Late effects of treatment for germ cell tumors during childhood and adolescence

Purpose: To evaluate the long-term sequelae of treatment for malignant germ cell tumors (GCT) during childhood and adolescence. Patients and Methods: Of 128 patients treated for GCT at St. Jude Children' s Research Hospital between 1962 and 1988, 73 are long-term survivors (cont inuously disease-free for greater than or equal to 5 years after diagnosis) , with a median follow-up of 11.3 years). Survivors' ages at diagnosis rang ed from birth to 18.3 years (median, 9.2 years); 64% (47 patients) were fem ale. Initial surgical resection was followed by observation for stage I ger minomas (n = 2), testicular tumors (n = 13), and selected cases of ovarian or sacrococcygeal tumors (n = 2), and by radiation therapy (RT) for patient s with stage II to III germinoma (n = 8). The remaining 48 patients receive d postoperative chemotherapy (vincristine, dactinomycin, and cyclophosphami de [VAC] +/- doxorubicin, 1962 to 1978; VAC and/or cisplatin, vinblastine, and bleomycin [PVB], 1979 to 1988). RT was added to the chemotherapy for 21 patients. Late complications involving various organ systems and their rel ationship to treatment were evaluated. Results: More than two-thirds of long-term survivors (n = 50) had at least 1 complication, and half (n = 38) had > 1 organ system affected, The system s most often involved included the musculoskeletal (41% of survivors), endo crine (42%), cardiovascular (16% excluding those who had only abnormal ches t radiograph), gastrointestinal (25%), genitourinary tract (23%), pulmonary (19%), and neurologic (16%) systems. High-frequency hearing loss occurred in 58% (11 of 19) of patients treated with cisplatin. Musculoskeletal, gast rointestinal, and urinary tract abnormalities were most frequent in patient s whose treatment included RT. Conclusions: A high frequency of late effects after treatment for pediatric GCT, particularly in patients who received RT, was demonstrated. Treatment sequelae could be anticipated from the intensity and type of therapeutic m odalities. Treatment-directed screening evaluations may improve quality of life in long-term survivors of pediatric GCT through timely identification of sequelae that can be prevented or ameliorated.