Germ cell tumors of the ovary: Is there a role for aggressive cytoreductive surgery for nondysgerminomatous tumors?

Abstract

Thirty-three patients with germ cell tumor of the ovary were seen at Kidwai Memorial Institute of Oncology (KMIO), Bangalore, between 1996 and 1999. Twelve patients had endodermal sinus tumor (EST), 11 dysgerminoma, seven mixed germ cell tumor, and three immature teratoma. Thirteen patients had bulky residual disease of >10 cm after the primary surgery. All but one patient received a combination of bleomycin, etoposide, and cisplatin (BEP) either as neoadjuvant (NACT, 3 cases) or as adjuvant therapy (28 cases). In the present study, all 11 patients with dysgerminoma achieved sustained complete remission (CR), irrespective of the size of residual disease at the time of chemotherapy. Four out of six cases (66.6%) with bulky nondysgerminomatous tumor achieved CR, which was sustained in three cases and one recurred. Fifteen of the remaining 16 (93.7%) nonbulky, nondysgerminomatous tumors achieved CR, which was sustained in 14 cases and recurred in one. This study indicates that there may be a role for aggressive cytoreductive surgery, either primary/interval or at the time of second-look laparotomy, in selected patients with nondysgerminomatous germ cell tumor of the ovary.

Neoadjuvant Bleomycin, Etoposide, and Cisplatin (BEP) Chemotherapy in the Treatment of Extensively Advanced Yolk Sac Tumors: A Single Center Experience

“…Second, the thoroughness of cytoreductive surgery might also contribute to our survival advantage. 4,5,22,23 The optimal cytoreduction rate reported in our series was even higher than the result achieved in a report that consisted mainly of patients with stage IYII disease, in which nearly 15% of patients were not able to achieve optimal cytoreduction. 24 Therefore, it is reasonable to expect a more favorable survival in our patients.…”

“…6,13,14,27 Notwithstanding, in colorectal patients, Kishi et al 28 revealed that the extended duration of NACT did not lead to an increased complete or major pathological response; instead, it was the only independent predictor of postoperative liver insufficiency. In nondysgerminomatous tumors, Bafna et al 22 disclosed that 2 to 3 cycles of NACT would suffice to induce intense necrosis. Our observations indicated that complete or nearly complete tumor response could be achieved even earlier; 1Y 2 cycles of BEP regimen would be sufficient to render a patient with extensively advanced YST operable.…”

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

“…22 Still, the standard of care is for a maximal surgical effort when it can be safely accomplished in patients with nondysgerminomatous tumors, as previous studies have shown patients with incompletely resected disease are more likely to experience disease progression and less likely to respond to chemotherapy. 23,24 Surveillance in patients of acceptable risk has been proposed according to several published schemas, 10 but this requires patient compliance.…”

Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

“…In that study, though, a large percentage of patients experienced a delay in the administration of adjuvant chemotherapy that was associated with an increased relapse rate (87.5%) 8. In another case series all patients with dysgerminoma (n=11) achieved sustained complete response regardless of residual disease status 14. However, the rate of complete response for patients with non-dysrgenimomatous tumors and residual disease was lower (66.7%, 4/6) compared to those without (93.8%, 15/16), P=0.17.…”

“…However, the rate of complete response for patients with non-dysrgenimomatous tumors and residual disease was lower (66.7%, 4/6) compared to those without (93.8%, 15/16), P=0.17. It should be noted that the delay in adjuvant chemotherapy administration (ranging from 1 to 22 months) occured in the majority of patients with bulky residual disease (76.9%, 10/13) 14. Residual disease has been identified as a poor prognostic factor for patients with yolk-sac tumors in two retrospective studies.…”