Chemotherapy and evaluation
Preoperative courses of chemotherapy were administered to patients with
bulky disease or metastasis. Initial chemotherapy comprised cisplatin,
etoposide, and bleomycin (PEB regimen): bleomycin 15
mg/m2 on day 1, etoposide 100 mg/m2on days 1 through 5 and cisplatin 20mg/m2 on days 1
through 5. Every cycle was repeated at three-week interval. Chemotherapy
doses were adjusted for infants < 12 months of age: cisplatin
0.7 mg/kg/dose, etoposide 3 mg/kg/dose, and bleomycin 0.5 mg/kg/dose.
AFP was monitored prior to every cycle of chemotherapy. Patients
underwent a thorough evaluation every two cycles of chemotherapy by
imaging work-up and tumor marker determinations. We proposed 4-6
preoperative chemotherapy courses before a radical complete resection
without major morbidity was achieved. Postsurgical chemotherapy was
determined based on histologic findings. If the resected specimen showed
no viable tumor cells and AFP declined within reasonable range of
half-life, pathologic response was
considered complete. Additional two courses of chemotherapy were
administered to patients. Patients with malignant residual disease in
pathological specimen continued to receive chemotherapy. Patients with
progressive disease or no response to the initial chemotherapy were
considered treatment failures and received second-line chemotherapy.
Total cycles of chemotherapy varied between 6-8 courses.