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    Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview for Childhood Extracranial GCTs

    Table 4. Comparison of Adult BEP and Pediatric PEB and JEB Chemotherapy Dosing Schedulesa continued...

    The approach to the management of extracranial GCTs has been derived from the results of several intergroup studies conducted by the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG).[1,2,6] These studies explored the use of PEB for the treatment of localized gonadal GCT [1] and the benefit of increasing the dose of cisplatin (high-dose [HD]-PEB: 200 mg/m2 vs. PEB: 100 mg/m2 of cisplatin) in a randomized manner in patients with extragonadal and advanced gonadal GCTs.[2] The intensification of cisplatin in the HD-PEB regimen provided some improvement in EFS but no difference in OS; however, the use of HD-PEB was associated with a significantly higher incidence and severity of otologic toxic effects and renal toxic effects. In a subsequent study, amifostine was not effective in preventing hearing loss in patients who received HD-PEB.[19]

    Table 5 provides an overview of standard treatment options for children with extracranial GCTs. Specific details of treatment by primary site and clinical condition are described in subsequent sections.

    Table 5. Standard Treatment Options for Childhood Extracranial Germ Cell Tumors (GCTs)

    Histology Standard Treatment Options
    JEB = carboplatin, etoposide, and bleomycin; PEB = cisplatin, etoposide, and bleomycin.
    Mature teratoma (nonsacrococcygeal) Surgery and observation
    Immature teratoma (nonsacrococcygeal) Surgery and observation (stage I)
    Surgery and chemotherapy (stages II-IV)(refer to theChildhood Malignant Ovarian GCTssection of this summary for specific information about the treatment of ovarian immature teratoma)
    Mature and immature teratomas (sacrococcygeal) Surgery and observation
    Malignant gonadal GCTs in children:
    Childhood malignant testicular GCTs:
    Malignant testicular GCTs in prepubertal males Surgery and observation (stage I)
    Surgery and chemotherapy (PEB) (stages II-IV)
    Malignant testicular GCTs in postpubertal males Refer to the PDQ summary onTesticular Cancer Treatmentfor more information.
    Childhood malignant ovarian GCTs:
    Dysgerminomas of the ovary Surgery and observation (stage I)
    Surgery and chemotherapy (PEB) (stages II-IV)
    Malignant nongerminomatous ovarian GCTs (yolk sac and mixed GCTs) Surgery and observation (stage I)(refer to theChildhood Malignant Ovarian GCTssection of this summary for specific information about the treatment of ovarian immature teratoma)
    Surgery and chemotherapy (PEB) (stage I and stages II-IV)
    Biopsy followed by chemotherapy (PEB) and surgery (initially unresectable tumors)
    Malignant extragonadal extracranial GCTs in children Surgery and chemotherapy (PEB)
    Biopsy followed by chemotherapy (PEB) and possibly surgery
    Recurrent malignant GCTs in children Refer to theTreatment of Recurrent Malignant GCTs in Childrensection of this summary for more information.
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