UKCCSGS GERM-CELL TUMOR (GCT) STUDIES - IMPROVING OUTCOME FOR CHILDREN WITH MALIGNANT EXTRACRANIAL NON-GONADAL TUMORS - CARBOPLATIN, ETOPOSIDE, AND BLEOMYCIN ARE EFFECTIVE AND LESS TOXIC THAN PREVIOUS REGIMENS

Background. We report the efficacy and late effects oi carboplatin, et oposide, and bleomycin (JEB) for extracranial non-gonadal tumours (GCI I, 1989-95) compared with the 5 previous regimens (GCI, 1979-1988) con sisting of 3 vincristine, actinomycin, and cyclophosphamide (VAC) and 2 platinum-based protocols. Methods and Results. Median follow-up for 52 patients in the GCI study and 46 in GCII was 105 and 48 months, res pectively. For GCI, 5- and 10-year actuarial survival was 63% (95% Con fidence interval 50 to 75%) or 72% (57 to 83%) if 6 cases given row-do se VAC were excluded. For GCII, 5-year survival was significantly grea ter at 95% (83 to 99%), P = 0.01. Event-Tree survival was 46% at 5 yea rs for GCI (33 to 59%) or 52% excluding the low-dose VAC cases (38 to 66%), while for GCII it was 87% (74 to 94%), P = 0.002. Five-year even t-free survival of 21 children given cisplatin, etoposide, and bleomyc in (BEP) in GCI was 57% (37 to 76%) compared with 87% (74 to 94%) for 46 given JEB in GCII, P = 0.02. Late effects in 30 evaluable survivors of GCI and 43 GCII included renal impairment in 6 in GCI and 0 in GCI I and deafness in 11 and 4, respectively. Among 17 survivors of sacroc occygeal rumours treated in GCI, 4 have neuropathic bladder/bowel and another shortening of a leg. In GCII, 4 of 26 have neuropathic bladder /bowel with lower limb weak ness in one. Conclusions, We found JEB to be more effective and less toxic than our previous regimens. Some surv ivors of sacrococcygeal tumours have neurological late effects. (C) 19 98 Wiley-Liss, Inc.