| Summary: | A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Paediatrics
Johannesburg 2016 === Germ cell tumours have a good prognosis if treated aggressively but the consequence of cure may be life-altering toxicity. Prolonged duration of symptoms is often thought to contribute to poor outcomes in patients with solid tumours.
Aims:
To document incidence, survival rates, extent of treatment-related toxicity and to identify poor prognostic indicators in children with germ cell tumours treated at the Charlotte Maxeke Johannesburg Academic Hospital. A secondary aim was to determine which classification system had validity in this cohort.
Methods:
A retrospective file review was conducted of children with germ cell tumours treated at the Charlotte Maxeke Johannesburg Academic Hospital over a 28 year period. Descriptive statistics were employed to document incidence, toxicity rates and outcomes. Kaplan-Meier estimations were performed to determine prognostic factors.
Results:
Seventy five patients were identified, 17 with benign tumours, 56 with malignant tumours and two unknown. Chemotherapy was given to 48 patients, in whom 32 (67%) experienced significant myelotoxicity. Of the 41 patients treated with cisplatin, 34% developed clinically significant hearing impairment. Five patients developed renal tubular acidosis, and two developed chronic renal failure.
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The only independent factor found to have prognostic significance was complete surgical excision. There was no correlation between prolonged duration of disease-specific symptoms and poor outcome. The classification of patients according to the IGCCC system does not appear to correlate closely with determinations of prognosis, in comparison with conventional staging systems.
All patients who relapsed did so in the first 3 years after diagnosis. The 3 year overall survival rate was 77.8%. There were no recorded cases of secondary malignancies or chemotherapy-induced infertility.
Conclusion
Complete surgical excision is vital for survival. Transient myelotoxicity and permanent hearing impairment are common when protocols incorporating cisplatin are used. Survival rates are acceptable for a middle-income country. Every effort should be made to preserve the good survival rate while decreasing toxicity. === MT2016
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