• Luiz Fernando Lopes, Carla Renata Pacheco Donato Macedo, Simone Dos Santos Aguiar, Jose Henrique S Barreto, Gisele Eiras Martins, Viviane Sonaglio, Marcelo Milone, Eduardo Ribeiro Lima, Maria Teresa de Assis Almeida, Paula Maria Azevedo Allemand Lopes, Flora Mitie Watanabe, Maria Lydia Mello D'Andrea, Mara Albonei Pianovski, Renato Melaragno, Sonia Maria Rossi Vianna, Mauber Eduardo Schultz Moreira, Paula Bruniera, and Cleyton Zanardo de Oliveira.
• Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de São Paulo; Viviane Sonaglio, Hospital A.C. Camargo; Maria Teresa de Assis Almeida, Universidade de São Paulo, ITACI FMUSP; Maria Lydia Mello D'Andrea, Hospital Infantil Darcy Vargas; Renato Melaragno, Hospital Santa Marcelina; Sonia Maria Rossi Vianna, Hospital do Servidor Publico Estadual; Paula Bruniera, Santa Casa de Misericordia de São Paulo, São Paulo; Luiz Fernando Lopes and Gisele Eiras Martins, Hospital de Cancer Infanto Juvenil de Barretos; Cleyton Zanardo de Oliveira, Hospital de Cancer de Barretos, Barretos; Simone dos Santos Aguiar, Centro Infantil Boldrini & CIPED/FCM/Unicamp, Campinas; Marcelo Milone, Centro de Tratamento Fabiana Macedo de Morais/GACC, São Jose dos Campos; Jose Henrique S. Barreto, Hospital São Rafael/ONCO Bahia, Salvador; Eduardo Ribeiro Lima, Hospital da Baleia, Belo Horizonte; Paula Maria Azevedo Allemand Lopes, Hospital da Criança de Brasilia Jose Alencar, Brasilia; Flora Mitie Watanabe, Hospital Infantil Pequeno Principe; Mara Albonei Pianovski, Hospital Erasto Gaertner, Curitiba; and Mauber Eduardo Schultz Moreira, Hospital Universitario de Santa Maria, Santa Maria, Brazil. lf.lopes@yahoo.com.
• J. Clin. Oncol. 2016 Feb 20; 34 (6): 603-10.

PurposeWe describe the results of a risk-adapted, response-based therapeutic approach from the Brazilian GCT-99 study on germ cell tumors.Patients And MethodsFrom May 1999 to October 2009, 579 participants were enrolled in the Brazilian GCT-99 study. Treatment, defined as specific chemotherapy regimen and number of cycles, was allocated by means of risk-group assignment at diagnosis with consideration for stage and primary tumor site. Patients at low risk received no chemotherapy. Patients at intermediate risk (IR) with a good response (GR) received four cycles of platinum and etoposide (PE), for total doses of platinum 420 mg/m(2) and etoposide 2,040 mg/m(2). Patients at IR with a partial response (PR) received three cycles of PE plus three cycles of ifosfamide, vinblastine, and bleomycin. Patients at high risk (HR) with a GR received four cycles of PE and ifosfamide (PEI) at total doses of platinum 420 mg/m(2), etoposide 1,200 mg/m(2), and ifosfamide 30 g/m(2). Patients at HR with a PR received six cycles of PEI.ResultsThe risk-group distribution was 213 LR, 138 IR, and 129 HR for 480 evaluable patients. Overall survival (OS) and event-free survival (EFS) rates at 10 years were, respectively, 90% and 88.6% in the IR-GR group (n = 126) and 74.1% and 74.1% in the IR-PR group (n = 12). Ten-year rates for the HR-GR group (n = 86) were an OS of 66.8% and an EFS of 62.5%. The HR-PR group (n = 43) had an OS of 74.8% and an EFS of 73.4%. In univariable and multivariable analysis, increased serum lactate dehydrogenase level and histology for a metastatic immature teratoma were prognostic of a worsened outcome.ConclusionReduction of therapy to two drugs did not compromise survival outcomes for patients in the IR-GR group, and escalation of therapy with PEI did not significantly improve OS and EFS in patients at HR.© 2016 by American Society of Clinical Oncology.

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