Journal of Clinical Oncology, Vol 1, 111-116, Copyright © 1983 by American Society of Clinical Oncology
The use of different induction and maintenance chemotherapy regimens for the treatment of advanced yolk sac tumors
DM Green, ML Brecher, M Grossi, L Simpson, JE Fisher, JE Allen, DR Cooney, TC Jewett Jr and AI Freeman
Four children with yolk sac tumor were treated with an aggressive
combination chemotherapy program. Three children had presacral primary
tumors, one having pulmonary metastases, and one had a testicular primary
tumor with pulmonary metastases. Three children were treated when they had
measurable disease, and one had no measurable disease. The chemotherapy
program consisted of a 6-wk induction period with vincristine (VCR),
cis-diamminedichloroplatinum (DDP), and bleomycin. Maintenance therapy
consisted of VCR, actinomycin D, and cyclophosphamide (cytoxan) every 3-4
wk as tolerated. Treatment was discontinued after 12 mo of complete
remission. All three patients with evaluable disease had a partial response
(PR) to induction therapy. Two underwent surgical exploration following
induction therapy, one a laparotomy and the other a thoracotomy, and were
found to have only scar tissue at the sites of presumed residual disease.
The third child with measurable disease progressed to a clinical complete
response (CR) during maintenance therapy. Two patients have had no evidence
of disease (NED) for 42+ and 41+ mo since starting therapy (28+ and 27+ mo
since completing treatment). Two patients are NED 11+ and 7+ mo since
starting therapy and remain on treatment. We have encountered no
significant renal or pulmonary toxicity, and there have been only two
hospitalizations during maintenance therapy for fever and neutropenia.
These preliminary results employing different induction and maintenance
chemotherapy programs and planned second-look surgical intervention appear
encouraging.
