Testicular germ-cell tumors in childhood and adolescence

Summary Testicular germ-cell tumors are relatively rare in childhood and adolescence, accounting for only 3.9% of all neoplasms. However, they have become a model for curable cancer. Furthermore, most of them have accurate serum markers [beta-human chorionic gonadotropin and alpha-fetoprotein], which provide in clinical stage I disease after semicastration a wait and see program. MAHO 82, 88, and 92 were cooperative studies on the treatment of testicular germ-cell tumors in childhood and adolescence. Between 1982 and 1993, 137 patients were registered. In all, 76 patients suffered from yolk-sac tumors (YST); 30, from differentiated teratomas (TD); 29, from malignant teratomas of either intermediate (MTI), undifferentiated (MTU), or trophoblastic type (MTT); and 2, from seminomas. All patients received semicastration. Chemotherapy was given to 53 patients on the basis of disease stage and histology. Standard therapy consisted of four courses of vinblastine, bleomycin and cisplatin. However, if viable tumor was suspected after two courses, delayed laparotomy was performed (seven patients). If there was then complete tumor regression, standard therapy was continued (four patients). If there was an incomplete tumor response, the patients received as salvage therapy three courses of etoposide (VP-16), ifosfamide, and cisplatin (three patients). Among the patients with YST, 73 had stage I disease and 3, higher-stage disease; 1 of these died due to tumor progression. In all, 56 patients were followed according to the wait and see policy; 9 of these needed a delayed standard chemotherapy. The rate of no evidence of disease (NED) was 98%. Among the patients with TD, 30 had stage I disease. The NED rate was 100%. Among the patients with malignant teratomas (MTI, MTU, and MTT), 13 had stage I disease. The NED rate was 100%. Ten patients had stage II disease and received chemotherapy. The NED value was 100%. Six patients had stage III disease; three died. Altogether, 26 of 29 patients survived disease-free. In summary, the probability for the disease-free survival of all 137 patients suffering from testicular germ-cell tumors is 97% after a median observation period of 60 months.