Outcomes of Surgery Alone and Surveillance Strategy in Young Women With Stage I Malignant Ovarian Germ Cell Tumors. Issue 5 (June 2016)

• Record Type: Journal Article
• Authors: Park, Jeong-Yeol; Kim, Dae-Yeon; Suh, Dae-Shik; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun
• Is Part Of: International journal of gynecological cancer. Volume 26:Issue 5(2016)
• Publication Date: 2016-06
• Subjects: Malignant ovarian germ cell tumor -- Stage I -- Surgery -- Fertility-sparing surgery -- Surveillance; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0000000000000702
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objectives: This study aimed to evaluate the safety of surgery alone followed by surveillance in young women with stage I malignant ovarian germ cell tumor (MOGCT). Methods: A retrospective review was performed on 31 patients with stage I MOGCT who were treated by surgery alone with follow-up. Results: The median patient age was 22 years (range, 6–45 years). The histological type was dysgerminoma in 17, immature teratoma in 11, yolk sac tumor in 1, and mixed MOGCT in 2 cases. Seventeen patients were stage IA, 1 was IB, and 13 were IC. All patients underwent fertility-sparing surgery, which involved either unilateral salpingo-oophorectomy or oophorectomy. Additionally, 12 (38.7%) patients underwent cystectomy of the contralateral ovary, but only 1 patient had MOGCT in the contralateral ovary. Twenty (65%) patients underwent a complete staging operation that included peritoneal exploration, biopsy, cytology, and/or omentectomy or omental biopsy; 7 (22.6%) patients who underwent pelvic and para-aortic lymphadenectomy. After a median follow-up time of 137 months (range, 24–268 months), 7 (22.6%) patients had recurrent disease, and underwent secondary surgery followed by chemotherapy with bleomycin, etoposide, and cisplatin (BEP). Six (86%) patients were successfully salvaged, but 1 died of disease progression. The 10-year disease-free survival rate was 77%, but the 10-year overall survival rate was 97%. Conclusions: Fertility-sparing surgery alone with surveillance could be a safe treatment strategy. Most recurrence can be successfully salvaged by surgery and BEP chemotherapy and the overall survival is not compromised. Using this strategy, 77.4% of patients may avoid unnecessary BEP chemotherapy.