Testicular Germ Cell Tumors in Adolescents – Results of the Protocol MAHO 98 and the Identification of Good Risk Patients

Abstract

Background: In adolescents aged 10–15 years germ cell tumors of the testis (TGCT) are rare and information for a risk adapted therapy limited.

Aims of the study: The protocol MAHO 98 for patients (pts) with TGCTs is stratified according to age, stage and histology. Pts ≥10 years received after tumororchiectomy 2 courses (crs) PVB and restaging. Residual tumor was resected and therapy continued in regard to inital stage and response.

Chemotherapy: PVB: cisplatin (20 mg/m²/day 1–5), vinblastine (3 mg/m²/day 1+2), and bleomycin (15 U/m²/day 1–3). For consolidation 1 crs PVB has been given to stage II patients with CR. In case of PR, 2 crs PEB (vinblastine substituted by etoposide 100 mg/m²/day 1–3) or relapse 3 crs PEI (bleomycin substituted by ifosfamide 1 500 mg/m²/day 1–5) were given.

Results: Between Jan 1998 and Dec 2005, 34 pts (≥10 year) were registered, 31 fulfilled the inclusion criteria. Median age: 15;6 years; months (range 13;5–20;2 ). Lugano staging: IA n=14, IB n=2, IC n=3, IIA n=4, IIB n=6, IIC n=1, IIIC n=1. The stage IIIC pt received preoperative chemotherapy, all other pts had tumororchiectomy first. Residual tumor after 2 crs PVB was detected in 4 pts and was resected. Late relapses occurred in 2 pts and were cured by additional therapy. All patients are surviving.

Conclusion: Young patients with TGCT stage I and II have an excellent prognosis and further reduction of therapy has to be considered.

Zusammenfassung

Hintergrund: Testikuläre Keimzelltumoren (TGCT) bei 10–15 jährigen Jungen sind selten und Daten zur Risiko-adaptierten Therapie spärlich.

Ziele der Studie: In dem GPOH-Protokoll MAHO 98 erhielten die Patienten (≥10 years) nach Tumororchiektomie einheitlich 2 Kurse PVB. Residuale Metastasen wurden reseziert und die Therapie entsprechend dem Ansprechen fortge­setzt.

Chemotherapie: PVB: Cisplatin (20 mg/m²/Tag 1–5), Vinblastin (3 mg/m²/Tag 1+2) und Bleomycin (15 U/m²/Tag 1–3). Zur Konsolidierung wurden bei Stadium II und CR 1 Kurs PVB, bei PR 2 Kurse PEB (Etoposid 100 mg/m²/Tag 1–3 statt Vinblastin), bzw. bei Rückfall 3 Kurse PEI (Ifosfamid 1 500 mg/m²/Tag 1–5 statt Bleomycin) verabreicht.

Ergebnisse: Es wurden 34 Patienten ≥10 Jahre registrieret; 31 Patienten erfüllten die einschlusskriterien. Alter: Median 15;6 Jahre (Schwankungsbreite 13;5–20;2). Lugano Sta­dien: IA n=14, IB n=2, IC n=3, IIA n=4, IIB n=6, IIC n=1, IIIC n=1. Der Patient mit Stadium IIIC erhielt präopertative Chemotherapie, alle anderen Patienten initial eine Tumororchiektomie. Residualer Tumor nach 2 Kursen PVB wurde bei 4 Patienten gefunden und reseziert. Die Ansprechrate auf das Protokoll betrug 31/31, jedoch wurden 2 späte Rückfälle registriert und erfolgreich nachbehandelt. Alle Patienten über­leben tumorfrei.

Schlussfolgerung: Junge Patienten mit malignem TGCT des Stadiums I oder II haben mit dem Protokoll MAHO 98 eine excellente Prognose. Über weitere Reduktionen der Therapie ist nachzudenken.

Key words

testicular germ cell tumor - stratified therapy in adolescents - preoperative chemotherapy - response rate

Schlüsselwörter

testikulare Keimzelltumoren - präoperative Chemotherapie - Ansprechrate - Risiko-adaptierte Therapie bei Jugendlichen

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