Current Strategy for the Treatment of Ovarian Germ Cell Tumors: Role of Extensive Surgery

Abstract

The necessity and extent of comprehensive surgical staging (CSS) and lymphadenectomy in the treatment of malignant ovarian germ cell tumors (MOGCTs) is still controversial. However, it is uniformly agreed that CSS with lymphadenectomy is crucial to follow up patients without adjuvant chemotherapy in stage I MOGCTs. Considering the chemotherapy-sensitive nature of MOGCTs, fertility-sparing cytoreductive surgery (FSCS) seems a reasonable approach in initial treatment for patients with advanced stage. When encountered with bilateral MOGCTs, debulking is surely granted if there is no desire for fertility. Both ovaries completely replaced by neoplastic tissue composed the most challenging situation especially when patients require childbearing potential. In dysgerminoma histology, which usually has good prognosis, residual disease could be left to spare fertility. USO of the largest and more heterogeneous ovarian mass and a biopsy of the contralateral lesion may be considered if the patients are compliant to regular follow-up. NACT followed by interval FSCS may be a reasonable option in patients with extensive disease, when initial debulking is not an option or where the poor general condition or clinical findings suggest an increased risk of surgical morbidity or preclude fertility-sparing surgery. This is currently not the standard of care but deserves future study. In some rare situation, when any remaining ovarian tissue means high risk, BSO may be performed with the uterus preserved for possible assisted reproduction with donor egg. Treatment failure occurs in a small group of MOGCTs after primary treatment. A good number of recurrences can be salvaged with selected salvage surgery, especially when optimal secondary cytoreduction can be achieved. Immature teratoma is a subtype of MOGCTs where secondary cytoreduction may have a strong role to play.

Treatment of bilateral ovarian dysgerminoma with 11-year follow-up: A case report

“…In Li's study of 34 patients who underwent salvage cytoreductive surgery, 5-year survival was 61% in the optimally cytoreduced group (≤1 cm), compared with 14% in the suboptimally cytoreduced group [12]. Meisel found recurrence in 31% patients [4], despite good results with more conservative surgery.…”

Ovarian germ cell tumour and bleomycin-induced lung injury

“…Ovarian mixed germ cell tumours consist of two or more types of germ cell neoplasms and often secrete tumour markers, such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), or lactate dehydrogenase (LDH). 4 The staging procedure for women with ovarian germ cell tumours is the same as for epithelial ovarian cancer. The majority of women undergo surgical cytoreduction before the start of chemotherapy and this is in direct contrast to testicular cancer, where surgery is reserved for residual masses post-chemotherapy.…”

“…Long-term cure rates are > 90% for early-stage and up to 80% for advanced disease. [4][5][6][7] Drugs may produce a variety of respiratory tract disorders. Pulmonary infiltrates with fibrosis may result from the use of cytotoxic drugs used in the treatment of cancer and the most common cause of these reactions is bleomycin.…”

Pediatric and Adolescent Malignant Ovarian Tumors: Mansoura 5 - Year Experience

“…However JEB protocol which is a less toxic carboplatin-based regimen [24] is used as well. Neoadjuvant chemotherapy could ameliorate surgical morbidity in cases of advanced disease and could increase the chance of fertility preservation [25,26], however it is not a recommended policy in our institutions.…”