A multicentre retrospective cohort study of ovarian germ cell tumours: Evidence for chemotherapy de-escalation and alignment of paediatric and adult practice.
Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Bleomycin
/ therapeutic use
Chemotherapy, Adjuvant
Child
Cisplatin
/ therapeutic use
Cohort Studies
Dysgerminoma
/ drug therapy
Endodermal Sinus Tumor
/ drug therapy
Etoposide
/ therapeutic use
Female
Gynecologic Surgical Procedures
Humans
Kaplan-Meier Estimate
Middle Aged
Neoadjuvant Therapy
Neoplasm Grading
Neoplasms, Germ Cell and Embryonal
/ drug therapy
Neoplasms, Second Primary
/ epidemiology
Ovarian Neoplasms
/ drug therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma
/ epidemiology
Progression-Free Survival
Proportional Hazards Models
Retrospective Studies
Teratoma
/ drug therapy
Treatment Outcome
Young Adult
BEP
Dysgerminoma
Immature teratoma
Mixed germ cell tumour
Ovarian germ cell cancer
Yolk sac tumour
Journal
European journal of cancer (Oxford, England : 1990)
ISSN: 1879-0852
Titre abrégé: Eur J Cancer
Pays: England
ID NLM: 9005373
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
10
12
2018
revised:
14
02
2019
accepted:
02
03
2019
pubmed:
8
4
2019
medline:
21
5
2020
entrez:
8
4
2019
Statut:
ppublish
Résumé
Adult guidelines recommend BEP (bleomycin, etoposide, cisplatin) for all ovarian germ cell tumours, causing debilitating toxicities in young patients who will survive long term. Paediatricians successfully reduce toxicities by using lower bleomycin doses and substituting carboplatin for cisplatin, while testicular and paediatric immature teratomas (ITs) are safely managed with surgery alone. The aim was to determine whether reduced-toxicity treatment could rationally be extended to patients older than 18 years. Multicentre cohort study was carried out in four large UK cancer centres over 12 years. One hundred thirty-eight patients were enrolled. Overall survival was 93%, and event-free survival (EFS) was 72%. Neoadjuvant/adjuvant chemotherapy (82% BEP) caused 27 potentially chronic toxicities, and one patient subsequently died from acute lymphoblastic leukaemia. There was no difference in histology, stage or grade in patients ≤/>18 years, and EFS was not different in these age groups (≤18:28% and >18:28%; log-rank P = 0.96). Histological subtype powerfully predicted EFS (log-rank P = 4.9 × 10 Survival was excellent but chemotherapy toxicities were severe, implying significant overtreatment. Our data support the extension of reduced-toxicity, paediatric regimens to adults. Our practice-changing findings that IT was chemotherapy resistant and pathological grade uninformative strongly endorse exclusive surgical management of ovarian ITs at all ages.
Sections du résumé
BACKGROUND
Adult guidelines recommend BEP (bleomycin, etoposide, cisplatin) for all ovarian germ cell tumours, causing debilitating toxicities in young patients who will survive long term. Paediatricians successfully reduce toxicities by using lower bleomycin doses and substituting carboplatin for cisplatin, while testicular and paediatric immature teratomas (ITs) are safely managed with surgery alone.
AIM
The aim was to determine whether reduced-toxicity treatment could rationally be extended to patients older than 18 years.
METHODS
Multicentre cohort study was carried out in four large UK cancer centres over 12 years.
RESULTS
One hundred thirty-eight patients were enrolled. Overall survival was 93%, and event-free survival (EFS) was 72%. Neoadjuvant/adjuvant chemotherapy (82% BEP) caused 27 potentially chronic toxicities, and one patient subsequently died from acute lymphoblastic leukaemia. There was no difference in histology, stage or grade in patients ≤/>18 years, and EFS was not different in these age groups (≤18:28% and >18:28%; log-rank P = 0.96). Histological subtype powerfully predicted EFS (log-rank P = 4.9 × 10
CONCLUSION
Survival was excellent but chemotherapy toxicities were severe, implying significant overtreatment. Our data support the extension of reduced-toxicity, paediatric regimens to adults. Our practice-changing findings that IT was chemotherapy resistant and pathological grade uninformative strongly endorse exclusive surgical management of ovarian ITs at all ages.
Identifiants
pubmed: 30954883
pii: S0959-8049(19)30177-7
doi: 10.1016/j.ejca.2019.03.001
pmc: PMC6522056
pii:
doi:
Substances chimiques
Bleomycin
11056-06-7
Etoposide
6PLQ3CP4P3
Cisplatin
Q20Q21Q62J
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
19-27Subventions
Organisme : Cancer Research UK
ID : 13034
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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