Is adjuvant chemotherapy indicated in ovarian immature teratomas? A combined data analysis from the Malignant Germ Cell Tumor International Collaborative

Abstract

BACKGROUND There is a debate regarding the management of ovarian immature teratomas (ITs). In adult women, postoperative chemotherapy is standard except for stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, a pooled analysis of pediatric and adult clinical trials was conducted. METHODS Data from 7 pediatric trials and 2 adult trials were merged in the Malignant Germ Cell International Collaborative data set. Four trials included patients with newly diagnosed pure ovarian ITs and were selected (Pediatric Oncology Group/Children’s Cancer Group Intergroup Study (INT 0106), Second UKCCSG Germ Cell Tumor Study (GC2), Gynecologic Oncology Group (GOG 0078 and GOG 0090). Adult and pediatric trials were analyzed separately. The primary outcome measures were event-free survival (EFS) and overall survival (OS). RESULTS One hundred seventy-nine patients were included (98 pediatric patients and 81 adult patients). Ninety pediatric patients were treated with surgery alone, whereas all adult patients received chemotherapy. The 5-year EFS and OS were 91% and 99%, respectively, for the pediatric cohort and 87% and 93%, respectively, for the adults. There were no relapses in grade 1 patients, regardless of the stage or age. Only 1 adult patient with a grade 2 IT relapsed. Among grade 3 patients, the 5-year EFS was 0.92 (0.72–0.98) for stage I/II and 0.52 (0.22–0.75) for stage III in the pediatric cohort (P = .005) and 0.91 (0.69–0.98) for stage I/II and 0.65 (0.39–0.83) for stage III/IV in the adult cohort (P = .01). Postoperative chemotherapy did not decrease relapses in the pediatric cohort. CONCLUSIONS The grade was the most important risk factor for relapse in ovarian ITs. Among grade 3 patients, the stage was significantly associated with relapse. Adjuvant chemotherapy did not decrease relapses in the pediatric cohort; its role in adults remains unresolved.

Pediatric Ovarian Growing Teratoma Syndrome

“…Neither the age at diagnosis nor the AFP level was related significantly to the risk of relapse. The administration of postoperative chemotherapy did not decrease the risk of relapse in the pediatric cohort [10]. Similarly to our study, other pediatric studies have shown no benefit of adjuvant chemotherapy postoperatively in the management of ovarian immature teratomas.…”

Pure pediatric ovarian immature teratomas: The French experience

“…The histological Norris grading system, based on the amount of immature neuroglial tissue, has a significant prognostic impact on postpubertal IT, whereas its impact on prepubertal ovarian IT has not been demonstrated yet. Surgery is the mainstay of therapy for IT, and the role of chemotherapy in such tumors is still unclear . There is a current controversy between pediatric and adult oncologists concerning the place of chemotherapy in IT: this analysis is made to contribute to the debate.…”

Ovarian germ cell tumour classification: views from the testis

“…Previously, their treatment has also often been different in the paediatric and adult cohorts, with significantly less treatment in the paediatric age range, while adults are offered more adjuvant chemotherapy . Many studies have comprehensively examined the pathogenesis and aetiology of the multitude of germ cell tumours .…”