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Surgery, surveillance may obviate chemotherapy in 50% of stage I pediatric malignant ovarian germ cell tumors
A strategy of surgical resection followed by surveillance can eliminate the need for 50% of patients with stage I pediatric malignant ovarian germ cell tumor to undergo chemotherapy, according to findings from the Children’s Oncology Group.
Researchers evaluated 25 girls aged 0 to 16 years with stage I malignant ovarian germ cell tumor (MOGCT) between November 2003 and July 2011.
Study participants were required to have one of the following histologic characteristics: yolk sac, choriocarcinoma or embryonal carcinoma.
The serum markers alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin were measured every 3 weeks through week 9, every month from months 2 through 6, and every 3 months from months 6 to 24.
Patients were re-categorized from the surveillance stratum to intermediate-risk stratum if their serum tumor markers did not decrease at the anticipated rate after initial surgery or if they showed evidence of recurrence. These patients underwent chemotherapy with compressed PEB (cisplatin, etoposide and bleomycin) every 3 weeks for three cycles.
Investigator-assessed EFS and OS served as endpoints.
At a median follow-up of 42 months, 12 patients showed evidence of recalcitrant disease or relapse (4-year EFS, 52%; 95% CI, 31-69). The median time to relapse was 2 months. The serum marker AFP was elevated in all patients at the time of recurrence.
Of the patients with recurrences, six had localized disease, two had disease that had metastasized, and four had only elevations in serum tumor markers. Of the patients who experienced relapse, 11 of the 12 subsequently underwent successful chemotherapy (4-year OS, 96%; 95% CI, 74-99).
“Despite the increased complexity of MOGCTs in pediatric and adolescent female patients, as compared with testicular germ cell tumors, surgery followed by close surveillance resulted in excellent OS,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.