The effect of cisplatin dose and surgical resection in children with malignant germ cell tumors at the sacrococcygeal region: A pediatric intergroup trial (POG 9049/CCG 8882)

Frederick Rescorla, Deborah Billmire, Charles Stolar, Charles Vinocur, Paul Colombani, John Cullen, Roger Giller, Barbara Cushing, Stephen Lauer, Mary Davis, Edith Hawkins, Jonathan Shuster, Mark Krailo

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Abstract

Purpose: This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors of the sacrococcygeal region (SCT). Methods: Seventy-four of 317 children presenting to Pediatric Oncology Group (POG)/Children's Cancer Group (CCG) institutions from 1990 through 1996 with malignant germ cell tumors had malignant SCT. There were 62 girls and 12 boys with a median age of 21 months (range, 3 days to 37 months) and median serum alpha-fetoprotein of 35,500 ng/mL. Twelve had undergone resection of a benign SCT as a newborn. Forty-four (59%) had evidence of metastatic disease at time of diagnosis. Presentation by type (Altman classification) was I, 0; II, 2; III, 30; and IV, 42. The initial procedure was biopsy in 45 and resection in 29. Patients were assigned randomly to receive 4 cycles of chemotherapy with etoposide (E) and bleomycin (B) and either high-dose cisplatin (200 mg/m2 per cycle; HDP) or standard dose cisplatin (100 mg/m2 per cycle; P). After completion of chemotherapy, 42 of 45 initially treated with biopsy underwent resection. Results: Overall 4-year survival rate is 90% (SE = 4%) and 4-year event-free survival (EFS) is 84% (SE = 6%). Event-free survival data for subgroups of interest are as follows: Conclusions: (1) The current survival rate of malignant sacrococcygeal tumors is excellent even with metastases. (2) Delayed surgical resection is not associated with an adverse outcome. (3) In this subset the treatment comparison was inconclusive however, followed the trend in the overall study of more than 300 children in which the high-dose cisplatin group had superior EFS (P < .05).

Original languageEnglish
Pages (from-to)12-17
Number of pages6
JournalJournal of Pediatric Surgery
Volume36
Issue number1
DOIs
StatePublished - 2001

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Sacrococcygeal Region
Germ Cell and Embryonal Neoplasms
Cisplatin
Pediatrics
Disease-Free Survival
Bleomycin
Etoposide
Neoplasms
Survival Rate
Biopsy
Drug Therapy
alpha-Fetoproteins
Newborn Infant
Neoplasm Metastasis
Serum

Keywords

  • Germ cell tumors
  • Sacrococcygeal tumors

ASJC Scopus subject areas

  • Surgery

Cite this

The effect of cisplatin dose and surgical resection in children with malignant germ cell tumors at the sacrococcygeal region : A pediatric intergroup trial (POG 9049/CCG 8882). / Rescorla, Frederick; Billmire, Deborah; Stolar, Charles; Vinocur, Charles; Colombani, Paul; Cullen, John; Giller, Roger; Cushing, Barbara; Lauer, Stephen; Davis, Mary; Hawkins, Edith; Shuster, Jonathan; Krailo, Mark.

In: Journal of Pediatric Surgery, Vol. 36, No. 1, 2001, p. 12-17.

Research output: Contribution to journalArticle

Rescorla, F, Billmire, D, Stolar, C, Vinocur, C, Colombani, P, Cullen, J, Giller, R, Cushing, B, Lauer, S, Davis, M, Hawkins, E, Shuster, J & Krailo, M 2001, 'The effect of cisplatin dose and surgical resection in children with malignant germ cell tumors at the sacrococcygeal region: A pediatric intergroup trial (POG 9049/CCG 8882)', Journal of Pediatric Surgery, vol. 36, no. 1, pp. 12-17. https://doi.org/10.1053/jpsu.2001.19993
Rescorla, Frederick ; Billmire, Deborah ; Stolar, Charles ; Vinocur, Charles ; Colombani, Paul ; Cullen, John ; Giller, Roger ; Cushing, Barbara ; Lauer, Stephen ; Davis, Mary ; Hawkins, Edith ; Shuster, Jonathan ; Krailo, Mark. / The effect of cisplatin dose and surgical resection in children with malignant germ cell tumors at the sacrococcygeal region : A pediatric intergroup trial (POG 9049/CCG 8882). In: Journal of Pediatric Surgery. 2001 ; Vol. 36, No. 1. pp. 12-17.
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abstract = "Purpose: This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors of the sacrococcygeal region (SCT). Methods: Seventy-four of 317 children presenting to Pediatric Oncology Group (POG)/Children's Cancer Group (CCG) institutions from 1990 through 1996 with malignant germ cell tumors had malignant SCT. There were 62 girls and 12 boys with a median age of 21 months (range, 3 days to 37 months) and median serum alpha-fetoprotein of 35,500 ng/mL. Twelve had undergone resection of a benign SCT as a newborn. Forty-four (59{\%}) had evidence of metastatic disease at time of diagnosis. Presentation by type (Altman classification) was I, 0; II, 2; III, 30; and IV, 42. The initial procedure was biopsy in 45 and resection in 29. Patients were assigned randomly to receive 4 cycles of chemotherapy with etoposide (E) and bleomycin (B) and either high-dose cisplatin (200 mg/m2 per cycle; HDP) or standard dose cisplatin (100 mg/m2 per cycle; P). After completion of chemotherapy, 42 of 45 initially treated with biopsy underwent resection. Results: Overall 4-year survival rate is 90{\%} (SE = 4{\%}) and 4-year event-free survival (EFS) is 84{\%} (SE = 6{\%}). Event-free survival data for subgroups of interest are as follows: Conclusions: (1) The current survival rate of malignant sacrococcygeal tumors is excellent even with metastases. (2) Delayed surgical resection is not associated with an adverse outcome. (3) In this subset the treatment comparison was inconclusive however, followed the trend in the overall study of more than 300 children in which the high-dose cisplatin group had superior EFS (P < .05).",
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T1 - The effect of cisplatin dose and surgical resection in children with malignant germ cell tumors at the sacrococcygeal region

T2 - A pediatric intergroup trial (POG 9049/CCG 8882)

AU - Rescorla, Frederick

AU - Billmire, Deborah

AU - Stolar, Charles

AU - Vinocur, Charles

AU - Colombani, Paul

AU - Cullen, John

AU - Giller, Roger

AU - Cushing, Barbara

AU - Lauer, Stephen

AU - Davis, Mary

AU - Hawkins, Edith

AU - Shuster, Jonathan

AU - Krailo, Mark

PY - 2001

Y1 - 2001

N2 - Purpose: This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors of the sacrococcygeal region (SCT). Methods: Seventy-four of 317 children presenting to Pediatric Oncology Group (POG)/Children's Cancer Group (CCG) institutions from 1990 through 1996 with malignant germ cell tumors had malignant SCT. There were 62 girls and 12 boys with a median age of 21 months (range, 3 days to 37 months) and median serum alpha-fetoprotein of 35,500 ng/mL. Twelve had undergone resection of a benign SCT as a newborn. Forty-four (59%) had evidence of metastatic disease at time of diagnosis. Presentation by type (Altman classification) was I, 0; II, 2; III, 30; and IV, 42. The initial procedure was biopsy in 45 and resection in 29. Patients were assigned randomly to receive 4 cycles of chemotherapy with etoposide (E) and bleomycin (B) and either high-dose cisplatin (200 mg/m2 per cycle; HDP) or standard dose cisplatin (100 mg/m2 per cycle; P). After completion of chemotherapy, 42 of 45 initially treated with biopsy underwent resection. Results: Overall 4-year survival rate is 90% (SE = 4%) and 4-year event-free survival (EFS) is 84% (SE = 6%). Event-free survival data for subgroups of interest are as follows: Conclusions: (1) The current survival rate of malignant sacrococcygeal tumors is excellent even with metastases. (2) Delayed surgical resection is not associated with an adverse outcome. (3) In this subset the treatment comparison was inconclusive however, followed the trend in the overall study of more than 300 children in which the high-dose cisplatin group had superior EFS (P < .05).

AB - Purpose: This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors of the sacrococcygeal region (SCT). Methods: Seventy-four of 317 children presenting to Pediatric Oncology Group (POG)/Children's Cancer Group (CCG) institutions from 1990 through 1996 with malignant germ cell tumors had malignant SCT. There were 62 girls and 12 boys with a median age of 21 months (range, 3 days to 37 months) and median serum alpha-fetoprotein of 35,500 ng/mL. Twelve had undergone resection of a benign SCT as a newborn. Forty-four (59%) had evidence of metastatic disease at time of diagnosis. Presentation by type (Altman classification) was I, 0; II, 2; III, 30; and IV, 42. The initial procedure was biopsy in 45 and resection in 29. Patients were assigned randomly to receive 4 cycles of chemotherapy with etoposide (E) and bleomycin (B) and either high-dose cisplatin (200 mg/m2 per cycle; HDP) or standard dose cisplatin (100 mg/m2 per cycle; P). After completion of chemotherapy, 42 of 45 initially treated with biopsy underwent resection. Results: Overall 4-year survival rate is 90% (SE = 4%) and 4-year event-free survival (EFS) is 84% (SE = 6%). Event-free survival data for subgroups of interest are as follows: Conclusions: (1) The current survival rate of malignant sacrococcygeal tumors is excellent even with metastases. (2) Delayed surgical resection is not associated with an adverse outcome. (3) In this subset the treatment comparison was inconclusive however, followed the trend in the overall study of more than 300 children in which the high-dose cisplatin group had superior EFS (P < .05).

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