864P - Teratoma with malignant transformation (TMT) in men with germ cell tumors (GCTs): retrospective study of 26 cases from a single institution

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Germ Cell Tumours
Presenter Nathalie Bonnin
Authors N. Bonnin1, H. Boyle2, M. Rivoire3, C. Bailly4, J. Droz1, A. Flechon1
  • 1Medical Oncology, Centre Léon Bérard, 69008 - Lyon CEDEX/FR
  • 2Centre Léon Bérard, 69008 - Lyon CEDEX/FR
  • 3Surgery, Centre Léon Bérard, 69008 - Lyon CEDEX/FR
  • 4Pathology, Centre Léon Bérard, 69008 - Lyon CEDEX/FR

Abstract

Background

GCT is the most common solid tumor in young men. TMT is a rare entity. It occurs in less than 2% of GCTs and is associated with poor prognosis.

Methods

Between Jan 1993 and Jan 2012, we identified retrospectively all pts with GCTs with TMT treated at our institution and report here their characteristics, treatment and clinical outcome.

Results

Twenty six patients (pts) with TMT were identified. Median age at initial diagnosis was 26 years (19–48). At initial diagnosis 20 pts had a gonadal primary (4 stage (sg) I, 8 sg II and 8 sg III) and 6 a primary mediastinal tumor (PMT). Six pts were classified as good prognosis, 5 as intermediate, 11 as poor according to the IGCCCG and 4 unknown. A teratoma component was described in the primary tumor of 22 out of the 25 pts with non seminomatous GCT. Only one pt had a pure seminoma (PMT). Four pts had TMT in their primary, 9 in resected post-chemotherapy, residual masses and 13 in a relapse. For these 13 pts, median time between initial GCT diagnosis and relapse as a TMT was 31.2 months (mo) (12.0-357.6). Various subtypes of TMT were observed: 10 adenocarcinomas, 4 neuroectodermal tumors, 6 rhadomyosarcomas, 2 leiomyosarcomas, 1 blastema, 1 angiosarcoma and 2 undefined sarcomas. Except 3 pts with sg I disease, all pts received first line cisplatin-based chemotherapy (CT). Surgery of residual masses was performed in 20 pts. Nineteen out of the 23 pts had initial clinical or surgical complete response (CR), 2 had a marker positive partial response and 2 had progressive disease. Iterative surgery for relapse was performed in 9 pts. Eight pts received CT according to TMT subtype and one achieved CR. With a median follow-up of 76.8 mo (9.5-369.0), 8 pts have died of disease (DOD), 1 has died of another cause, 2 are alive with disease and 15 alive without disease. Among the 8 pts DOD: 3 pts had PMT, 3 were sg III and 2 sg I; all relapsed and surgery was incomplete for 4 pts and 1 was inoperable. There was no difference between subtypes of TMT.

Conclusions

TMT is more frequent in GCTs with extensive disease, PMT and relapsed disease. Iterative and complete surgical resection is the mainstay of treatment. CT is usually palliative but sometimes gives long responses.

Disclosure

All authors have declared no conflicts of interest.