Treatment Strategy for Childhood Extracranial Secreting Germ Cell Tumours Based on Alphafoetoprotein (AFP) Level: Protocol TGM95 of the Société Française d’Oncologie Pédiatrique (SFOP)
The previous SFOP TGM85 and TGM90 studies showed that carboplatin (400 mg/m2) was less efficient that cisplatin (100 mg/m2), that patients with AFP levels over 15000 ng/ml had a worse outcome, and that the VIP regimen (VP 16, Ifosfamide, cisplatin) was an efficient salvage therapy [1–3]. Based on these results, the SFOP developed the TGM95 protocol, a cisplatin-based chemotherapy adapted to initial resection, serum AFP and presence of metastases. Patients are stratified into three risk groups with the following guidelines: low risk (LR) patients with complete resection of a localized tumour (pSl): “watch and wait” with chemotherapy only in cases of tumour marker increase; median risk (MR) patients: non metastatic incompletely resected or unresectable tumour with AFP less than 15000: VBP (Vinblastine, Bleomycine, cisplatin) regimen; high risk (HR) patients: AFP 15000 or more, and/or metastasis: VIP regimen. In both groups, patients received two additional courses of chemotherapy after normalization of tumour markers. The residual tumour or the organ initially involved (if not previously done) were excised after normalization of tumour markers.
KeywordsGerm Cell Tumour Embryonal Carcinoma Unresectable Tumour Nonseminomatous Germ Cell Nonseminomatous Germ Cell Tumor
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