Clinical stage I nonseminomatous germ cell tumors of the testis in childhood and adolescence: an analysis of 31 cases.

Abstract

A 20-year single-institution experience of clinical stage I nonseminomatous germ cell tumors of the testis (NSGCTT) in childhood and adolescents was reviewed in relation to clinical characteristics, treatment modalities, and survival. Thirty-one patients with clinical stage I NSGCTT were seen between 1980 and 2000: 14 children and 17 adolescents. Yolk sac tumors and/or teratomas occurred in the children, whereas mixed histologies, including embryonal carcinoma, were predominant in the adolescents. After orchiectomy, the children were assigned to surveillance and the adolescents to active treatment: 16 underwent retroperitoneal lymph node dissection (RPLND) and 1 had adjuvant cisplatin-based chemotherapy because of a high-risk histology. Three of the 14 children (21.4%) relapsed 3, 7, and 8 months after orchiectomy: all 3 had yolk sac tumors and presented with increased alpha-fetoprotein levels. No patients had retroperitoneal relapse; two recurred locally and one in the lung. All three children were treated with cisplatin-based chemotherapy with or without surgery. Among the 16 adolescents undergoing RPLND, 4 (25%) had nodal metastases. Three of the 12 patients (25%) who had negative nodes at RPLND relapsed in the lung 3, 7, and 8 months after RPLND. All were treated with cisplatin-based chemotherapy with or without surgery. Five-year relapse-free and overall survival rates for the whole series were 80.6% and 100%, respectively. This series enabled the authors to pinpoint several important aspects of stage I NSGCTT in children and adolescents. In particular, almost all the childhood cases had the same yolk sac tumor histology, the children tended to have localized disease, and an increased alpha-fetoprotein level had a very high predictive value, suggesting that follow-up should include AFP measurements. A conservative approach is the best option in children, while adolescent NSGCTT behaves like the adult disease and management must include similar treatment strategies.

• Authors: Monica Terenziani, Luigi Piva, Filippo Spreafico, Roberto Salvioni, Maura Massimino, Roberto Luksch, Graziella Cefalo, Michela Casanova, Andrea Ferrari, Daniela Polastri, Elena Mazza, Franca Fossati Bellani, Nicola Nicolai
• Journal: Journal of pediatric hematology/oncology (J Pediatr Hematol Oncol) 2002 Aug-Sep Vol. 24 Issue 6 Pg. 454-8 ISSN: 1077-4114 [Print] United States
• PMID: 12218592 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antineoplastic Agents
• alpha-Fetoproteins
• Cisplatin

Topics

• Adolescent
• Antineoplastic Agents (therapeutic use)
• Child
• Child, Preschool
• Cisplatin (therapeutic use)
• Combined Modality Therapy
• Endodermal Sinus Tumor (mortality, pathology, therapy)
• Follow-Up Studies
• Germinoma (mortality, pathology, therapy)
• Humans
• Infant
• Lymph Node Excision
• Lymphatic Metastasis
• Male
• Neoplasm Staging
• Orchiectomy
• Retrospective Studies
• Risk Factors
• Survival Rate
• Teratoma (mortality, pathology, therapy)
• Testicular Neoplasms (mortality, pathology, therapy)
• alpha-Fetoproteins (metabolism)