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).