All issues > Volume 40(12); 1997

Original Article

J Korean Pediatr Soc. 1997;40(12):1707-1718. Published online December 15, 1997.

A Result of Treatment of Malignant Germ Cell Tumors in Childhood

Hyoung Jin HJ Kang¹, Jun Ah JA Lee¹, Hyo Jeong HJ Han¹, Hyoung Su HS Choi¹, Hyeon Jin HJ Park¹, Ki Woong KW Sung¹, Eun Sun ES Yoo¹, Hee Young HY Shin¹, Hyo Seop HS Ahn¹, Kwi Won KW Park², Byung Keu BK Cho³, Hwang H Choi⁴, Chul Woo CW Kim⁵

¹Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
²Department of Pediatric Surgery, Seoul National University, College of Medicine, Seoul, Korea
³Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea
⁴Department of Urology, Seoul National University, College of Medicine, Seoul, Korea
⁵Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea

Abstract

Purpose
: Germ cell tumors have variable clinical characteristics according to the age, sex, primary site, and pathologic diagnosis. To provide the therapeutic principle, the clinical characteristics, response to the treatment, and prognostic factors were analyzed.
Methods
: Medical records of 57 children who were diagnosed as malignant germ cell tumor in Seoul National University Children' s Hospital from January 1986 till June 1996 were reviewed.
Results
: 1) Fifty seven cases(male : 22, female : 43, true hermaphrodite : 1) were analyzed. The age of diagnosis was between 2 months and 15 years and median age was 4 year 7 month. 2) The primary sites were sacrococcygeal area(28%), intracranial area(25%), ovary (18%), testis(11%), retroperitoneum(7%), and mediastinum(4%) in order of frequency. Another cases were in liver, spinal cord, skull base, tongue, and ovary & testis in hermaphrodite. 3) Pathologic diagnosis was possible in 53 cases. Mixed germ cell tumor(37%), endodermal sinus tumor(23%), germinoma(13%), immature teratoma(8%), embryonal carcinoma (4%), and choriocarcinoma(2%) were included in order of frequency. 4) The stage by CCG/POG classification revealed that 6% of stage I, 19% of stage II, 43% of stage III, and 32% of stage IV in 53 cases. 5) After the initial surgery or needle biopsy, radiation therapy was done in the intracranial tumor with EP induction or modified CCG 8891, etc. and cis-VAB, EP, VAB-3, VAC, or CCG 8891, etc. was done in the extracranial tumor with/without radiation therapy. 6) The response rate revealed that 71% of complete response, 22% of partial response, and 7% of progressive disease in 45 cases. 7) The response rate was related to the primary site but not pathology and stage. All the gonadal tumors had complete response. 8) The 5 year-survival rate of all malignant germ cell tumors was 73%. Stage 4 or sacrococcygeal tumor had poor survival rate.
Conclusions
: Stage 4 and sacrococcygeal area were thought as the poor prognostic factors affecting survival. Survival rate of tumors at sacrococcygeal area were poor owing to the relatively younger age of onset, and poor response rate. The 5 year-survival rate of tumors treated with cis-VAB were 74% but shown complications frequently. So BEP will be preferred.

Keywords :Germ cell tumor, Children, Chemotherapy, Survival rate, Prognostic factor