Surgical staging and adjuvant chemotherapy in the management of patients with adult granulosa cell tumors of the ovary

Jin, Ke; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong‐Man; Kim, Kyu-Rae; Kim, Young‐Tak; Nam, Joo‐Hyun

doi:10.1016/j.ygyno.2011.12.442

Cited by 113 publications

(136 citation statements)

References 25 publications

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“…In a recent study by Park et al [39] the 5 year DFS and OS rates in early stage (stage I and II) disease was 89 % and 99 % respectively while in advanced stage (stage III and IV) disease it was 72 % and 80 % respectively. The 10 year DFS and OS rates in early stage (stage I and II) disease was 89 % and 90 % respectively while in advanced stage (stage III and IV) disease it was 57 % and 67 % respectively ( Table 1).…”

Section: Prognostic Factorsmentioning

confidence: 91%

“…27.3 % of JGCT had ascites but none had malignant cells. Preoperative tumor rupture was seen in 17.6 % and 27.3 % cases of AGCT and JGCT respectively Several studies [39,[41][42][43], Table 2, evaluating the role of lymph node dissection have shown that nodal dissection is not a significant factor for survival and is not recommended in surgical staging of GCT. Enlarged or suspicious nodes should be removed to allow evaluation and maximal cytoreduction.…”

Section: Surgical Managementmentioning

confidence: 99%

See 1 more Smart Citation

Recent Advances in Granulosa Cell Tumor Ovary: A Review

Kottarathil

Antony

Nair

et al. 2012

Indian J Surg Oncol

105

108

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Granulosa cell tumors constitute less than 5 % of all ovarian tumors. Unlike epithelial ovarian tumors, they occur in a younger age group, are usually detected in an early stage and often have features of hyperestrogenism. The presenting symptoms are usually nonspecific with abdominal pain or distension. They follow an indolent course and are characterized by a long natural history. Mutation of FOXL2 (402C->G) seen in 97 % of adult GCT may be pathognomonic for adult GCT. Only stage of the disease has been consistently shown in various studies to affect survival of patients with GCT. The initial management of patients, for whom fertility is not an issue, is total abdominal hysterectomy, bilateral salpingo-oophorectomy and removal of all gross disease. Nodal dissection is not a significant factor for survival and is not recommended in surgical staging of GCT. Fertility preserving surgery with unilateral salpingooophorectomy is feasible in young patients with stage Ia GCT. Patients with early stage disease (stage I and II) have a very good prognosis with 5 year DFS and OS of 89 % and 99 % respectively and these groups of patients usually don't require any postoperative treatment. Patients with stage Ic disease associated with poor prognostic factors like large tumor size or high mitotic index and stage II, have a higher chance of relapse, and may benefit with postoperative treatment but role of chemotherapy is still debatable. In advanced stage disease (stage III and IV) the 5 year DFS and OS disease was 72 % and 80 % respectively hence the option of postoperative treatment with 6 cycles of BEP should be considered in this group. Recently paclitaxel is being investigated as an effective tool in GCT. The efficacy of radiation in GCT is not well defined but in optimally debulked cases postoperative radiation is a viable option. Due to high chance of recurrence even years after apparent clinical cure of the primary tumor, lifelong follow up with clinical examination and tumor markers like inhibin B is recommended. About 25 % GCT develop recurrence and the median time to recur is usually 4-5 years. Most recurrences are intraperitoneal and usually a complete debulking of the disease is feasible even in the recurrent setting. Postoperative chemotherapy (platinum based) is usually given after surgery more so in cases with widespread disease or after suboptimal cytoreduction. Recurrent chemoresistant, progressive non-responding GCT or patients with high surgical risk are ideal candidates for targeted therapy.

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Section: Prognostic Factorsmentioning

confidence: 91%

Section: Surgical Managementmentioning

confidence: 99%

Recent Advances in Granulosa Cell Tumor Ovary: A Review

Kottarathil

Antony

Nair

et al. 2012

Indian J Surg Oncol

105

108

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show abstract

“…For patients with stage II to IV tumors, recommended options (all are category 2B) include RT for limited disease or platinumbased chemotherapy (BEP or paclitaxel/carboplatin regimens are preferred) (see LCOH-9 and OV-B, 4 of 7; pages 1143 and 1146, respectively). [208][209][210][211] Surveillance recommendations for malignant sex cord-stromal tumors are provided in the algorithm, which are based on the Society of Gynecologic Oncology recommendations (see "Surveillance for Malignant Germ Cell and Sex Cord-Stromal Tumors" in the complete version of these guidelines ). 186 Prolonged surveillance is recommended for granulosa cell tumors, because they can recur years later (eg, 30 years).…”

Section: Malignant Sex Cord-stromal Tumorsmentioning

confidence: 99%

Ovarian Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology

Morgan

Armstrong

Alvarez

et al. 2016

J Natl Compr Canc Netw

287

223

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“…Most authors recommend the use of bleomycin, etoposide, and platinum (BEP) for 3 to 6 cycles. 15 Late recurrence is a hallmark of ovarian granulosa cell tumour, hence indefinite followup of patients with ovarian granulosa cell tumour has been emphasised. 16,17 Most common tumour markers useful in early detection of recurrence are inhibin B and Mullerian inhibiting substance/AMH.…”

Section: Discussion Of Managementmentioning

confidence: 99%