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