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Half of Patients With Stage I Pediatric Malignant Ovarian Germ Cell Tumors Can Be Spared Chemotherapy After Initial Surgery With Surveillance Strategy

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Key Points

  • Recurrence was observed in 12 of 25 patients at 1 to 8 months after surgery.
  • All patients responded to salvage chemotherapy initiated at relapse.
  • Four-year overall survival was 96%.

In a Children’s Oncology Group study (AGCT0132) reported in the Journal of Clinical Oncology, Billmire et al found that overall survival can be preserved in patients with stage I pediatric malignant ovarian germ cell tumor with a strategy of initial surveillance after surgical resection.

Study Details

The study involved 25 girls aged 0 to 16 years with stage I malignant ovarian germ cell tumors enrolled between November 2003 and July 2011. Required histologies included yolk sac tumor, embryonal carcinoma, or choriocarcinoma. Surveillance consisted of regular measurement of serum tumor markers and radiologic imaging. Patients with residual or recurrent disease received chemotherapy with compressed PEB (cisplatin at 33 mg/m2 on days 1–3, etoposide at 167 mg/m2 on days 1–3, and bleomycin at 15 U/m2 on day 1) every 3 weeks for three cycles.

Patients had a median age of 12 years, and 23 had elevated alpha-fetoprotein at diagnosis. Histologies consisted of pure yolk sac tumor in eight patients, yolk sac tumor plus mature teratoma in three, yolk sac tumor plus immature teratoma in seven, and mixed malignancy in seven.

Recurrence and Survival

After a median follow-up of 42 months, 4-year event-free survival was 52% (95% confidence interval [CI] = 31%–69%) and 4-year overall survival was 96% (95% CI = 74%–99%). Tumor events requiring chemotherapy occurred in 12 patients from 1 to 8 months after surgery (median, 2 months). All 12 had increased alpha-fetoprotein; no mass was detected in four, five had localized pelvic disease, two had metastatic disease to the liver and pleura, and one had unknown site of relapse.

All patients responded to salvage chemotherapy. Two patients had a second relapse. One received alternate chemotherapy, with subsequent biopsy showing viable yolk sac tumor. She died due to tumor progression at 16 months after diagnosis. The second patient received paclitaxel, ifosfamide, and carboplatin (as part of Children’s Oncology Group study AGCT0521) and was alive and disease-free at 2 years after completing therapy.

The investigators concluded, “Fifty percent of patients with stage I pediatric [malignant ovarian germ cell tumors] can be spared chemotherapy; treatment for those who experience recurrence preserves [overall survival]. 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.”

Deborah F. Billmire, MD, of Indiana University, is the corresponding author for the Journal of Clinical Oncology article.

The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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