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  • Title: [Results of the German studies (MAHO) for treatment of testicular germ cell tumors in children--an update].
    Author: Schmidt P, Haas RJ, Göbel U, Calaminus G.
    Journal: Klin Padiatr; 2002; 214(4):167-72. PubMed ID: 12165897.
    Abstract:
    BACKGROUND: The MAHO studies for treatment of testicular germ cell tumors in childhood and adolescence registered between 1982 and 1/2001 260 patients (pts.). Aims of the studies were: 1. Delay of chemotherapy in YST of stage I A. 2. Delay of modified lymphadenectomy for staging in I A tumors. 3. Stepwise reduction of therapy in low stage tumors but increasing therapy in tumors of metastatic pattern. Standard therapy consisted of 4 courses of vinblastine, bleomycin and cisplatin. In stage II C or higher chemotherapy included cisplatin, VP 16 and bleomycin. As salvage therapy VP16, ifosfamide and cisplatin was given. RESULTS: According to histology and stage only 75/260 pts. needed chemotherapy. Out of 140 pts. with YST 139 survived disease free according to a "watch and wait" policy. 16 of these patients (13 %) needed a delayed standard chemotherapy 6 - 60 weeks after orchiectomy. Patients with mature (40 pts.) and immature (19 pts.) teratoma were cured by orchiectomy alone. 59 pts. suffered from other malignant non-seminomatous tumors (EC, chorio, mixed tumors). 20 of these had a clinical stage I including 5 with a pathologic stage I A. 15 received adjuvant chemotherapy and all 20 pts. survived relapse-free. 22 pts. had stage II, 8 of these received salvage therapy in addition to standard chemotherapy, 21 of 22 pts. survived. 17 pts. had stage III or IV, 5 of these died despite receiving salvage therapy, 9 pts. survived in complete remission, 3 pts. had partial remission. Both patients with a seminoma (stage I) survived. In summary, the probability of disease free survival of 260 pts. is 97 % after a median observation time of 60 months. CONCLUSION: In alpha-fetoprotein producing YST tumors of clinical stage I A after semincastratio the "watch and wait" surveillance strategy is found to be optimal. Only about 13 % of these patients had to be treated by chemotherapy at a later time point and thus could be cured. For YST pts. of stages greater than stage I A and all other malignant testicular tumors in childhood effective chemotherapy exists with an overall cure rate of about 95 %. Local irradiation or staging lymphadenectomy is unnecessary.
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