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