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British Journal of Cancer Aug 1990Between February 1986 and July 1988 a total of 21 children aged 1 to 16 years with malignant germ cell tumours (MGCT), 18 with either metastatic disease or unresectable...
Between February 1986 and July 1988 a total of 21 children aged 1 to 16 years with malignant germ cell tumours (MGCT), 18 with either metastatic disease or unresectable primary tumour, received the JEB regimen - carboplatin dosage calculated from the EDTA glomerular filtration rate (approximately 600 mg m-2), etoposide 120 mg m-2 daily x 3, and bleomycin 15 mg m-2 weekly. Primary sites were: testis (6), ovary (8), sacrococcyx (4), pineal gland (2) and vagina (1). AFP levels were elevated in 19, beta-HCG in 8. Complete marker response was achieved in 19 out of 19 evaluable patients and complete remission of measurable tumour in 16 out of 19, 12 with chemotherapy alone and 4 with the addition of surgery. A reduction in glomerular filtration rate greater than 10% occurred in 3 of 12 evaluable patients; in none greater than 20%. Sequential audiography was normal in 11 out of 12 evaluated. The regimen was myelosuppressive with WHO grade III or IV myelosuppression occurring in 12 patients. Three patients have relapsed; one with a pineal germinoma who relapsed in the abdomen six months after diagnosis, and two with sacrococcygeal teratomas and lung metastases. Two of these remain in second complete remission after further treatment. There was one death from probable bleomycin pulmonary toxicity. We conclude that this regimen is simple to administer and, apart from myelosuppression, it is well tolerated. It appears to have comparable efficacy to cisplatin-based regimens but with much less nephrotoxicity and ototoxicity and avoids the use of alkylating agents and anthracyclines.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Child; Child, Preschool; Etoposide; Female; Humans; Infant; Lung; Male; Neoplasms, Germ Cell and Embryonal; Organoplatinum Compounds
PubMed: 1696831
DOI: 10.1038/bjc.1990.272 -
Annals of Oncology : Official Journal... Dec 1996
Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cisplatin; Etoposide; Female; Germinoma; Humans; Male; Ovarian Neoplasms; Randomized Controlled Trials as Topic; Testicular Neoplasms
PubMed: 9037354
DOI: 10.1093/oxfordjournals.annonc.a010521 -
Journal of Pediatric Hematology/oncology Mar 2011Primary yolk sac tumor of the diaphragm in children is very rare, and diagnosis of a diaphragmatic tumor poses challenges to clinical physicians. Here, we report a... (Review)
Review
Primary yolk sac tumor of the diaphragm in children is very rare, and diagnosis of a diaphragmatic tumor poses challenges to clinical physicians. Here, we report a primary diaphragmatic yolk sac tumor in a 9-month-old girl, together with a review of 4 earlier reported cases in the English literature. Carboplatin-containing regimen successfully decreased the tumor size and a total resection of the tumor was made subsequently. The patient was disease-free 8 months after the completion of treatment.
Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Diaphragm; Endodermal Sinus Tumor; Etoposide; Female; Humans; Infant
PubMed: 21317810
DOI: 10.1097/MPH.0b013e3181ff0e17 -
Medical and Pediatric Oncology Apr 1998We report the efficacy and late effects of carboplatin, etoposide, and bleomycin (JEB) for extracranial non-gonadal tumours (GCII, 1989-95) compared with the 5 previous... (Clinical Trial)
Clinical Trial Comparative Study Review
UKCCSG's germ cell tumour (GCT) studies: improving outcome for children with malignant extracranial non-gonadal tumours--carboplatin, etoposide, and bleomycin are effective and less toxic than previous regimens. United Kingdom Children's Cancer Study Group.
BACKGROUND
We report the efficacy and late effects of carboplatin, etoposide, and bleomycin (JEB) for extracranial non-gonadal tumours (GCII, 1989-95) compared with the 5 previous regimens (GCI, 1979-1988) consisting of 3 vincristine, actinomycin, and cyclophosphamide (VAC) and 2 platinum-based protocols.
METHODS AND RESULTS
Median follow-up for 52 patients in the GCI study and 46 in GCII was 105 and 48 months, respectively. For GCI, 5- and 10-year actuarial survival was 63% (95% Confidence interval 50 to 75%) or 72% (57 to 83%) if 6 cases given low-dose VAC were excluded. For GCII, 5-year survival was significantly greater at 95% (83 to 99%), p = 0.01. Event-free survival was 46% at 5 years for GCI (33 to 59%) or 52% excluding the low-dose VAC cases (38 to 66%), while for GCII it was 87% (74 to 94%), p = 0.002. Five-year event-free survival of 21 children given cisplatin, etoposide, and bleomycin (BEP) in GCI was 57% (37 to 76%) compared with 87% (74 to 94%) for 46 given JEB in GCII, P = 0.02. Late effects in 30 evaluable survivors of GCI and 43 GCII included renal impairment in 6 in GCI and 0 in GCII and deafness in 11 and 4, respectively. Among 17 survivors of sacrococcygeal tumours treated in GCI, 4 have neuropathic bladder/bowel and another shortening of a leg. In GCII, 4 of 26 have neuropathic bladder/bowel with lower limb weakness in one.
CONCLUSIONS
We found JEB to be more effective and less toxic than our previous regimens. Some survivors of sacrococcygeal tumours have neurological late effects.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Child; Child, Preschool; Cisplatin; Etoposide; Female; Germinoma; Humans; Infant; Male; Prognosis; Recurrence; Survival Analysis; Treatment Outcome
PubMed: 9473756
DOI: 10.1002/(sici)1096-911x(199804)30:4<217::aid-mpo3>3.0.co;2-j -
Journal of the National Cancer Institute Jan 1993
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cisplatin; Cyclophosphamide; Dactinomycin; Etoposide; Humans; Leukemia, Myeloid, Acute; Male; Mediastinal Neoplasms; Neoplasms, Germ Cell and Embryonal; Neoplasms, Second Primary; Remission Induction; Salvage Therapy; Testicular Neoplasms; Vinblastine
PubMed: 7677936
DOI: 10.1093/jnci/85.1.60 -
Journal of Clinical Oncology : Official... Nov 2000To evaluate carboplatin, etoposide, and bleomycin (JEB) in children with malignant extracranial germ cell tumors (GCTs). (Clinical Trial)
Clinical Trial
The United Kingdom Children's Cancer Study Group's second germ cell tumor study: carboplatin, etoposide, and bleomycin are effective treatment for children with malignant extracranial germ cell tumors, with acceptable toxicity.
PURPOSE
To evaluate carboplatin, etoposide, and bleomycin (JEB) in children with malignant extracranial germ cell tumors (GCTs).
PATIENTS AND METHODS
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.
RESULTS
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.
CONCLUSION
Conservative surgery, a watch-and-wait approach after complete excision, and JEB for those requiring chemotherapy produced high cure rates and few serious complications.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Child; Child, Preschool; Chorionic Gonadotropin; Combined Modality Therapy; Etoposide; Female; Germinoma; Humans; Infant; Infant, Newborn; Male; Ovarian Neoplasms; Prognosis; Survival Analysis; Testicular Neoplasms; alpha-Fetoproteins
PubMed: 11078494
DOI: 10.1200/JCO.2000.18.22.3809 -
European Journal of Pediatric Surgery :... Jun 1997To see the impact of cisplatin- and carboplatin-based protocols on survival in malignant sacrococcygeal teratomas (SCT).
AIM OF STUDY
To see the impact of cisplatin- and carboplatin-based protocols on survival in malignant sacrococcygeal teratomas (SCT).
METHODS
Twenty infants and children with malignant SCT were treated at the Hospital for Sick Children, Great Ormond Street, London, over a 16-year period from 1979 to 1994. There were 5 males and 15 females, age ranged from 1 day to 3.5 years (mean 18 months).
RESULTS
Twelve patients (60%) had distant metastasis: 9 lung metastasis, 2 liver involvement, 2 bony metastases, 1 cerebral metastasis and 1 bilateral inguinal lymph node deposits. From 1982 to 1986, patients received the BEP chemotherapy protocol which included cis-platinum, bleomycin and etoposide (VP 16). After 1986, cis-platinum was replaced with carboplatin in the new JEB protocol. Patient 1 did not receive any chemotherapy, Patients 2-4 received varying protocols (2 deaths), Patients 5-8 received the BEP regime (1 death) and Patients 9-20 received JEB (1 death). The first three deaths were due to uncontrolled local disease and/or metastasis, while the latter death was due to bleomycin toxicity. Overall, 9 of 12 (75%) patients with distant metastasis survived as opposed to 7 of 8 (88%) patients with localised disease. Of the 12 patients who received the JEB protocol, 11 (92%) survived, including 7 patients with metastatic disease and 2 with local recurrence. Seven patients (35%) had relapse while on treatment or follow-up, 4 of these are disease-free with further therapy. In 6 of these children, serum AFP rose before there was clinical or radiological evidence of relapse. In 2 other patients, further chemotherapy was recommenced solely on the basis of rising serum AFP, these patients did not subsequently develop overt metastasis.
CONCLUSIONS
We conclude that the treatment of choice for malignant SCT is the JEB regime, to be given for 4 courses or to be continued for 2 courses beyond documented Complete Response (CR). Excision of the primary tumour and coccyx should be done in all cases even if a CR has been documented. Metastases not responding to chemotherapy would need appropriate surgery, radiotherapy is hardly ever needed. An overall cure rate exceeding 90% can be expected.
Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Cause of Death; Chemotherapy, Adjuvant; Child, Preschool; Cisplatin; Coccyx; Combined Modality Therapy; Etoposide; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Sacrum; Spinal Neoplasms; Survival Rate; Teratoma
PubMed: 9241501
DOI: 10.1055/s-2008-1071078 -
Journal of Clinical Oncology : Official... Jan 1991The combination of carboplatin, etoposide, and bleomycin (CEB) was evaluated as initial chemotherapy in 76 patients with good-prognosis metastatic nonseminomatous germ... (Clinical Trial)
Clinical Trial
The combination of carboplatin, etoposide, and bleomycin (CEB) was evaluated as initial chemotherapy in 76 patients with good-prognosis metastatic nonseminomatous germ cell tumors (NSGCT) between 1984 and 1988. The classification of eligible patients included Royal Marsden Hospital (RMH) stages IM, IIA, IIB, IIC, IIIA, IIIB, IV0ABCL1, and IV0ABL2. Four courses of combination chemotherapy were administered in a 21-day cycle, and surgical excision of residual mass was performed in 27 cases (23 laparotomies and four thoracotomies). At the time of analysis, median follow-up was 24 months from start of chemotherapy (range, 6 to 54 months). The 2-year cause-specific survival probability was 98.5%, the single cause-related mortality being caused by bleomycin pneumonitis. Five patients failed CEB chemotherapy, but all have been successfully salvaged with a combination of surgery and intensive chemotherapy, follow-up from completion of all treatment being 35 to 44 months. The toxicity of CEB included bone marrow suppression and alopecia in all patients but no significant neurotoxicity or ototoxicity, and minimal renal toxicity. Only four (5%) patients had a decrease in the glomerular filtration rate greater than 15%. In 51% of patients, the hemoglobin fell below 10 g/dL. The WBC count nadir was less than 1,500/microL in 11% of treatment cycles and in 16% the platelet nadir fell below 50,000/microL. Decreases in the WBC and platelet counts were of very brief duration. Only one of 310 CEB cycles was complicated by neutropenic sepsis, and there were no episodes of thrombocytopenic purpura or bleeding. We conclude that the CEB combination represents an effective alternative to cisplatin-based chemotherapy in good-prognosis NSGCT and that the replacement of cisplatin by carboplatin leads to reduced toxicity.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Child; Etoposide; Follow-Up Studies; Glomerular Filtration Rate; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Germ Cell and Embryonal; Remission Induction; Sperm Count; Survival Rate; Testicular Neoplasms
PubMed: 1702147
DOI: 10.1200/JCO.1991.9.1.62 -
Pelvic teratoma with extensive spinal involvement in a neonate: an important differential diagnosis.British Journal of Neurosurgery Jun 2008A 6-week-old girl presented with an abdominal mass and spinal cord compression. Clinical and radiological features indicated a diagnosis of congenital neuroblastoma....
A 6-week-old girl presented with an abdominal mass and spinal cord compression. Clinical and radiological features indicated a diagnosis of congenital neuroblastoma. Histology revealed a diagnosis of germ cell tumour after therapy for neuroblastoma had been commenced. This is, to the authors' knowledge, the first reported case of paediatric dumbbell retroperitoneal teratoma.
Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Diagnosis, Differential; Etoposide; Female; Humans; Hypertension; Infant; Neoplasm, Residual; Neuroblastoma; Pelvic Neoplasms; Retroperitoneal Neoplasms; Spinal Cord Compression; Teratoma; Treatment Outcome
PubMed: 18568732
DOI: 10.1080/02688690701704531 -
European Neurology 2002
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cannabis; Carboplatin; Drug Interactions; Etoposide; Fatal Outcome; Humans; Male; Neoplasms, Germ Cell and Embryonal; Stroke; Testicular Neoplasms
PubMed: 12373036
DOI: 10.1159/000065511