Germ cell tumors in children: 20-year Experience of treatment in the N.N. Petrov National Medical Research Center of Oncology

Background. According to the world literature, a 5-year survival rate of 60-90% has been achieved with the use of chemotherapy for germ cell tumors (GCTs) among children. The prognosis depends on the histological variant, age, localization and prevalence of the tumor, and also on the initial level of the cancer-specific markers. Objective: to evaluate the survival rates of GCT patients under 18 years of age. Methods. Patients who were on treatment in the Department of Chemotherapy and Combined Treatment of Malignant Tumors in Children of the N.N. Petrov NMRCO from 1996 to 2017, were stratified into 3 groups (low, medium and high risk). In the Group 1 polychemotherapy was not performed; children in the Group 2 have received cytostatic treatment according to the VBP scheme; children in the Group 3 - according to the VIP scheme. 8 (11.1%) patients received therapeutic program according to the MAKEI-96 protocol. This program took into account the localization of the primary tumor, the stage of the pathological process, and the completeness of resection. The protocol offered PE and PEI schemes. The remaining patients were treated according to the following platinum-containing regimens: BEP, IGR, JEB, CADO, VAC. Results. The study included 72 patients (55 girls and 17 boys) under the age of 8 with extracranial localization of GCTs. Forty seven (65.3%) patients received therapy according to the principles of the TGM protocol. Complete remission was achieved in 59 (81.9%) patients. 14 (19.4%) children died. The mean follow-up period was 8 years (median, 5 years; IQR, 1 month to 21 years). The overall 5-year survival of GCT patients under the age of 18 years was 78.8±5%, recurrence-free survival - 76.8±5.6%, event-free survival - 61.6±5.8%, progression-free survival - 62.5±5.8%. Overall survival in the low-risk group was 100%, in the standard risk group - 92.8±3.7%, in the high-risk group - 55.1±10.1% (p=0.00097). There was significant difference in the recurrence-free survival and event-free survival rates in the standard and high-risk groups: recurrence-free survival in the standard risk group - 85.3±5.6%, in the high risk group - 53±13% (p=0.0097); event-free survival - 83.4±5.7 and 27.8±8.6%, respectively (p=0.0000). Conclusion. GCTs are the most curable oncological diseases in children. About 80% of patients with disseminated forms have a chance of recovery when using platinum-containing polychemotherapy regimens. The survival rates obtained in our study are comparable with the global ones.

germ cell tumors, platinum-containing polychemotherapy regimens