| Abstract: |
BACKGROUND Germ cell tumors (GCTs) primarily affect adolescent and young adult men. Detailed clinical and treatment characteristics in older men are lacking. METHODS Patients with GCT seen over a 20-year period at Memorial Sloan-Kettering Cancer Center were identified. Primary tumor site and histology were compared for patients aged ≥ 50 years at diagnosis versus younger men. For patients aged ≥ 50, individual chart review was performed and treatment delays, changes, and toxicities were recorded for those treated with first-line chemotherapy. RESULTS Of 4235 diagnoses of GCT, 3999 (94.4%) were made at age < 50 versus 236 (5.6%) at age ≥ 50. Compared with patients diagnosed before age 50, older men more frequently had seminoma (62.7% versus 36.7%) and less frequently, nonseminoma (34.7% versus 63.2%) (P <.0001). Predominant histology switched from nonseminoma to seminoma around age 35. Distribution of primary sites also differed for older versus younger men (testis: 89.4% versus 92.9%; retroperitoneal: 3.8% versus 0.7%; CNS 0% versus 1.7%) except for mediastinal primary tumors, which remained constant across age groups. Fifty patients age ≥ 50 received first-line platinum-based chemotherapy; 30 experienced complications leading to treatment discontinuation, delay ≥ 7 days, or regimen change. Twenty-two (44%) patients experienced neutropenic fever, 6 despite prophylactic growth factor support. Estimated 5-year survival for chemotherapy-treated patients was 84.9%. CONCLUSIONS Men aged ≥ 50 years comprise less than 10% of GCT diagnoses and have distinct clinical and histological characteristics as compared with younger patients. Although complications from chemotherapy occur frequently in older men, prognosis remains excellent when risk-directed treatment is administered with curative intent. © 2013 American Cancer Society. |
| Keywords: |
adolescent; adult; cancer chemotherapy; child; controlled study; preschool child; school child; treatment outcome; aged; aged, 80 and over; child, preschool; middle aged; retrospective studies; major clinical study; overall survival; neutropenia; cisplatin; cancer patient; cancer radiotherapy; chemotherapy, adjuvant; radiotherapy, adjuvant; cancer staging; neoplasm staging; tumor localization; carboplatin; multiple cycle treatment; etoposide; antineoplastic combined chemotherapy protocols; drug administration schedule; incidence; kidney failure; age factors; histology; ifosfamide; central nervous system tumor; groups by age; central nervous system; febrile neutropenia; survival time; brain; infant; medical record; testicular neoplasms; bleomycin; testicular cancer; retroperitoneal tumor; neoplasms, germ cell and embryonal; platinum compounds; epidemiology; drug substitution; population surveillance; mediastinum; mediastinum tumor; germ cell tumors; testis; seminoma; treatment withdrawal; non seminomatous germinoma; retroperitoneum; medical records; kaplan-meier estimate; primary site; age over 50; spermatocytic seminoma
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