The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study

Mangili, Giorgia; Sigismondi, Cristina; Lorusso, Domenica; Cormio, Gennaro; Candiani, Massimo; Scarfone, Giovanna; Mascilini, F.; Gadducci, Angiolo; Mosconi, Anna Maria; Scollo, Paolo; Cassani, Chiara; Pignata, Sandro; Ferrandina, Gabriella

doi:10.1093/annonc/mdw563

Cited by 65 publications

(62 citation statements)

References 28 publications

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“…In the literature, patients with early and advanced stages showed cure rates approaching 100% and 75% respectively [30] and yolk sac tumors behaved aggressively [31]. In the present study, advanced stages and yolk sac tumors rates are 53% and 31% respectively.…”

Section: Discussionsupporting

confidence: 58%

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

Sarhan¹,

Halim²,

Elzayat³

et al. 2017

JCTI

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Background: Pediatric ovarian tumors are rare. The aim of this work is to study the epidemiological characteristics and treatment outcome of these tumors in our locality. Methods: This retrospective study was performed in accordance with the ethical policies. Between January 2011 to December 2015, Thirteen cases of pediatric ovarian cancers were recorded in the Pediatric Oncology Unit of Oncology Center of Mansoura University and the Clinical Oncology & Nuclear Medicine Department of Mansoura University Hospital. The clinico-epidemiologic data and the treatment protocols were analyzed. Results: The median age was 10 years (range: 2-17). Presenting symptoms were mainly lower abdominal pain (6; 46.2%) and palpable abdominal mass (4; 30.7). Through laparotomy all patients underwent unilateral salpingo-oophorectomy except one case for whom bilateral salpingiooophorectomy was done. Six patients were stage I (46.2%), 2 patients were stage II (15.4%) and 5 patients were stage III tumors (38.4%). The majority had germ cell tumors (11; 85%). Adjuvant chemotherapy was given to all cases. Further chemotherapy was needed in 6 cases due to progression or recurrence. The median follow up was 35 months while the median overall survival was 40 months. Mortality rates were 90% in stages II and III together. The advanced stages and yolk sac pathology had the highest mortality. One of the survived cases got married and delivered a baby. Conclusion: Germ cell tumors are the commonest pediatric malignant ovarian tumors. Multimodality treatment is essential. Fertility preservation should be respected. Our mortality rates are relatively high.

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Section: Discussionsupporting

confidence: 58%

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

Sarhan¹,

Halim²,

Elzayat³

et al. 2017

JCTI

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“…Owing to the high chemo-sensitivity of malignant ovarian germ cell tumors and the high success rate of salvage treatment for recurrence in patients with malignant ovarian germ cell tumors, observation after initial staging surgery may prevent short- and long-term complications caused by chemotherapy and may be feasible for low risk, stage I patients 5. Selecting patients who have a low risk of recurrence and may benefit from avoiding chemotherapy is a treatment challenge.…”

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confidence: 99%

“…Selecting patients who have a low risk of recurrence and may benefit from avoiding chemotherapy is a treatment challenge. The risk factors for recurrence in clinically apparent early-stage malignant ovarian germ cell tumors include mainly yolk sac tumor histology or yolk sac tumor component in mixed malignant ovarian germ cell tumors and incomplete peritoneal staging 5. In cases of recurrence, salvage treatment is usually successful 5 6 15.…”

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confidence: 99%

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

Qin

Xu²,

2019

Int J Gynecol Cancer

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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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“…There is no consensus on the management of ovarian IT, and their inclusion in analyses on MOGCT is debated: approaches differ between adults and pediatric professionals, and even between pediatric series. [13][14][15][16] We included IT with elevated AFP because central pathology review was not mandatory and there was a risk of missing some foci of YST within IT 17 : in 2004, we chose to include IT with AFP level cutoff "high for age," which is why we had such a wide range. This is another controversial issue: some national pediatric groups (UK, COG) [16][17][18] adopt an AFP cutoff for treating IT, while others do not.…”

Section: Discussionmentioning

confidence: 99%

Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study

Terenziani

Bisogno

Boldrini

et al. 2017

Pediatric Blood & Cancer

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Objective: Malignant ovarian germ cell tumors (MOGCT) carry an excellent prognosis, and the treatment aims to achieve results with the least possible treatment-related morbidity. The aim of this study was to assess the outcomes of pediatric patients with MOGCT. 5-year overall survival [OS] 100%), seven relapsed (three patients with Dysg and four patients with Non-Dysg) and were rescued with chemotherapy (plus surgery in three patients). Among the evaluable patients with stages II-IV, 48 (98%) achieved complete remission after chemotherapy ± surgery, one (IT + AFP, stage IV) had progressive disease. In the whole series (median follow-up 80 months), the 5-year OS and EFS were 98.5% (95% CI: 95.6-100%) and 84.5% (95% CI: 76.5-93.5%). Conclusions:We confirm the excellent outcome for MOGCT. Robust data are lacking on surgical staging, surveillance for Non-Dysg with stage I, the management of IT + AFP, and the most appropriate BEP regimen. As pediatric oncologists, we support the role of surveillance after proper surgical staging providing cases are managed by experts at specialized pediatric centers.

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The role of staging and adjuvant chemotherapy in stage I malignant ovarian germ cell tumors (MOGTs): the MITO-9 study

Abstract: This study shows that surveillance seems not to affect survival; chemotherapy should be reserved for relapse resulting in high cure rate. Incomplete peritoneal surgical staging is associated with recurrence. Yolk sac histology worsens the prognosis.

Cited by 65 publications

References 28 publications

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

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

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

Malignant ovarian germ cell tumors in pediatric patients: The AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) study

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