Detection of Relapse by Tumor Markers Versus Imaging in Children and Adolescents With Nongerminomatous Malignant Germ Cell Tumors: A Report From the Children's Oncology Group

• Authors: Adriana Fonseca, University of Toronto; Caihong Xia, Children's Oncology Group; Armando J. Lorenzo, University of Toronto; Mark Krailo, Children's Oncology Group; Thomas Olson, Emory University; Farzana Pashankar, Yale University; Marcio H. Malogolowkin, University of California Davis; James F. Amatruda, University of Texas Southwestern; Deborah F. Billmire, Riley Hospital for Children; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital; A. Lindsay Frazier, Dana Farber Cancer Institute; Furqan Shaikh, University of Toronto
• Journal Title: Journal of Clinical Oncology
• Volume: Volume 37, Number 5
• Publisher: American Society of Clinical Oncology | 2019-02-10, Pages 396-+
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1200/JCO.18.00790
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Biology, Radiation
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; COMPUTED-TOMOGRAPHY; STAGE-I; RADIATION-EXPOSURE; INITIAL SURGERY; SURVEILLANCE; RISK; CHEMOTHERAPY; DECLINE; CISPLATIN; CHEST

Abstract

PURPOSE To investigate relapse detection methods among children and adolescents with nongerminomatous malignant germ cell tumors (MGCTs) and to determine whether tumor markers alone might be sufficient for surveillance. METHODS We retrospectively reviewed all patients enrolled in a phase III, single-arm trial for low-risk and intermediate-risk MGCTs. The method used to detect relapse was assessed based on case report forms, tumor markers, imaging, and pathology reports. Relapses were classified into one of two categories on the basis of whether they were (1) detectable by tumor marker elevation or (2) not detectable by tumor markers. RESULTS A total of 302 patients were enrolled, and 284 patients had complete data for review. Seven patients had normal tumor markers at initial diagnosis, and none experienced a relapse. At a median follow-up of 5.3 years, 48 patients (16.9%) had experienced a relapse. After central review, 47 of 48 relapses (98%) were detected by tumor marker elevation. Of the 47 patients, 16 (33.3%) had abnormal tumor markers with normal/unknown imaging, 31 patients (64.6%) had abnormal tumor markers with abnormal imaging, and one patient (2.1%) had abnormal imaging with unknown marker levels at relapse. CONCLUSION Tumor marker elevation is a highly sensitive method of relapse surveillance, at least among children and adolescents with tumor marker elevation at initial diagnosis. Eliminating exposure to imaging with ionizing radiation may enhance the safety of relapse surveillance in patients treated for MGCT.