Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors

Report from the children's oncology group

Deborah F. Billmire, John W. Cullen, Frederick J. Rescorla, Mary Davis, Marc G. Schlatter, Thomas A. Olson, Marcio Malogolowkin, Farzana Pashankar, Doojduen Villaluna, Mark Krailo, Rachel A. Egler, Carlos Rodriguez-Galindo, A. Lindsay Frazier

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection. Patients and Methods: Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m2 on days 1 to 3, etoposide 167 mg/m2 on days 1 to 3, bleomycin 15 U/m2 on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method. Results: Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52%; 95% CI, 31% to 69%). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96%; 95% CI, 74% to 99%). Conclusion: Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults.

Original languageEnglish (US)
Pages (from-to)465-470
Number of pages6
JournalJournal of Clinical Oncology
Volume32
Issue number5
DOIs
StatePublished - Feb 10 2014
Externally publishedYes

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Germ Cell and Embryonal Neoplasms
Pediatrics
Recurrence
Yolk Sac
Survival
Bleomycin
alpha-Fetoproteins
Etoposide
Tumor Biomarkers
Drug Therapy
Cisplatin
Disease-Free Survival
Histology
Embryonal Carcinoma
Choriocarcinoma
Survivors
Young Adult
Biomarkers

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors : Report from the children's oncology group. / Billmire, Deborah F.; Cullen, John W.; Rescorla, Frederick J.; Davis, Mary; Schlatter, Marc G.; Olson, Thomas A.; Malogolowkin, Marcio; Pashankar, Farzana; Villaluna, Doojduen; Krailo, Mark; Egler, Rachel A.; Rodriguez-Galindo, Carlos; Frazier, A. Lindsay.

In: Journal of Clinical Oncology, Vol. 32, No. 5, 10.02.2014, p. 465-470.

Research output: Contribution to journalArticle

Billmire, DF, Cullen, JW, Rescorla, FJ, Davis, M, Schlatter, MG, Olson, TA, Malogolowkin, M, Pashankar, F, Villaluna, D, Krailo, M, Egler, RA, Rodriguez-Galindo, C & Frazier, AL 2014, 'Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: Report from the children's oncology group', Journal of Clinical Oncology, vol. 32, no. 5, pp. 465-470. https://doi.org/10.1200/JCO.2013.51.1006
Billmire, Deborah F. ; Cullen, John W. ; Rescorla, Frederick J. ; Davis, Mary ; Schlatter, Marc G. ; Olson, Thomas A. ; Malogolowkin, Marcio ; Pashankar, Farzana ; Villaluna, Doojduen ; Krailo, Mark ; Egler, Rachel A. ; Rodriguez-Galindo, Carlos ; Frazier, A. Lindsay. / Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors : Report from the children's oncology group. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 5. pp. 465-470.
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abstract = "Purpose: To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection. Patients and Methods: Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m2 on days 1 to 3, etoposide 167 mg/m2 on days 1 to 3, bleomycin 15 U/m2 on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method. Results: Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52{\%}; 95{\%} CI, 31{\%} to 69{\%}). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96{\%}; 95{\%} CI, 74{\%} to 99{\%}). Conclusion: Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults.",
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T1 - Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors

T2 - Report from the children's oncology group

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AU - Cullen, John W.

AU - Rescorla, Frederick J.

AU - Davis, Mary

AU - Schlatter, Marc G.

AU - Olson, Thomas A.

AU - Malogolowkin, Marcio

AU - Pashankar, Farzana

AU - Villaluna, Doojduen

AU - Krailo, Mark

AU - Egler, Rachel A.

AU - Rodriguez-Galindo, Carlos

AU - Frazier, A. Lindsay

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N2 - Purpose: To determine whether overall survival (OS) can be preserved for patients with stage I pediatric malignant ovarian germ cell tumor (MOGCT) with an initial strategy of surveillance after surgical resection. Patients and Methods: Between November 2003 and July 2011, girls age 0 to 16 years with stage I MOGCT were enrolled onto Children's Oncology Group study AGCT0132. Required histology included yolk sac, embryonal carcinoma, or choriocarcinoma. Surveillance included measurement of serum tumor markers and radiologic imaging at defined intervals. In those with residual or recurrent disease, chemotherapy with compressed PEB (cisplatin, etoposide, and bleomycin) was initiated every 3 weeks for three cycles (cisplatin 33 mg/m2 on days 1 to 3, etoposide 167 mg/m2 on days 1 to 3, bleomycin 15 U/m2 on day 1). Survivor functions for event-free survival (EFS) and OS were estimated using the Kaplan-Meier method. Results: Twenty-five girls (median age, 12 years) with stage I MOGCT were enrolled onto AGCT0132. Twenty-three patients had elevated alpha-fetoprotein (AFP) at diagnosis. Predominant histology was yolk sac. After a median follow-up of 42 months, 12 patients had evidence of persistent or recurrent disease (4-year EFS, 52%; 95% CI, 31% to 69%). Median time to recurrence was 2 months. All patients had elevated AFP at recurrence; six had localized disease, two had metastatic disease, and four had tumor marker elevation only. Eleven of 12 patients experiencing relapse received successful salvage chemotherapy (4-year OS, 96%; 95% CI, 74% to 99%). Conclusion: Fifty percent of patients with stage I pediatric MOGCT can be spared chemotherapy; treatment for those who experience recurrence preserves OS. Further study is needed to identify the factors that predict recurrence and whether this strategy can be extended successfully to older adolescents and young adults.

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