Development of a risk stratification system to guide treatment for female germ cell tumors Journal Article

Authors: Meisel, J. L.; Woo, K. M.; Sudarsan, N.; Eng, J.; Patil, S.; Jacobsen, E. P.; Murali, R.; Gardner, G. J.; Bosl, G. J.; Aghajanian, C.; Feldman, D. R.
Article Title: Development of a risk stratification system to guide treatment for female germ cell tumors
Abstract: Objective Due to their rarity, little is known about prognostic factors in female germ cell tumors (GCTs) or outcomes following systemic therapy. Management is largely based on studies of male GCT and epithelial ovarian cancer. Methods Chart review was performed for all females with GCT seen at Memorial Sloan Kettering Cancer Center (MSKCC) from 1990 to 2012. Patients receiving chemotherapy were stratified using a modification of the male IGCCCG risk system, and the classifier was correlated with outcome. Results Of 93 patients, 92 (99%) underwent primary surgery and 85 (92%) received chemotherapy. Modified IGCCCG classification was significantly associated with progression-free survival (PFS) and overall survival (OS), both when applied preoperatively and pre-chemotherapy (p < 0.001 for all four analyses). Progression after initial chemotherapy (n = 29) was detected by imaging in 14 (48%) patients, by serum tumor markers in 6 (21%) patients, and by multiple methods in the rest. Seven (29%) of 24 patients treated with salvage chemotherapy achieved long-term PFS, including 4/6 who received high-dose chemotherapy (HDCT) as initial salvage versus 3/16 treated with other initial salvage regimens. The estimated 3-year OS rate was 84% (95% CI, 76-92%), with a trend favoring dysgerminoma over non-dysgerminoma histologies (p = 0.12). Conclusions Modified IGCCCG classification was prognostic for female GCT patients in this cohort and identified a poor-risk group who may benefit from more intensive first-line chemotherapy. Both imaging and tumor marker evaluation were important in identifying relapses after first-line chemotherapy. The majority of long-term remissions with salvage therapy were achieved with initial salvage HDCT. © 2015 Elsevier Inc.
Keywords: adolescent; adult; child; human tissue; aged; major clinical study; overall survival; histopathology; cancer recurrence; salvage therapy; cisplatin; doxorubicin; fluorouracil; cancer combination chemotherapy; cancer growth; conference paper; cancer staging; nuclear magnetic resonance imaging; outcome assessment; follow up; ovarian cancer; carboplatin; progression free survival; computer assisted tomography; etoposide; cyclophosphamide; vincristine; tumor marker; histology; ifosfamide; cancer survivor; infant; folinic acid; computer assisted emission tomography; ovary carcinoma; bleomycin; teratoma; oxaliplatin; malignant transformation; germ cell tumor; germ cell tumors; choriocarcinoma; yolk sac tumor; risk management; autologous stem cell transplant; female genital tract cancer; salvage chemotherapy; dysgerminoma; cancer prognosis; human; female; priority journal; igcccg
Journal Title: Gynecologic Oncology
Volume: 138
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2015-09-01
Start Page: 566
End Page: 572
Language: English
DOI: 10.1016/j.ygyno.2015.06.029
PROVIDER: scopus
PUBMED: 26115974
PMCID: PMC5012648
Notes: Export Date: 2 October 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Ginger J Gardner
    212 Gardner
  2. Sujata Patil
    501 Patil
  3. Darren Richard Feldman
    276 Feldman
  4. Rajmohan Murali
    203 Murali
  5. George Bosl
    424 Bosl
  6. Jana Eng
    8 Eng
  7. Jane Lowe Meisel
    10 Meisel
  8. Kaitlin Marie Woo
    100 Woo