Treatment of nondysgerminomatous ovarian germ cell tumors

Mitchell, Paul; Al-Nasiri, N.; A’Hern, Roger; Fisher, Cyril; Horwich, A.; Pinkerton, CR; Shepherd, John H.; Gallagher, Chris; Slevin, M. L.; Harper, Peter; Osborne, Richard; Mansi, Jeanine; Oliver, T.; Gore, Martin

doi:10.1002/(sici)1097-0142(19990515)85:10<2232::aid-cncr19>3.0.co;2-4

Cited by 97 publications

(70 citation statements)

References 44 publications

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“…Platinum-containing chemotherapy changed the outcome for YST patients from fatal to potentially curable. Among all subtypes of MOGCT, YST is highly malignant and has a poor prognosis (Mitchell et al 1999). Today, the standard treatment of MOGCTs is fertility-preserving surgery and three to four cycles of combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP) (Gershenson 1994).…”

Section: Introductionmentioning

confidence: 99%

Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)

Kojimahara

Nakahara

Takano

et al. 2013

Tohoku J. Exp. Med.

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Yolk sac tumor (YST) of the ovary is a rare germ cell tumor comprising about 1% of all ovarian malignancies. YST usually occurs as a rapidly growing unilateral tumor in young women. With the introduction of cisplatin, YST has been changed from a fatal tumor to a curable tumor. The standard treatment of YST consists of fertility-preserving surgery and 3 or 4 courses of adjuvant combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP). However, the long-term prognosis of BEP-treated YST patients has not been well studied. We therefore conducted a retrospective multicenter study to investigate the prognostic factors of 33 YST patients, including 25 patients treated with BEP. The median age at initial treatment was 20 years (range 10-53). There were 15 patients (at stage I), one (stage II), 16 (stage III), and one (stage IV). Nominal and grouped numerical values were analyzed by the KaplanMeier method. All patients had unilateral tumor, with right-side predominance (23 patients; P = 0.02). Eighteen patients had pure YST, 13 had mixed germ cell tumor with YST component, and other 2 patients were not specified. Twenty-eight patients received fertility-preserving surgery. Twenty-seven patients had optimal surgery with less than 1 cm residual tumor diameter. Median number of chemotherapy courses was 5. Median follow-up period was 49 months. The cumulative 5-year survival rate was 87%. Univariate analysis revealed the following significant prognostic factors (P < 0.05): stage, tumor diameter, and residual tumor. Extensive debulking surgery to minimize residual tumor would improve the prognosis.

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Section: Introductionmentioning

confidence: 99%

Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)

Kojimahara

Nakahara

Takano

et al. 2013

Tohoku J. Exp. Med.

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“…Making a diagnosis can be challenging because αFP is not routinely tested in postmenopausal women. Tumor markers to be assessed should include αFP, lactate dehydrogenase (LDH), βhCG and CA125, and these are important in diagnosis, surveillance, monitoring response to treatment and potentially prognosis [45][46][47][48]. YSTs typically produce αFP, while βhCG production can be found in choriocarcinomas, embryonal carcinomas and polyembryomas; the latter two can also produce αFP.…”

Section: Discussionmentioning

confidence: 63%

Systemic management of malignant ovarian germ cell tumors in older women: two case reports and a review of the literature

Luís

Boussios

Dumas

et al. 2016

CBN

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Background Ovarian germ cell tumors (OGCT) account for 2-5% of ovarian malignancies, with an annual incidence of 0.5-1:100,000, typically occurring in young women. Yolk sac tumor (YST) is the second most common type of OGCT and has an aggressive phenotype. The rarity of this pathology in postmenopausal women poses challenges in the diagnosis and treatment. Patients and Methods We report two clinical cases of YST in postmenopausal women treated at the Royal Marsden and discuss diagnosis and treatment issues of OGCTs in older women. A literature review was also performed, which identified thirty-nine cases, including the two reported in this article. Results and ConclusionThis showed that YSTs in older women are rare and are generally aggressive with poor clinical outcomes. Twelve of the described patients with malignant OGCTs died within 8 months of diagnosis.In conclusion, YST in postmenopausal women can have an aggressive disease course compared with younger patients. More evidence for the tolerability and outcomes of cytoreductive surgical approaches and intensive chemotherapy regimens in older patients is required.

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“…OYSTs are characterized by a high malignant potential, but are also highly chemosensitive. It was reported that 3 courses of bleomycin, etoposide and cisplatin (BEP) was the current standard adjuvant therapy, with 4 courses of BEP recommended in case of bulky residual disease following surgery (8,25,26). An effective postoperative chemotherapy regimen (BEP regimen) following surgery is a prognostic factor at least as significant as stage in these chemosensitive tumors (27).…”

Section: Discussionmentioning

confidence: 99%

“…Certain studies presented evidence of the association between serum AFP level and the prognosis of OYST. Mitchell et al (8) reported that a shorter relapse-free survival (RFS) was primarily observed among patients with AFP >1,000 kU/l compared to that among patients with AFP ≤1,000 kU/l [odds ratio (OR)=0.09, 95% confidence interval (CI): 0.01-0.85]. In addition, de La Motte Rouge et al (9) demonstrated that there was a significant association between high serum AFP levels and 5-year overall survival (OS) of OYST (OR=0.24; 95% CI: 0.05-1.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of serum α-fetoprotein in ovarian yolk sac tumors: A systematic review and meta-analysis

Guo¹,

Zhang²,

Zhu³

2014

Molecular and Clinical Oncology

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Abstract. This study was conducted to determine the prognostic value of serum α-fetoprotein (AFP) levels in patients with ovarian yolk sac tumor (OYST). We performed a systematic review and meta-analysis to assess the associations between serum AFP level and prognosis in OYST. A total of 12 quantitative studies met the inclusion criteria. Preoperative AFP was not found to be associated with overall survival (OS) [odds ratio (OR)= 0.84, 95% confidence interval (CI): 0.43-1.62] in OYST. However, a high postoperative AFP level was associated with worse OS (OR=0.16, 95% CI: 0.05-0.48) and relapse-free survival (RFS) (OR=0.18, 95% CI: 0.08-0.43) compared to a low postoperative AFP level in patients with OYST. In addition, a postoperative AFP level of >1,000 ng̸ml was associated with a decrease in OS (OR= 0.16, 95% CI: 0.05-0.50) and RFS (OR=0.21, 95% CI: 0.08-0.57). In conclusion, the postoperative, but not the preoperative, AFP level was found to be a prognostic factor in patients with OYST. In particular, a postoperative AFP level of >1,000 ng/ml was an indicator of poor prognosis in patients with OYST.

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Treatment of nondysgerminomatous ovarian germ cell tumors

Cited by 97 publications

References 44 publications

Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)

Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)

Systemic management of malignant ovarian germ cell tumors in older women: two case reports and a review of the literature

Prognostic value of serum α-fetoprotein in ovarian yolk sac tumors: A systematic review and meta-analysis

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