The United Kingdom Children's Cancer Study Group's second germ cell tumor study: Carboplatin, etoposide, and bleomycin are effective treatment for children with malignant extracranial germ cell tumors, with acceptable toxicity

Purpose: To evaluate carboplatin, etopaside, and bleomycin (JEB) in childre n with malignant extracranial germ cell tumors (GCTs). Patients and Methods: Malignant GCTs in children aged 0 to 16, years were e xcised without major morbidity or otherwise biopsied. Stage I testicular an d some ovarian GCTs were resected and monitored with alpha-fetoprotein (AFP ) ("watch-and-wait" approach). Patients with recurrent stage I disease and all other patients received JEB (etoposide 120 mg/m(2) on days 1 through 3, carboplatin 600 mg/m(2) on day 2, and bleomycin 15 mg/m2 on day 3), Course s were administered every 3 to 4 weeks until remission, and then two more c ourses were given. Chemotherapy toxicities were assessed using World Health Organization or Brock grading. Results: Between January 1989 and December 1997; 192 patients were register ed. Eight were excluded because either there wets no histologic diagnosis ( n = 3) or chemotherapy was given off-study (n = 5), The remaining 184 patie nts had germinoma In = 20), malignant teratoma In = 55), embryonal carcinom a (n = 1), yolk sac tumor (n = 107), or choriocarcinoma In = 1). forty-seve n patients were treated with surgery alone, and 137 patients received JEB. The 5-year survival rate in March 1999 for all 184 patients was 93.2% (95% confidence interval [CI], 87.9% to 96,3%): for the 137 JEB-treated patients , it was 90.9% (95% CI, 83.9% to 95.0%), with an event-free survival rate o f 87.8% (95% CI, 81.1% to 92,4%). The median follow-up after JEB treatment wets 53 months (range, 0 to 109 months): the median number of courses wets five (range, three to eight). Site, stage, and AFP level had prognostic sig nificance. Nonfatal hematologic toxicity was common, but deafness and pulmo nary and renal toxicities were rare. One child died of a thoracic tumor and bronchopulmonary dysplasia, and another died of acute my eloid leukemia. Conclusion: Conservative surgery, a watch-and-wait approach after complete excision, and JEB for those requiring chemotherapy produced high cure rates and few serious complications. (C) 2000 by American Society of Clinical On cology.