Skip to main content
SpringerLink
Log in

Management of Pediatric Malignant Germ Cell Tumors: ICMR Consensus Document

  • Review Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

With the introduction of cisplatin, the outcome of children with malignant germ cell tumors (MGCT) has improved to nearly 90% 5 year survival. Over the years, through the results of various multinational co-operative trials, the chemotherapy and surgical guidelines for both the gonadal and extra-gonadal MGCTs have been refined to decrease the early and late morbidities and at the same time improve survival. Introduction of risk categorization has further added to this effort. There has been no recommendation on how the children with malignant germ cell tumors should be treated in India. The current manuscript is written with the objective of developing a consensus guideline for practitioners at a National level. Based on extensively reviewed literature and personal experience of the major pediatric oncology centres in India, the ICMR Expert group has made recommendations for management of children with MGCT India.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jain V, Agarwala S, Bakhshi S, et al. Malignant germ cell tumours in children: management and outcomes from the AIIMS-MGCT 94 trial. Pediatr Blood Cancer. 2009;53:732.

    Google Scholar 

  2. Lo Curto M, Lumia F, Alaggio R, et al. Malignant germ cell tumors in childhood: results of the first Italian cooperative study “TCG 91”. Med Pediatr Oncol. 2003;41:417–25.

    Article  PubMed  Google Scholar 

  3. Schneider DT, Calaminus G, Koch S, et al. Epidemiologic analysis of 1,442 children and adolescents registered in the German germ cell tumor protocols. Pediatr Blood Cancer. 2004;42:169–75.

    Article  PubMed  Google Scholar 

  4. Teilum G. Classification of endodermal sinus tumour (mesoblastoma vitellinum) and so-called “embryonal carcinoma” of the ovary. Acta Pathol Microbiol Scand. 1965;64:407–29.

    CAS  PubMed  Google Scholar 

  5. Göbel U, Schneider DT, Calaminus G, Haas RJ, Schmidt P, Harms D. Germ-cell tumors in childhood and adolescence. Ann Oncol. 2000;11:263–71.

    Article  PubMed  Google Scholar 

  6. Schneider DT, Terenziani M, Cecchetto G, Olson TA. Gonadal and extragonadal germ cell tumors, sex cord stromal and rare gonadal tumors. In: Schneider DT, Brecht IB, Olson TA, Ferrari A, editors. Rare tumors in children and adolescents. Berlin Heidelberg: Springer; 2012. p. 327–402.

    Chapter  Google Scholar 

  7. Schneider DT, Calaminus G, Reinhard H, et al. Primary mediastinal germ cell tumors in children and adolescents: results of the German cooperative protocols MAKEI 83/86, 89, and 96. J Clin Oncol. 2000;18:832–9.

    Article  CAS  PubMed  Google Scholar 

  8. Göbel U, Schneider DT, Calaminus G, et al. Multimodal treatment of malignant sacrococcygeal germ cell tumors: a prospective analysis of 66 patients of the German cooperative protocols MAKEI 83/86 and 89. J Clin Oncol. 2001;19:1943–50.

    Article  PubMed  Google Scholar 

  9. Mulligan RM. Pathogenesis of teratoid tumors of the ovary and testis. Pathol Annu. 1975;10:271–98.

    CAS  PubMed  Google Scholar 

  10. Kurman RJ, Norris HJ. Endodermal sinus tumor of the ovary: a clinical and pathologic analysis of 71 cases. Cancer. 1976;38:2404–19.

    Article  CAS  PubMed  Google Scholar 

  11. Chretien PB, Milam JD, Foote FW, Miller TR. Embryonal adenocarcinomas (a type of malignant teratoma) of the sacrococcygeal region: clinical and pathologic aspects of 21 cases. Cancer. 1970;26:522–35.

    Article  CAS  PubMed  Google Scholar 

  12. Einhorn LH, Donohue J. Cis-diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med. 1977;87:293–8.

    Article  CAS  PubMed  Google Scholar 

  13. Billmire DF. Malignant germ cell tumors in childhood. Semin Pediatr Surg. 2006;15:30–6.

    Article  PubMed  Google Scholar 

  14. Hale GA, Marina NM, Jones-Wallace D, et al. Late effects of treatment for germ cell tumors during childhood and adolescence. J Pediatr Hematol Oncol. 1999;21:115–22.

    Article  CAS  PubMed  Google Scholar 

  15. Mann JR, Raafat F, Robinson K, et al. 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. J Clin Oncol. 2000;18:3809–18.

  16. Schmidt P, Haas RJ, Göbel U, Calaminus G. Results of the German studies (MAHO) for treatment of testicular germ cell tumors in children-an update. [Article in German]. Klin Padiatr. 2002;214:167–72.

  17. Schlatter M, Rescorla F, Giller R, et al.; Children’s cancer group; Pediatric oncology group. Excellent outcome in patients with stage I germ cell tumors of the testes: a study of the children’s cancer group/pediatric oncology group. J Pediatr Surg. 2003;38:319–24.

  18. Cushing B, Giller R, Cullen JW, et al. Randomized comparison of combination chemotherapy with etoposide, bleomycin, and either high-dose or standard-dose cisplatin in children and adolescents with high-risk malignant germ cell tumors: a pediatric intergroup study—pediatric oncology group 9049 and children’s cancer group 8882. J Clin Oncol. 2004;22:2691–700.

  19. Billmire DF, Cullen JW, Rescorla FJ, et al. Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the children's oncology group. J Clin Oncol. 2014;32:465–70.

  20. Shaikh F, Nathan PC, Hale F, Uleryk E, Frazier L. Is there a role for carboplatin in the treatment of malignant germ cell tumors? A systematic review of adult and pediatric trials. Pediatr Blood Cancer. 2013;60:587–92.

    Article  CAS  PubMed  Google Scholar 

  21. Isaacs H Jr. Germ cell tumors. In: Isaacs H Jr, editor. Tumors of the Fetus and Newborn. Vol. 35 in the series Major Problems in Pathology. Philadelphia: Saunders; 1997. p. 15–38.

  22. Dehner LP. Neoplasms of the fetus and neonate. In: Naeye RL, Kissane JM, Kaufman N, editors. Perinatal diseases, international academy of pathology, monograph number 22. Baltimore: Williams and Wilkins; 1981. p. 286–345.

    Google Scholar 

  23. Heifetz SA, Cushing B, Giller R, et al. Immature teratomas in children: pathologic considerations: a report from the combined pediatric oncology group/children’s cancer group. Am J Surg Pathol. 1998;22:1115–24.

  24. Cushing B, Giller R, Ablin A, et al. Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents: a report of the pediatric oncology group and the children’s cancer group. Am J Obstet Gynecol. 1999;181:353–8.

    Article  CAS  PubMed  Google Scholar 

  25. Marina NM, Cushing B, Giller R, et al. Complete surgical excision is effective treatment for children with immature teratomas with or without malignant elements: a pediatric oncology group/children’s cancer group intergroup study. J Clin Oncol. 1999;17:2137–43.

  26. Adzick NS, Crombleholme TM, Morgan MA, Quinn TM. A rapidly growing fetal teratoma. Lancet. 1997;349:538.

    Article  CAS  PubMed  Google Scholar 

  27. Graf JL, Albanese CT, Jennings RW, Farrell JA, Harrison MR. Successful fetal sacrococcygeal teratoma resection in a hydropic fetus. J Pediatr Surg. 2000;35:1489–91.

    Article  CAS  PubMed  Google Scholar 

  28. Esposito G, Cigliano B, Paludetto R. Abdominothoracic gastric teratoma in a female newborn infant. J Pediatr Surg. 1983;18:304–5.

    Article  CAS  PubMed  Google Scholar 

  29. Haley T, Dimler M, Hollier P. Gastric teratoma with gastrointestinal bleeding. J Pediatr Surg. 1986;21:949–50.

    Article  CAS  PubMed  Google Scholar 

  30. Gengler JS, Ashcraft JW, Slattery P. Gastric teratoma: the sixth reported case in a female infant. J Pediatr Surg. 1995;30:889–90.

    Article  CAS  PubMed  Google Scholar 

  31. Van der Hauwaert LG. Cardiac tumours in infancy and childhood. Br Heart J. 1971;33:125–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Costas C, Williams RL, Fortune RL. Intracardiac teratoma in an infant. Pediatr Cardiol. 1986;7:179–81.

    Article  CAS  PubMed  Google Scholar 

  33. Bruch SW, Adzick NS, Reiss R, Harrison MR. Prenatal therapy for pericardial teratomas. J Pediatr Surg. 1997;32:1113–5.

    Article  CAS  PubMed  Google Scholar 

  34. Rescoria FJ, Sawin RS, Coran AG, Dillon PW, Azizkhan RG. Long-term outcome for infants and children with sacrococcygeal teratoma: a report from the childrens cancer group. J Pediatr Surg. 1998;33:171–6.

  35. Ghosn M, Droz JP, Theodore C, et al. Salvage chemotherapy in refractory germ cell tumors with etoposide (VP-16) plus ifosfamide plus high-dose cisplatin: a VIhP regimen. Cancer. 1988;62:24–7.

    Article  CAS  PubMed  Google Scholar 

  36. Marina N, London WB, Frazier AL, et al. Prognostic factors in children with extragonadal malignant germ cell tumors: a pediatric intergroup study. J Clin Oncol. 2006;24:2544–8.

    Article  PubMed  Google Scholar 

  37. Faure-Conter C, Orbach D, Cropet C, et al. Salvage therapy for refractory or recurrent pediatric germ cell tumors: the french SFCE experience. Pediatr Blood Cancer. 2014;61:253–9.

    Article  PubMed  Google Scholar 

  38. Blohm ME, Vesterling-Hörner D, Calaminus G, Göbel U. Alpha 1-fetoprotein (AFP) as a reference values in infants up to 2 years of age. Pediatr Hematol Oncol. 1998;15:135–42.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Prepared as an outcome of Indian Council of Medical Research (ICMR) sub-committee on pediatric lymphomas and solid tumors coordinated by the Division of non-communicable diseases, ICMR.

Contributions

SA and AM: Writing and literature search; DB, GK, TV, MP, GC, BA, VR and SL: Review and revisions; TK, RSD and GKR: Administrative support; SB: Writing, review and revisions. SA will act as guarantor for the paper.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India

    Sandeep Agarwala & Aparajita Mitra

  2. Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Deepak Bansal

  3. Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute & Research Center, Delhi, India

    Gauri Kapoor

  4. Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India

    Tushar Vora, Maya Prasad, Girish Chinnaswamy & Brijesh Arora

  5. Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India

    Venkatraman Radhakrishnan

  6. Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India

    Siddharth Laskar

  7. NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India

    Tanvir Kaur & Rupinder Singh Dhaliwal

  8. Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

    G. K. Rath

  9. Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

    Sameer Bakhshi

Authors
  1. Sandeep Agarwala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aparajita Mitra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deepak Bansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gauri Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tushar Vora
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maya Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Girish Chinnaswamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brijesh Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Venkatraman Radhakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Siddharth Laskar
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tanvir Kaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rupinder Singh Dhaliwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. G. K. Rath
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Sameer Bakhshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandeep Agarwala.

Ethics declarations

Conflict of Interest

None.

Source of Funding

ICMR organized the meeting and funded the travel.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agarwala, S., Mitra, A., Bansal, D. et al. Management of Pediatric Malignant Germ Cell Tumors: ICMR Consensus Document. Indian J Pediatr 84, 465–472 (2017). https://doi.org/10.1007/s12098-017-2308-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-017-2308-2

Keywords

Search

Navigation