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PROMISING OUTCOMES OF EXTRACRANIAL GERM CELL TUMORS IN CHILDREN & ADOLESCENTS: LESSONS LEARNT OVER A DECADE.
  • +9
  • Subramaniam Ramanathan,
  • Maya Prasad,
  • Tushar Vora,
  • BADIRA CHERIYALINKAL PARAMBIL,
  • Seema Kembhavi,
  • Mukta Ramadwar,
  • Nehal Khanna,
  • Siddhartha Laskar,
  • PURNA KURKURE,
  • Sajid Qureshi,
  • Sripad Banavali,
  • Girish Chinnaswamy
Subramaniam Ramanathan
Tata Memorial Centre
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Maya Prasad
Tata Memorial Hospital
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Tushar Vora
Tata Memorial Centre
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BADIRA CHERIYALINKAL PARAMBIL
Tata Memorial Centre
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Seema Kembhavi
Tata Memorial Hospital
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Mukta Ramadwar
Tata Memorial Centre
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Nehal Khanna
Tata Memorial Centre
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Siddhartha Laskar
Tata Memorial Centre
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PURNA KURKURE
Tata Memorial Centre
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Sajid Qureshi
Tata Memorial Centre
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Sripad Banavali
Tata Memorial Centre
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Girish Chinnaswamy
Tata Memorial Centre
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Abstract

Background: The purpose of this single-centre study was to analyse the outcomes of extracranial germ cell tumors (GCTs) in children treated on a multi-modality regimen at a single-centre. Methods: Retrospective study of children (<18 years) with a histopathologically confirmed diagnosis of extracranial GCT over a period of 10 years (January’09-December’18) treated on a uniform institution-based protocol. All completely excised teratomas and stage I gonadal tumors received no further therapy (low risk); Stage IV Ovarian, Stage III-IV extragonadal GCTs received 6 cycles of chemotherapy (high risk) and the remaining received 4 cycles of chemotherapy (intermediate risk). Results: A total of 336 kids were treated of which the analysable cohort comprised of 297with a boy-girl ratio of 1.72:1 and median age of 4 years. Gonadal GCTs(n-180) were commoner than extragonadal GCTs(n-117) with ovary as primary site in 128 children(43%) and sacrococcygeal site being the commonest extragonadal location(n-41;14%). LR, IR and HR disease were noted in 60(20.2%) patients, 125(42%)patients and 112(37.8%)patients respectively. Forty-one patients relapsed and 43 children expired (disease related-33; toxic deaths-9; unknown-1). The 5-year EFS/OS was 79.3%/84.4% respectively with gonadal site, low-risk and non-metastatic disease associated with statistically better EFS (median follow-up:52.1±37.3 months). Conclusion(s): Both cisplatin and carboplatin based regimens had comparable outcomes. The low and intermediate GCTs had an excellent outcome, thus warranting a gradual shift in the approach to these tumors by reducing therapy and decreasing late effects of therapy. In high risk GCTs however, intensifying therapies to improve outcomes must be balanced against the risk of cumulative toxicity.