{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T14:39:03Z","timestamp":1789915143922,"version":"4.0.1"},"reference-count":20,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"6","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2016,2,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> We describe the results of a risk-adapted, response-based therapeutic approach from the Brazilian GCT-99 study on germ cell tumors. <\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p> From May 1999 to October 2009, 579 participants were enrolled in the Brazilian GCT-99 study. Treatment, defined as specific chemotherapy regimen and number of cycles, was allocated by means of risk-group assignment at diagnosis with consideration for stage and primary tumor site. Patients at low risk received no chemotherapy. Patients at intermediate risk (IR) with a good response (GR) received four cycles of platinum and etoposide (PE), for total doses of platinum 420 mg\/m<jats:sup>2<\/jats:sup> and etoposide 2,040 mg\/m<jats:sup>2<\/jats:sup>. Patients at IR with a partial response (PR) received three cycles of PE plus three cycles of ifosfamide, vinblastine, and bleomycin. Patients at high risk (HR) with a GR received four cycles of PE and ifosfamide (PEI) at total doses of platinum 420 mg\/m<jats:sup>2<\/jats:sup>, etoposide 1,200 mg\/m<jats:sup>2<\/jats:sup>, and ifosfamide 30 g\/m<jats:sup>2<\/jats:sup>. Patients at HR with a PR received six cycles of PEI. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> The risk-group distribution was 213 LR, 138 IR, and 129 HR for 480 evaluable patients. Overall survival (OS) and event-free survival (EFS) rates at 10 years were, respectively, 90% and 88.6% in the IR-GR group (n = 126) and 74.1% and 74.1% in the IR-PR group (n = 12). Ten-year rates for the HR-GR group (n = 86) were an OS of 66.8% and an EFS of 62.5%. The HR-PR group (n = 43) had an OS of 74.8% and an EFS of 73.4%. In univariable and multivariable analysis, increased serum lactate dehydrogenase level and histology for a metastatic immature teratoma were prognostic of a worsened outcome. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> Reduction of therapy to two drugs did not compromise survival outcomes for patients in the IR-GR group, and escalation of therapy with PEI did not significantly improve OS and EFS in patients at HR. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2014.59.1420","type":"journal-article","created":{"date-parts":[[2016,1,5]],"date-time":"2016-01-05T02:30:08Z","timestamp":1451961008000},"page":"603-610","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":24,"title":["Lowered Cisplatin Dose and No Bleomycin in the Treatment of Pediatric Germ Cell Tumors: Results of the GCT-99 Protocol From the Brazilian Germ Cell Pediatric Oncology Cooperative Group"],"prefix":"10.1200","volume":"34","author":[{"given":"Luiz Fernando","family":"Lopes","sequence":"first","affiliation":[{"name":"Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de S\u00e3o Paulo; Viviane Sonaglio, Hospital A.C. Camargo; Maria Teresa de Assis Almeida, Universidade de S\u00e3o Paulo, ITACI FMUSP; Maria Lydia Mello D'Andrea, Hospital Infantil Darcy Vargas; Renato Melaragno, Hospital Santa Marcelina; Sonia Maria Rossi Vianna, Hospital do Servidor Publico Estadual; Paula Bruniera, Santa Casa de Misericordia de S\u00e3o..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Renata Pacheco Donato","family":"Macedo","sequence":"additional","affiliation":[{"name":"Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de S\u00e3o Paulo; Viviane Sonaglio, Hospital A.C. Camargo; Maria Teresa de Assis Almeida, Universidade de S\u00e3o Paulo, ITACI FMUSP; Maria Lydia Mello D'Andrea, Hospital Infantil Darcy Vargas; Renato Melaragno, Hospital Santa Marcelina; Sonia Maria Rossi Vianna, Hospital do Servidor Publico Estadual; Paula Bruniera, Santa Casa de Misericordia de S\u00e3o..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone dos Santos","family":"Aguiar","sequence":"additional","affiliation":[{"name":"Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de S\u00e3o Paulo; Viviane Sonaglio, Hospital A.C. Camargo; Maria Teresa de Assis Almeida, Universidade de S\u00e3o Paulo, ITACI FMUSP; Maria Lydia Mello D'Andrea, Hospital Infantil Darcy Vargas; Renato Melaragno, Hospital Santa Marcelina; Sonia Maria Rossi Vianna, Hospital do Servidor Publico Estadual; Paula Bruniera, Santa Casa de Misericordia de S\u00e3o..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Henrique S.","family":"Barreto","sequence":"additional","affiliation":[{"name":"Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de S\u00e3o Paulo; Viviane Sonaglio, Hospital A.C. Camargo; Maria Teresa de Assis Almeida, Universidade de S\u00e3o Paulo, ITACI FMUSP; Maria Lydia Mello D'Andrea, Hospital Infantil Darcy Vargas; Renato Melaragno, Hospital Santa Marcelina; Sonia Maria Rossi Vianna, Hospital do Servidor Publico Estadual; Paula Bruniera, Santa Casa de Misericordia de S\u00e3o..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisele Eiras","family":"Martins","sequence":"additional","affiliation":[{"name":"Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de S\u00e3o Paulo; Viviane Sonaglio, Hospital A.C. Camargo; Maria Teresa de Assis Almeida, Universidade de S\u00e3o Paulo, ITACI FMUSP; Maria Lydia Mello D'Andrea, Hospital Infantil Darcy Vargas; Renato Melaragno, Hospital Santa Marcelina; Sonia Maria Rossi Vianna, Hospital do Servidor Publico Estadual; Paula Bruniera, Santa Casa de Misericordia de S\u00e3o..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane","family":"Sonaglio","sequence":"additional","affiliation":[{"name":"Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de S\u00e3o Paulo; Viviane Sonaglio, Hospital A.C. Camargo; Maria Teresa de Assis Almeida, Universidade de S\u00e3o Paulo, ITACI FMUSP; Maria Lydia Mello D'Andrea, Hospital Infantil Darcy Vargas; Renato Melaragno, Hospital Santa Marcelina; Sonia Maria Rossi Vianna, Hospital do Servidor Publico Estadual; Paula Bruniera, Santa Casa de Misericordia de S\u00e3o..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Milone","sequence":"additional","affiliation":[{"name":"Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de S\u00e3o Paulo; Viviane Sonaglio, Hospital A.C. Camargo; Maria Teresa de Assis Almeida, Universidade de S\u00e3o Paulo, ITACI FMUSP; Maria Lydia Mello D'Andrea, Hospital Infantil Darcy Vargas; Renato Melaragno, Hospital Santa Marcelina; Sonia Maria Rossi Vianna, Hospital do Servidor Publico Estadual; Paula Bruniera, Santa Casa de Misericordia de S\u00e3o..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo Ribeiro","family":"Lima","sequence":"additional","affiliation":[{"name":"Luiz Fernando Lopes, Brazilian Society of Pediatric Oncology; Carla Renata Pacheco Donato Macedo, Instituto de Oncologia Pediatrica-GRAACC, Universidade Federal de S\u00e3o Paulo; Viviane Sonaglio, Hospital A.C. 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