Outcomes
Time to follow-up was available for 32 patients (mean 3.9 years; range,
one month to 21.2 years). Overall, nine patients (21.2%) experienced
disease relapse or progression; four patients experienced local relapse
after CR (one germinoma, one teratoma, two NGGCTs) and five patients
experienced disease progression despite therapy. Of the four patients
who experienced local relapse, salvage regimens included platinum-based
chemotherapy (n=3), repeat surgery (n=2) and radiotherapy (n=1). Three
patients who experienced disease relapse were successfully salvaged and
had no evidence of disease (NED) at last follow-up, whereas one died
from treatment-related pneumonia. Four patients who had progressive
disease died, while one remained alive with residual tumor at last
follow-up.
Overall, four patients (9.8%) died from tumor progression (three
teratomas, one unspecified histology), while the remaining eight
patients (19.5%) died from treatment-related adverse events. Of the
germinoma patients, two died from chemotherapy-related sepsis, one from
pneumonia, one from post-surgery cardiopulmonary failure and one from
Moyamoya following RT only. Of the NGGCT patients, one died from
chemotherapy-related sepsis, one from post-surgical infection and one
from pneumonia following surgery/chemotherapy/RT.
At last follow-up, 28 patients (68.3%) were alive with NED and one
patient (2.4%) was alive with residual tumor. The 3-year OS for all
histological types was 66% (95% CI 45.7%-81.5%). Three-year OS was
62% for germinomas (95% CI 30.5%-85.5%), 79% for NGGCTs (95% CI
38%-94.3%) and 53% for teratomas (95% CI 13.2%-82.5%) (Fig. 1A).
There was no significant difference in 3-year OS based on histology
(p =0.74). Three-year OS was 74.7% (95% CI 47.4%-89.9%) for
those who received RT, 76.7% (95% CI 48.2%-90.8%) for chemotherapy
and 72.4% (95% CI 44.7%-90.5%) for combined chemotherapy/RT (Fig.
1b). There was no significant difference in 3-year OS based on treatment
(p =0.87).