Site of metastases does not influence the clinical outcome of children with metastatic Germ Cell Tumors (GCT). A report from the Children's Oncology Group (COG)

Reviewer: Charles Wood, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 4, 2006

Presenter: Malogolowkin MH et al.
Presenter's Affiliation: Children's Oncology Group, Arcadia, CA
Type of Session: Scientific


  • A previous protocol had randomized patients with either extragonadal GCT or high-risk gonadal GCT to high-dose versus standard-dose cisplatin/etoposide/bleomycin combination chemotherapy (PEB)
  • This study sought to evaluate the outcome of patients with metastatic GCT (Stage IV) at diagnosis based on the site(s) of metastasis

Materials and Methods

  • 299 patients with either extragonadal GCT or high-risk gonadal GCT were treated between March 1990 and February 1996 on a Pediatric Intergroup Trial consisting of randomization between high- and standard-dose chemotherapy arms
  • Patients received 4 courses of PEB followed by a second-look surgery and an additional 2 courses of PEB for residual disease or persistently elevated tumor markers
  • Out of this cohort, all patients with Stage IV disease at diagnosis were retrospectively evaluated for outcome based on site(s) of metastasis


  • 133 of the 299 patients were identified to have Stage IV disease at diagnosis
  • the median age was 2.6 years (range 3 days – 19.3 years), and the majority were female (70)
  • the most common sites of disease were ovarian, testicular, and extragonadal
  • the most common histologies were pure yolk sac tumors and mixed germ cell tumors
  • no significant differences in 5-year event-free survival (EFS) or overall survival (OS) were detected based on site of metastasis

Author's Conclusions

  • outcome for Stage IV GCT patients is excellent with cisplatin-based chemotherapeutic regimens and is independent of the site(s) of metastasis

Clinical/Scientific Implications

  • metastatic GCT are one of the uncommon malignancies which can have excellent outcomes with contemporary treatment regimens
  • sites of metastases do not seem to play a large role in determining outcome in these patients
  • Agressive management with chemotherapy remains warranted in all patients presenting with metastatic disease regardless of pattern of spread


Where Are the Adults in the Room?
by Rodney Warner, JD
November 20, 2015