Originally published as JCO Early Release 10.1200/JCO.2008.16.4202 on January 21 2009

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Cisplatin and Etoposide in Childhood Germ Cell Tumor: Brazilian Pediatric Oncology Society Protocol GCT-91

From the Brazilian Germ Cell Tumour Study Group of the Sociedade Brasileira de Oncologia Pediátrica, Centro de Tratamento e Pesquisa Hospital do Câncer; Instituto de Oncologia Pediatrica, Universidade Federal de São Paulo; Hospital Santa Marcelina; Hospital do Servidor Publico Estadual; and Instituto da Criança, Universidade de São Paulo, São Paulo; Grupo de Pediatria Oncologica, São Jose dos Campos; Centro Infantil Boldrini, Campinas; Hospital de Base do Distrito Federal, Brasilia; and Clinica Onco, Salvador, Brazil; Departement of Oncology, St Jude Children's Research Hospital, Memphis, TN; and Clinic of Pediatrics, Dortmund, Germany.

Corresponding author: Luiz Fernando Lopes, MD, PhD, Sociedade Brasileira de Oncologia Pediátrica, Av Moema, 94 cj 31, Cep 04077-020 São Paulo-SP, Brasil; e-mail: lf.lopes{at}yahoo.com.

Purpose In 1988, we formed a consortium of Brazilian institutions to develop uniform standards for the diagnostic assessment and multidisciplinary treatment of children and adolescents with germ cell tumors. We also implemented the first childhood Brazilian germ cell tumor protocol, GCT-91, evaluating two-agent chemotherapy with cisplatin and etoposide (PE). We now report on the clinical characteristics and survival of children and adolescents with germ cell tumors treated on this protocol.

Patients and Methods From May 1991 to April 2000, 115 patients (106 assessable patients) were enrolled onto the Brazilian protocol with a diagnosis of germ cell tumor.

Results Patients were treated with surgery only (n = 35) and chemotherapy (n = 71). Important prognostic factors included stage (P = .025), surgical procedure at diagnosis according to resectability (P < .032), and abnormal lactate dehydrogenase value at diagnosis (P < .001).

Conclusion The improvement in survival by the introduction of a standard protocol is an important achievement. This is of particular importance for smaller institutions with previous limited experience in the treatment of childhood germ cell tumors. In addition, the results of a two-agent regimen with PE were favorable (5-year overall survival rate is 83.3% for patients in the high-risk group [n = 36] who received PE v 58.8% for patients in the high-risk patients group who received PE plus ifosfamide, vinblastine, and bleomycin [n = 17; P = .017]). Thus for selected patients, complex three-agent regimens may not be necessary to achieve long-term survival, even for some patients with advanced disease.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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