Childhood ovarian non-seminomatous germ cell tumors: A Highly Curable Disease With Few Long-Term Treatment-Related Toxicities. Results of the French TGM95 study.
Fiche publication
Date publication
juin 2021
Journal
International journal of cancer
Auteurs
Membres identifiés du Cancéropôle Est :
Pr CHASTAGNER Pascal
Tous les auteurs :
Pavone R, Pacquement H, Pasquet M, Sudour-Bonnange H, Hameury F, Sarnacki S, Chastagner P, Faure-Conter C, Poirée M, Taque S, Patte C, Fresneau B
Lien Pubmed
Résumé
We report survival and late effects analysis of TGM95 study for childhood (≤18years) ovarian non-seminomatous germ cell tumors (NS-GCT). Patients with localized tumors (FIGO-stage IA) had no adjuvant treatment (low-risk, LR). Patients with advanced-stage received 3-5 VBP (vinblastin-bleomycin-cisplatinum) in intermediate-risk group (IR: FIGO-stage IC-II-III and AFP<15,000ng/ml) or 4-6 VIP (etoposide-ifosfamide-cisplatinum) in high-risk group (HiR: metastatic or AFP≥15,000ng/ml). Seventy-seven patients were included (median age=12years): 14 LR (13 FIGO-stage IA, 1 retrospectively IC), 26 IR (12 IC, 12 II-III, 2 not-available) and 37 HiR (2 IA with AFP≥15,000ng/ml, 27 II-III, 8 IV). After a median follow-up of 13.4years, 12 events (8 relapses) and 6 deaths (2 GCT-related, 2 due to acute myeloid leukemia and 2 non-cancer related) occurred. All relapses (6 LR, 1 IR) occurred within 2years. Four contralateral mature teratomas were observed within 8years. Five-year EFS and OS were 88.2% (95%CI=79-94%) and 94.6% (95%CI=87-98%). Seven patients (9%) had bilateral gonadectomy. Among 51 survivors at 2years aged>15years (median=26years) with remaining ovarian tissue, all had developed spontaneous puberty and 21 (41%) had at least one pregnancy (including two with infertility treatment). Among 69 patients treated with platinum-based chemotherapy, chronic-kidney-disease was diagnosed in 4 patients (3 after VIP) and significant ototoxicity occurred in 3 (all grade-2). Childhood ovarian NS-GCTs have an excellent prognosis with few late effects. The low-intensive etoposide-free VBP regimen could be an alternative in children with IR disease especially in cases of tumor rupture. The risk of contralateral mature teratoma needs regular monitoring of the remaining ovary. This article is protected by copyright. All rights reserved.
Référence
Int J Cancer. 2021 Jun 19;: