Mann J R, Raafat F, Robinson K, Imeson J, Gornall P, Sokal M, Gray E, McKeever P, Hale J, Bailey S, Oakhill A
Oncology Department, Birmingham Children's Hospital, Birmingham, United Kingdom.
J Clin Oncol. 2000 Nov 15;18(22):3809-18. doi: 10.1200/JCO.2000.18.22.3809.
To evaluate carboplatin, etoposide, and bleomycin (JEB) in children with malignant extracranial germ cell tumors (GCTs).
Malignant GCTs in children aged 0 to 16 years were excised without major morbidity or otherwise biopsied. Stage I testicular and some ovarian GCTs were resected and monitored with alpha-fetoprotein (AFP) ("watch-and-wait" approach). Patients with recurrent stage I disease and all other patients received JEB (etoposide 120 mg/m(2) on days 1 through 3, carboplatin 600 mg/m(2) on day 2, and bleomycin 15 mg/m(2) on day 3). Courses were administered every 3 to 4 weeks until remission, and then two more courses were given. Chemotherapy toxicities were assessed using World Health Organization or Brock grading.
Between January 1989 and December 1997, 192 patients were registered. Eight were excluded because either there was no histologic diagnosis (n = 3) or chemotherapy was given off-study (n = 5). The remaining 184 patients had germinoma (n = 20), malignant teratoma (n = 55), embryonal carcinoma (n = 1), yolk sac tumor (n = 107), or choriocarcinoma (n = 1). Forty-seven patients were treated with surgery alone, and 137 patients received JEB. The 5-year survival rate in March 1999 for all 184 patients was 93.2% (95% confidence interval [CI], 87.9% to 96.3%); for the 137 JEB-treated patients, it was 90.9% (95% CI, 83.9% to 95.0%), with an event-free survival rate of 87.8% (95% CI, 81.1% to 92.4%). The median follow-up after JEB treatment was 53 months (range, 0 to 109 months); the median number of courses was five (range, three to eight). Site, stage, and AFP level had prognostic significance. Nonfatal hematologic toxicity was common, but deafness and pulmonary and renal toxicities were rare. One child died of a thoracic tumor and bronchopulmonary dysplasia, and another died of acute myeloid leukemia.
Conservative surgery, a watch-and-wait approach after complete excision, and JEB for those requiring chemotherapy produced high cure rates and few serious complications.
评估卡铂、依托泊苷和博来霉素（JEB方案）用于治疗儿童恶性颅外生殖细胞肿瘤（GCTs）的效果。
对0至16岁患有恶性GCTs的儿童进行手术切除，若无严重并发症则进行切除，否则进行活检。对Ⅰ期睾丸和部分卵巢GCTs患者进行切除，并通过甲胎蛋白（AFP）进行监测（“观察等待”方法）。复发的Ⅰ期疾病患者和所有其他患者接受JEB方案治疗（第1至3天给予依托泊苷120mg/m²，第2天给予卡铂600mg/m²，第3天给予博来霉素15mg/m²）。每3至4周进行一个疗程，直至缓解，然后再进行两个疗程。使用世界卫生组织或布罗克分级法评估化疗毒性。
1989年1月至1997年12月期间，登记了192例患者。8例被排除，原因是没有组织学诊断（n = 3）或化疗未按研究方案进行（n = 5）。其余184例患者患有生殖细胞瘤（n = 20）、恶性畸胎瘤（n = 55）、胚胎癌（n = 1）卵黄囊瘤（n = 107）或绒毛膜癌（n = 1）。47例患者仅接受手术治疗，137例患者接受JEB方案治疗。1999年3月，所有184例患者的5年生存率为93.2%（95%置信区间[CI]，87.9%至96.3%）；接受JEB方案治疗的137例患者中为90.9%（95%CI，83.9%至95.0%），无事件生存率为87.8%（95%CI，81.1%至92.4%）。JEB方案治疗后的中位随访时间为53个月（范围，0至109个月）；中位疗程数为5个（范围，3至8个）。肿瘤部位、分期和AFP水平具有预后意义。非致命性血液学毒性常见，但耳聋以及肺部和肾脏毒性罕见。一名儿童死于胸内肿瘤和支气管肺发育不良，另一名死于急性髓细胞白血病。
保守性手术、完全切除后的“观察等待”方法以及对需要化疗的患者采用JEB方案可产生高治愈率且严重并发症少。
