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dc.titleLowered 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 Groupen
dc.contributor.authorLopes L.F.pt_BR
dc.contributor.authorMacedo C.R.P.D.pt_BR
dc.contributor.authorDos Santos Aguiar S.pt_BR
dc.contributor.authorBarreto J.H.S.pt_BR
dc.contributor.authorMartins G.E.pt_BR
dc.contributor.authorSonaglio V.pt_BR
dc.contributor.authorMilone M.pt_BR
dc.contributor.authorLima E.R.pt_BR
dc.contributor.authorDe Assis Almeida M.T.pt_BR
dc.contributor.authorLopes P.M.A.A.pt_BR
dc.contributor.authorWatanabe F.M.pt_BR
dc.contributor.authorD'Andrea M.L.M.pt_BR
dc.contributor.authorPianovski M.A.pt_BR
dc.contributor.authorMelaragno R.pt_BR
dc.contributor.authorVianna S.M.R.pt_BR
dc.contributor.authorMoreira M.E.S.pt_BR
dc.contributor.authorBruniera P.pt_BR
dc.contributor.authorDe Oliveira C.Z.pt_BR
unicamp.authorCentro Infantil Boldrini, CIPED/FCM/Unicamp, Campinas, Brazilpt_BR Society of Pediatric Oncology, Hospital de Cancer Infanto Juvenil de Barretos, Av Joao Baroni 3025, Barretos, SP, Brazilpt_BR de Oncologia Pediatrica-GRAACC, Universidade Federal de São Paulo, Brazilpt_BR A.C. Camargo, Brazilpt_BR de São Paulo, ITACI FMUSP, Brazilpt_BR Infantil Darcy Vargas, Brazilpt_BR Santa Marcelina, Brazilpt_BR Do Servidor Publico Estadual, Brazilpt_BR Casa de Misericordia de São Paulo, São Paulo, Brazilpt_BR de Cancer Infanto Juvenil de Barretos, Brazilpt_BR de Cancer de Barretos, Barretos, Brazilpt_BR de Tratamento Fabiana Macedo de Morais/GACC, São Jose dos Campos, Brazilpt_BR São Rafael/ONCO Bahia, Salvador, Brazilpt_BR da Baleia, Belo Horizonte, Brazilpt_BR da Criança de Brasilia Jose Alencar, Brasilia, Brazilpt_BR Infantil Pequeno Principe, Brazilpt_BR Erasto Gaertner, Curitiba, Brazilpt_BR Universitario de Santa Maria, Santa Maria, Brazilpt_BR
dc.description.abstractPurpose We describe the results of a risk-adapted, response-based therapeutic approach from the Brazilian GCT-99 study on germ cell tumors. Patients and Methods 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/m2 and etoposide 2,040 mg/m2. 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/m2, etoposide 1,200 mg/m2, and ifosfamide 30 g/m2. Patients at HR with a PR received six cycles of PEI. Results 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. Conclusion 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. © 2016 by American Society of Clinical Oncology.en
dc.relation.ispartofJournal of Clinical Oncologypt_BR
dc.publisherAmerican Society of Clinical Oncologypt_BR
dc.identifier.citationJournal Of Clinical Oncology. American Society Of Clinical Oncology, v. 34, n. 6, p. 603 - 610, 2016.pt_BR
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