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Type: Artigo de periódico
Title: Lowered Cisplatin Dose And No Bleomycin In The Treatment Of Pediatric Germ Cell Tumors: Results Of The Gct-99 Protocol From The Brazilian Germ Cell Pediatric Oncology Cooperative Group.
Author: Lopes, Luiz Fernando
Macedo, Carla Renata Pacheco Donato
Aguiar, Simone Dos Santos
Barreto, Jose Henrique S
Martins, Gisele Eiras
Sonaglio, Viviane
Milone, Marcelo
Lima, Eduardo Ribeiro
Almeida, Maria Teresa de Assis
Lopes, Paula Maria Azevedo Allemand
Watanabe, Flora Mitie
D Andrea, Maria Lydia Mello
Pianovski, Mara Albonei
Melaragno, Renato
Vianna, Sonia Maria Rossi
Moreira, Mauber Eduardo Schultz
Bruniera, Paula
Zanardo de Oliveira, Cleyton
Abstract: We describe the results of a risk-adapted, response-based therapeutic approach from the Brazilian GCT-99 study on germ cell tumors. From May 1999 to October 2009, 579 participants were enrolled in the Brazilian GCT-99 study. Treatment, defined as specific chemotherapy regimen and number of cycles, was allocated by means of risk-group assignment at diagnosis with consideration for stage and primary tumor site. Patients at low risk received no chemotherapy. Patients at intermediate risk (IR) with a good response (GR) received four cycles of platinum and etoposide (PE), for total doses of platinum 420 mg/m(2) and etoposide 2,040 mg/m(2). Patients at IR with a partial response (PR) received three cycles of PE plus three cycles of ifosfamide, vinblastine, and bleomycin. Patients at high risk (HR) with a GR received four cycles of PE and ifosfamide (PEI) at total doses of platinum 420 mg/m(2), etoposide 1,200 mg/m(2), and ifosfamide 30 g/m(2). Patients at HR with a PR received six cycles of PEI. The risk-group distribution was 213 LR, 138 IR, and 129 HR for 480 evaluable patients. Overall survival (OS) and event-free survival (EFS) rates at 10 years were, respectively, 90% and 88.6% in the IR-GR group (n = 126) and 74.1% and 74.1% in the IR-PR group (n = 12). Ten-year rates for the HR-GR group (n = 86) were an OS of 66.8% and an EFS of 62.5%. The HR-PR group (n = 43) had an OS of 74.8% and an EFS of 73.4%. In univariable and multivariable analysis, increased serum lactate dehydrogenase level and histology for a metastatic immature teratoma were prognostic of a worsened outcome. Reduction of therapy to two drugs did not compromise survival outcomes for patients in the IR-GR group, and escalation of therapy with PEI did not significantly improve OS and EFS in patients at HR.
Citation: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology. v. 34, n. 6, p. 603-610, 2016-Feb.
Rights: fechado
Identifier DOI: 10.1200/JCO.2014.59.1420
Date Issue: 2016
Appears in Collections:Unicamp - Artigos e Outros Documentos

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