Multimodal treatment of malignant sacrococcygeal germ cell tumors: A prospective analysis of 66 patients of the German cooperative protocols MAKEI 83/86 and 89

Purpose: To evaluate a multimodal approach including surgery and cisplatinu m chemotherapy for treatment of children with malignant sacrococcygeal germ cell tumors (GCT) and to compare adjuvant and neoadjuvant strategies in ad vanced tumors. Patients and Methods: Between 1983 and 1995, 71 patients with malignant sac rococcygeal GCT were prospectively enrolled onto the German protocols for n on-testicular GCT Maligne Keimzelltumoren 83/86 and 89. Five patients who r eceived no chemotherapy (n = 2) or nonplatinum chemotherapy (n = 2) or who did not undergo tumor resection (n = 1) were excluded from this analysis. A mong the 66 patients analyzed were 14 boys and 52 girls. The median age was 17.4 months (range, 7 months to 119 months). Median follow-vp wets 79 mont hs (range, 4 months to 145 months). Results: Fifty-two patients presented with locally advanced stage T2 tumors , and 30 patients held distant metastases at diagnosis. Patients received a median of eight cycles (range, four to nine cycles) of cisplatinum-based c hemotherapy. Thirty-five patients underwent tumor resection at diagnosis an d received adjuvant cisplatinum-based chemotherapy (group A). Thirty-one pa tients received up-front chemotherapy followed by delayed tumor resection ( group B). Group B included more metastcltic tumors than group A (group B, 1 9 of 31 patients; group A, 11 of 35 patients, P = .01). Preoperative chemot herapy facilitated complete tumor resections (group B, 20 of 31 patients; g roup A, five of 35 patients, P < .001) and avoided second-look surgery. Met astases at diagnosis and completeness of the first attempt of tumor resecti on were significant prognostic predictors; however, metastases were not pre dictive for patients treated with vp-front chemotherapy. At 5 years follow- up, event-free survival was 0.76 <plus/minus> 0.05 (50 of 66 patients), and overall survival was 0.81 +/- 0.05 (54 of 66 patients). Four patients died as a result of therapy-related complications, and eight patients died of t heir rumors. Patients with locally advanced and metastatic tumors (T2b M1) fared better with neoadjuvant treatment [overall survival: 0.83 +/- 0.09 (1 6 of 19 patients) versus 0.45 +/- 0.15 (five of 11 patients), P = .01]. Conclusion: Even locally advanced and metastatic sacrococcygeal GCT can be successfully treated with vp-front cisplatinum-based chemotherapy followed by delayed but complete tumor resection. (C) 2001 by American Society of Cl inical Oncology.