Management of Ovarian Germ Cell Tumors

Purpose To review contemporary management of malignant ovarian germ cell tumors (MOGCT). Design The literature on the topic of MOGCT is reviewed, including pathology, prognostic factors, surgical strategies, postoperative therapy, late effects of therapy, and treatment of recurrence. Results Prognostic factors for MOGCT include the International Federation of Gynecology and Obstetrics staging system's stage, residual disease, histologic type, and elevation of serum tumor markers. Fertility-sparing surgery is possible in a large proportion of patients. The importance of comprehensive surgical staging is somewhat controversial. For patients with advanced-stage disease, maximum cytoreductive surgery appears to be beneficial. Although second-look surgery is not recommended routinely, selected patients may benefit from secondary cytoreduction. For those patients who require postoperative chemotherapy, standard therapy consists of the combination of bleomycin, etoposide, and cisplatin. However, there is a growing trend toward surveillance; this strategy continues to be studied. Although premature menopause may occur in a small proportion of patients, at least 80% of those who undergo fertility-sparing surgery and chemotherapy may expect to preserve reproductive function. For patients with early-stage disease, cure rates approach 100%. For those with advanced-stage disease, cure rates are reportedly at least 75%. Conclusion MOGCT is a rare malignancy that principally affects girls and young women. With optimal therapy, the prognosis is excellent, and most patients may retain reproductive function.

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Analysis of outcomes and prognostic factors after fertility-sparing surgery in malignant ovarian germ cell tumors

Gynecologic Oncology ◽

10.1016/j.ygyno.2017.03.023 ◽

2017 ◽

Vol 145 (3) ◽

pp. 513-518 ◽

Cited By ~ 21

Author(s):

Jeong-Yeol Park ◽

Dae-Yeon Kim ◽

Dae-Shik Suh ◽

Jong-Hyeok Kim ◽

Yong-Man Kim ◽

...

Keyword(s):

Prognostic Factors ◽

Germ Cell ◽

Germ Cell Tumors ◽

Fertility Sparing Surgery ◽

Fertility Sparing

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Are omentectomy and lymphadenectomy necessary in patients with apparently early-stage malignant ovarian germ cell tumors?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000078 ◽

2019 ◽

Vol 29 (2) ◽

pp. 398-403 ◽

Cited By ~ 4

Author(s):

Beijiao Qin ◽

Wenyan Xu ◽

Yanfang Li

Keyword(s):

Prognostic Factors ◽

Germ Cell ◽

Early Stage ◽

Survival Rates ◽

Germ Cell Tumors ◽

Yolk Sac ◽

Immature Teratoma ◽

Yolk Sac Tumor ◽

Cancer Center ◽

Early Stage Disease

ObjectiveTo evaluate the role of omentectomy and lymphadenectomy in the treatment of clinically apparent early-stage malignant ovarian germ cell tumors.MethodsWe retrospectively reviewed 245 patients with malignant ovarian germ cell tumors (yolk sac tumor, dysgerminoma, and immature teratoma) and with clinically early-stage disease, who were treated at Sun Yat-sen University Cancer Center between January 1, 1970 and December 31, 2017. The survival of patients who underwent either omentectomy or lymphadenectomy, or both (omentectomy/lymphadenectomy group) was compared with that of patients who did not undergo omentectomy or lymphadenectomy (non-omentectomy/lymphadenectomy group).ResultsSixty patients were diagnosed with yolk sac tumor, 74 with dysgerminoma, and 111 with immature teratoma. Of these 245 patients, 216 patients had stage I disease, 28 patients had stage II, and 1 patient had stage IIIA. There were 190 patients who underwent omentectomy and/or lymphadenectomy and 55 patients in the non-omentectomy/lymphadenectomy group, respectively. In the omentectomy/lymphadenectomy group, 112 patients underwent both omentectomy and lymphadenectomy, 71 underwent omentectomy only, and 7 underwent lymphadenectomy only. Two hundred and fourteen of 245 patients (87.3%) received post-operative chemotherapy. Median follow-up was 73 months (range 1–388). The 10-year overall survival rates in the omentectomy/lymphadenectomy group and non-omentectomy/lymphadenectomy groups were 96.8% and 100%, respectively (p=0.340). Multivariate analysis evaluating all potential prognostic factors showed that omentectomy and lymphadenectomy are not prognostic factors for survival.ConclusionsOmentectomy and lymphadenectomy do not appear to improve survival and may be omitted in patients with clinically apparent early-stage malignant ovarian germ cell tumors.

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Prognostic Impact of Laterality in Malignant Ovarian Germ Cell Tumors

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31820581e5 ◽

2011 ◽

Vol 21 (2) ◽

pp. 257-262 ◽

Cited By ~ 17

Author(s):

Haider Mahdi ◽

Sanjeev Kumar ◽

Shelly Seward ◽

Assaad Semaan ◽

Ramesh Batchu ◽

...

Keyword(s):

Germ Cell ◽

Proportional Hazards ◽

Germ Cell Tumors ◽

Cox Proportional Hazards ◽

Prognostic Impact ◽

Advanced Stage ◽

Kaplan Meier ◽

Stage Disease ◽

Histologic Types ◽

Mixed Germ Cell Tumors

Objective:To compare the survival of patients with bilateral versus unilateral malignant ovarian germ cell tumors (OGCT).Methods:Patients with a diagnosis of OGCT were identified from the Surveillance, Epidemiology, and End Results Program for the period 1988 to 2006 and were divided into bilateral and unilateral subgroups. Only surgically treated patients were included. Histologic types were grouped into dysgerminoma, malignant teratoma, and mixed germ cell tumors with pure nondysgerminoma cell tumors. Statistical analysis using Wilcoxon rank sum test, Kaplan-Meier survival methods, and Cox proportional hazards regression model were performed.Results:In 1529 patients with OGCT, 1463 (95.7%) were unilateral and 66 (4.3%) were bilateral. Bilaterality was more common with dysgerminomas (6.5%) and mixed germ cell tumors with pure nondysgerminoma cell tumors (6.25%) than with immature teratomas (1.7%),P< 0.001. Most OGCT (67.3%) were stage I. Bilateral OGCT were more likely than unilateral tumors to be associated with advanced-stage disease (FIGO III and IV, 41% vs 20%,P< 0.04). Overall 5-year survival was 93.6% for unilateral OGCT and 80.7% in bilateral OGCT,P< 0.001. In multivariate analysis, bilaterality was not an independent predictor of survival when controlling for age, histology, stage, and surgical staging (hazard ratio, 1.3; 95% confidence interval, 0.7-2.5;P= 0.40).Conclusions:Compared with unilateral tumors, bilateral OGCT are more often associated with advanced-stage disease, high-risk histology, and poor survival. When other prognostic factors are accounted for, bilaterality was not an independent prognostic predictor of survival.

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Gynecologic Cancer Intergroup (GCIG) Consensus Review for Ovarian Germ Cell Tumors

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000223 ◽

2014 ◽

Vol 24 (Supp 3) ◽

pp. S48-S54 ◽

Cited By ~ 55

Author(s):

Jubilee Brown ◽

Michael Friedlander ◽

Floor J. Backes ◽

Philipp Harter ◽

Dennis M. O’Connor ◽

...

Keyword(s):

Germ Cell ◽

Early Stage ◽

Gynecologic Cancer ◽

Tumor Biology ◽

Germ Cell Tumors ◽

Clinical Trial Design ◽

Cooperative Groups ◽

Stage Disease ◽

Fertility Sparing ◽

Collaborative Efforts

AbstractMost women diagnosed with malignant ovarian germ cell tumors have curable disease and experience excellent survival with manageable treatment-associated morbidity, related both to tumor biology and improvements in treatment over the last 4 decades. Malignant ovarian germ cell tumors occur predominantly in girls, adolescents, and young women and are often unilateral tumors of early stage, although advanced-stage disease occurs in approximately 30% of patients. Tumors are usually chemosensitive, thereby allowing fertility-sparing surgery in most women with high chance of cure. Differences in practice do exist among providers in various subspecialties and geographic areas. In most settings, collaborative efforts among specialties allow the optimal treatment of women with these rare tumors, and implementation of standard guidelines at an international level should translate to effective clinical trial design, rapid accrual to clinical trials, and universally improved patient outcomes.This consensus guideline represents a summary of recommendations for diagnosis and management that has been agreed upon by cooperative groups worldwide. It builds upon individual publications including previously published summary documents and provides the most current practice standards validated worldwide.

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Survival and Reproductive Function After Treatment of Malignant Germ Cell Ovarian Tumors

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.4.1015 ◽

2001 ◽

Vol 19 (4) ◽

pp. 1015-1020 ◽

Cited By ~ 147

Author(s):

Gerardo Zanetta ◽

Cristina Bonazzi ◽

Maria Grazia Cantù ◽

Sergio Bini† ◽

Anna Locatelli ◽

...

Keyword(s):

Survival Rate ◽

General Population ◽

Germ Cell ◽

Germ Cell Tumors ◽

Reproductive Function ◽

Conservative Surgery ◽

Ovarian Tumors ◽

Fertility Sparing ◽

Significant Difference

PURPOSE: Germ cell ovarian tumors are curable. The possible sequelae of chemotherapy on long-term survivors are still unknown, but these patients may expect normal lives. The aim of this study was to evaluate the outcome and reproductive function in a population of women treated since 1982. MATERIALS AND METHODS: Between 1982 and 1996, 169 women with malignant germ cell ovarian tumors were seen (70 dysgerminomas, 28 endodermal sinus tumors, 24 mixed tumors, and 47 immature teratomas). Seventy-one had advanced or recurrent disease. Fertility-sparing surgery was performed in 138 (81%) women, 81 of whom received postoperative chemotherapy. RESULTS: With a median follow-up of 67 months, the survival rate was 94% for dysgerminoma, 89% for endodermal sinus tumors, 100% for mixed types, and 98% for immature teratoma. For women who were treated conservatively, the survival rate was 98%, 90%, 100%, and 100%, respectively. Two women had adnexal recurrences, and both received salvage treatment. After treatment, all but one postpubertal woman had recovery of menses within 9 months. During follow-up, 12 untreated and 20 treated patients had 55 conceptions. We recorded 40 pregnancies at term, six terminations, and nine miscarriages. Four malformations were observed: one in 14 conceptions of patients who had not received chemotherapy and three in 41 conceptions of treated patients. CONCLUSION: Irrespective of subtype and stage, conservative surgery should become the standard approach to treating most patients with malignant ovarian germ cell tumors. Fertility seems to be only marginally affected by treatments. Miscarriages are in the expected range for the general population. The malformation rate is slightly higher than in the general population, but no significant difference was seen between patients who did and did not receive chemotherapy.

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A retrospective study of reproductive outcomes after fertility-sparing surgery and postoperative adjuvant chemotherapy in malignant ovarian germ cell tumors and sex cord-stromal tumors

Journal of Ovarian Research ◽

10.1186/s13048-017-0348-x ◽

2017 ◽

Vol 10 (1) ◽

Cited By ~ 6

Author(s):

Ning Zhang ◽

Ruifang Chen ◽

Keqin Hua ◽

Ying Zhang

Keyword(s):

Retrospective Study ◽

Adjuvant Chemotherapy ◽

Germ Cell ◽

Germ Cell Tumors ◽

Reproductive Outcomes ◽

Postoperative Adjuvant Chemotherapy ◽

Stromal Tumors ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Sex Cord Stromal Tumors

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A retrospective analysis of the pattern of care and survival in patients with malignant ovarian germ cell tumors

South Asian Journal of Cancer ◽

10.4103/sajc.sajc_6_18 ◽

2019 ◽

Vol 08 (01) ◽

pp. 35-40 ◽

Cited By ~ 1

Author(s):

Reshu Agarwal ◽

Anupama Rajanbabu ◽

Pavithran Keechilattu ◽

Indu R. Nair ◽

D. K. Vijaykumar ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Disease Free Survival ◽

Stage I ◽

Surgical Staging ◽

Advanced Stage ◽

Pattern Of Care ◽

Survival Difference ◽

Fertility Sparing ◽

Incomplete Surgery

Abstract Objective: The objective of this study is to evaluate the pattern of care and survival outcome in patients with malignant ovarian germ cell tumors (MOGCTs). Materials and Methods: Between January 2004 and August 2017, 50 patients with MOGCT were identified at Amrita Institute of Medical Sciences and 48 included in analyses. Histologic subtypes were as follows: dysgerminoma 11; immature teratoma 16; yolk sac tumor 3; and mixed germ cell tumor 18. 31 (64.6% patients belonged to Stage I and 17 (35.4%) patients were advanced stage (Stage II-IV). Results: Median follow-up period was 34 months (range: 1–241 months). The 5- and 10-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 87.5% and 94.4%, respectively. DFS and OS of incomplete surgery Stage I patients 28.6% and 68.6%, respectively, were significantly lower than completely staged patients 100%. Out of 8 incomplete surgery patients, 5 recurred of which 2 died of disease within 4 and 9 months of recurrence. There was no survival difference with comprehensive surgical staging (CSS) and pediatric surgical staging (PSS) in Stage I MOGCT (DFS and OS 100%). Stage I dysgerminoma kept on active surveillance after PSS had equivalent survival of 100%. There was no survival difference in advanced stage MOGCT treated with primary debulking surgery and neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery (DFS and OS 100%). Conclusion: Incomplete surgery in Stage I MOGCT was associated with poor survival. There was no survival difference with CSS and PSS. NAC followed by surgery could be a reasonable option for patients of advanced stage MOGCT.

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