{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T23:43:11Z","timestamp":1788565391105,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chemotherapy for non\u2010seminomatous germ cell tumours (NSGCT) exposes to dose\u2010dependent toxicities. The TGM13\u2010NS protocol (EudraCT 2013\u2010004039\u201060) aimed to decrease the chemotherapy burden compared to the previous TGM95 protocol while maintaining the 5\u2010year event\u2010free survival (EFS) at 80% or more.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>Patients less than 19\u00a0years of age with disseminated NSGCT were enrolled (May 2014 to May 2019) and stratified into four groups: two intermediate\u2010risk (IR: localised tumour with low tumour markers [TM]) groups treated with VBP (vinblastine\u2013bleomycin\u2013cisplatin): three courses for IR1 (ovarian tumour any age\/testis tumour less than or equal to 10\u00a0years) and four courses for IR2 (extragonadal tumour 10\u00a0years or less) groups, and two high\u2010risk (HR: metastatic and\/or high TM) groups treated with etoposide\u2013cisplatin and either ifosfamide (VIP) or bleomycin (BEP): three courses for HR1 (ovarian tumour any age\/testis tumour less than or equal to 10\u00a0years and low TM\/testis tumour more than 10\u00a0years and very low TM) groups and four courses for HR2 (remainder) groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred fifteen patients were included: median age of 12.8\u00a0years (0.4\u201318.9); tumour sites: 44 ovaries, 37 testes and 34 extragonadal. The 5\u2010year EFS and overall survival (OS) were 87% (95% CI: 80\u201392) and 95% (89\u201398), respectively (median follow\u2010up: 3.5\u00a0years, range: 0.2\u20135.9), similar to those of the TGM95 protocol (5\u2010year EFS 89% (84\u201393), 5\u2010year OS 93% (89\u201395), <jats:italic>p<\/jats:italic>\u00a0=\u00a0.561). The 5\u2010year EFS were 93% (95% CI: 80\u201398), 88% (71\u201395) and 79% (62\u201390) for ovarian, testicular and extragonadal tumours, respectively. The 5\u2010year EFS varied (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.02) according to the risk groups: 90% (66\u201397), 64% (30\u201385), 95% (72\u201399) and 87% (74\u201394) for IR1, IR2, HR1 and HR2, respectively. TM decline adjusted to tumour site, and alpha\u2010fetoprotein (AFP) level revealed a prognostic impact of time to normalisation on EFS: HR\u00a0=\u00a01.03 (1.003\u20131.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Risk\u2010adapted and globally decreased chemotherapy burden maintains excellent outcomes, exclusive of the IR2 group, which warrants more intensive chemotherapy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30117","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T12:13:50Z","timestamp":1669896830000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Extracranial germ cell tumours in children and adolescents: Results from the French TGM13 protocol"],"prefix":"10.1002","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4717-4943","authenticated-orcid":false,"given":"Cecile","family":"Faure\u2010Conter","sequence":"first","affiliation":[{"name":"Department of Pediatric Oncology Institut d'Hemato\u2010oncologie Pediatrique  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-139X","authenticated-orcid":false,"given":"Daniel","family":"Orbach","sequence":"additional","affiliation":[{"name":"SIREDO Oncology Center (Care Innovation and Research for Children Adolescents and young Adults with Cancer) Institut Curie PSL University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1991-3585","authenticated-orcid":false,"given":"H\u00e9l\u00e8ne","family":"Sudour\u2010Bonnange","sequence":"additional","affiliation":[{"name":"Pediatric and Adolescents Oncology Unit Anti\u2010Cancer Center Oscar Lambret  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecile","family":"Verit\u00e9","sequence":"additional","affiliation":[{"name":"Pediatric Hematology\u2010Oncology Unit Pellegrin Hospital CHU Bordeaux  Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovic","family":"Mansuy","sequence":"additional","affiliation":[{"name":"CHU de Nancy\u2010H\u00f4pital de Brabois Service d'h\u00e9mato\u2010oncologie p\u00e9diatrique Vandoeuvre\u2010l\u00e8s\u2010Nancy Cedex  Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelique","family":"Rome","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology Timone Children's Hospital.  Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecile","family":"Dumesnil","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology University Hospital Center of Rouen.  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estelle","family":"Thebaud","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology University Hospital Center of Nantes.  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