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GROWING TERATOMA SYNDROME IN CHILDREN AND ADOLESCENTS: PREVALENCE AND SURGICAL OUTCOME
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  • Giorgio Persano,
  • Federico BEATI,
  • Maria Debora De Pasquale,
  • Cristina Martucci,
  • Silvia Madafferi,
  • Evelina Miele,
  • Alessandra Stracuzzi,
  • Pierluigi Di Paolo,
  • Gianluigi Natali,
  • Rita Alaggio,
  • Alessandro Crocoli,
  • Alessandro Inserra
Giorgio Persano
Ospedale Pediatrico Bambino Gesu

Corresponding Author:[email protected]

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Federico BEATI
Ospedale Pediatrico Bambino Gesu
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Maria Debora De Pasquale
Ospedale Pediatrico Bambino Gesu
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Cristina Martucci
Ospedale Pediatrico Bambino Gesu
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Silvia Madafferi
Ospedale Pediatrico Bambino Gesu
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Evelina Miele
Ospedale Pediatrico Bambino Gesu
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Alessandra Stracuzzi
Ospedale Pediatrico Bambino Gesu
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Pierluigi Di Paolo
Ospedale Pediatrico Bambino Gesu
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Gianluigi Natali
Ospedale Pediatrico Bambino Gesu
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Rita Alaggio
Ospedale Pediatrico Bambino Gesu
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Alessandro Crocoli
Ospedale Pediatrico Bambino Gesu
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Alessandro Inserra
Ospedale Pediatrico Bambino Gesu
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Abstract

Background and aims Patients affected by metastatic germ cell tumors may occasionally experience enlargement of metastatic lesions with concurrent normalization of tumor markers after chemotherapy. This phenomenon is described as Growing Teratoma Syndrome (GTS). The aim of the present study is to assess the prevalence of GTS in the pediatric population and its implications in terms of surgical outcome. Methods The clinical notes of patients diagnosed with stage III and IV malignant germ cell tumors from January 2010 until December 2020 at our Institution were retrospectively reviewed. Patients with residual disease after chemotherapy were studied; the occurrence of GTS, treatment strategies, survival and outcome were analyzed. Results Thirty-three patients with high stage malignant germ cell tumors were diagnosed in our Institution in the analyzed period. Eleven patients (34%) had radiologic evidence of enlargement of metastases after chemotherapy; nine of them (28%) had normal markers after chemotherapy and were classified as GTS patients. All nine patients underwent resection of metastatic lymph nodes and six had surgery on visceral metastases. In six patients, radical excision of all metastatic sites was achieved; five patients are alive and in complete remission while one died for peri-operative complications. Out of the three patients who could not achieve radical excision of the metastases, two died for progressive disease and one is alive with progressive disease. Conclusions Patients affected by GTS have a risk of progression of chemotherapy-resistant disease and death. Radical surgical excision is essential to achieve disease control and long-term survival.
Submitted to Pediatric Blood & Cancer
16 Mar 2024Assigned to Editor
16 Mar 20241st Revision Received
16 Mar 2024Submission Checks Completed
07 Apr 2024Review(s) Completed, Editorial Evaluation Pending
09 Apr 2024Editorial Decision: Revise Minor
19 May 2024Review(s) Completed, Editorial Evaluation Pending
19 May 2024Editorial Decision: Accept