groups were categorized as children (0 to <11 years), adolescents (11 to <18 years), and young adults (18 to ≤30 years). The study compared EFS and adjusted for risk group by using Cox proportional hazards analysis. RESULTS From a total of 2024 individual records, 593 patients met the inclusion criteria: 90 were children, 109 were adolescents, and 394 were young adults. The 5-year EFS rate was lower for adolescents (72%; 95% confidence interval [CI], 62%-79%) than children (90%; 95% CI, 81%-95%; P = .003) or young adults (88%; 95% CI, 84%-91%; P = .0002). The International Germ Cell Cancer Collaborative Group risk group was associated with EFS in the adolescent age group (P = .0020). After adjustments for risk group, the difference in EFS between adolescents and children remained significant (hazard ratio, 0.30; P = .001). CONCLUSIONS EFS for adolescent patients with metastatic GCTs was similar to that for young adults but significantly worse than for that children. This finding highlights the importance of coordinating initiatives across clinical trial organizations to improve outcomes for adolescents and young adults. LAY SUMMARY Adolescent males with metastatic germ cell tumors (GCTs) are frequently treated with regimens developed for children. In this study, a large data set of male patients with metastatic GCTs across different age groups has been built to understand the outcomes of adolescent patients in comparison with children and young adults. The results suggest that adolescent males with metastatic GCTs have worse results than children and are more similar to young adults with GCTs. Therefore, the treatment of adolescents with GCTs should resemble therapeutic approaches for young adults.
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Affiliation(s)
- Furqan Shaikh
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Stark
- Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Adriana Fonseca
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ha Dang
- Children's Oncology Group, Monrovia, California
| | - Caihong Xia
- Children's Oncology Group, Monrovia, California
| | - Mark Krailo
- Children's Oncology Group, Monrovia, California
| | | | | | - Thomas A Olson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - James C Nicholson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Matthew J Murray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James F Amatruda
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | | | - Sara Stoneham
- Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom
| | - A Lindsay Frazier
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
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