This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schneider, D. T. Articles by Göbel, U. Search for Related Content PubMed PubMed Citation Articles by Schneider, D. T. Articles by Göbel, U. Social Bookmarking                            What's this?

Treatment of Recurrent Malignant Sacrococcygeal Germ Cell Tumors: Analysis of 22 Patients Registered in the German Protocols MAKEI 83/86, 89, and 96

From the Department of Pediatric Hematology and Oncology, Children’s Hospital, and the Department of Radiotherapy, Heinrich-Heine-University, Medical Center, Düsseldorf; the Department of Radiotherapy, University of Tübingen; the Department of Pediatric Surgery, Ruhr University Bochum, Marienhospital, Herne; the Department of Pediatric Surgery, University Hospital Mannheim, Germany; and the Department of Pediatric Hematology and Oncology, St. Anna Children’s Hospital, Vienna, Austria.

Address reprint requests to D.T. Schneider, MD, Department of Pediatric Hematology and Oncology, Children’s Hospital, Heinrich-Heine-University, Medical Center, Moorenstr. 5, D-40225 Düsseldorf, Germany; email: makei{at}med.uni-duesseldorf.de

PURPOSE: To evaluate therapeutic options for recurrent malignant sacrococcygeal germ cell tumors (GCT) following three-agent, cisplatinum-based, first-line chemotherapy and tumor resection.

PATIENTS AND METHODS: Twenty-two patients were evaluated in 22 first-, 14 second-, five third-, and two fourth-relapse situations. One patient, who relapsed with pure teratoma, was excluded from the analysis of adjuvant treatment.

RESULTS: Seventeen patients presented with an isolated local recurrence, two patients showed a distant relapse, and three patients suffered from a combined local and distant recurrence. Twelve patients achieved complete remission (CR) after surgery (n = 12) and adjuvant platinum chemotherapy (n = 10). Seven of these patients remain in continuous CR, and five patients relapsed. All patients who achieved only a partial remission developed a second relapse. Three of 14 patients could be cured after a second (or further) relapse. Altogether, 10 patients survived disease free, and 12 patients died as a result of tumor progression (n = 11) or therapy-related complications (n = 1). The completeness of salvage surgery and clinical remission status after first salvage treatment were the most important prognostic parameters. In addition, patients in first or second relapse with locally advanced or poorly responding tumors benefited from preoperative chemotherapy in combination with regional hyperthermia (RHT). In some patients after microscopically incomplete resection, irradiation at doses > 45 Gy contributed to a favorable outcome.

CONCLUSION: The complete resection of the local recurrence represents the cornerstone of salvage treatment. Preoperative platinum-based chemotherapy, combined with RHT in some patients, facilitates complete tumor resection. Radiotherapy should be reserved for those patients with microscopically incomplete tumor resection. As the chance of cure decreases with further relapses, it is important to establish a stringent therapeutic strategy to avoid significant treatment delays and, most importantly, insufficient local therapy.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				R. D. Palmer, N. L. Barbosa-Morais, E. L. Gooding, B. Muralidhar, C. M. Thornton, M. R. Pett, I. Roberts, D. T. Schneider, N. Thorne, S. Tavare, et al. Pediatric Malignant Germ Cell Tumors Show Characteristic Transcriptome Profiles Cancer Res., June 1, 2008; 68(11): 4239 - 4247. [Abstract] [Full Text] [PDF]

				S. C. Wishnia, J. E. Rosen, M. A. Hamid, S. Haas, and N. Moreno-Ruiz Management of a Presacral Teratoma in an Adult J. Clin. Oncol., May 20, 2008; 26(15): 2586 - 2589. [Full Text] [PDF]