Survival and fertility of patients with malignant ovarian germ cell tumours

Disease-free survival (DFS), overall survival (OS) and fertility of patients treated for malignant ovarian germ cell tumours at the Institute of Oncology Ljubljana from 1990-2000 were assessed. Twenty-three patients with a median age of 25 (15-67) years were treated. Five had pure dysgerminoma, three endodermal sinus tumour, ten immature teratoma and five had mixed germ cell tumours. Eleven patients had FIGO Stage I and the others advanced stage disease. All patients underwent initial surgery; in 13 of 15 patients under 35 years unilateral salpingo-oophorectomy was performed. Twenty-one patients received adjuvant cisplatin-based chemotherapy. At the median follow-up of 68 (11-140) months DFS was 74% and OS 87%. Six patients (two did not receive adjuvant chemotherapy) relapsed at a median of 16 (3-63) months after surgery. At relapse four were treated with surgery and chemotherapy, one with chemotherapy only and one with palliative radiotherapy only: two are still in complete remission, one has residual disease and three died of disease. Ten of 13 patients with fertility-preserving surgery regained menstrual cycles and one gave birth to a normal child. DFS and OS in our group of patients (over 15 years of age) are comparable to other institution's experience. Fertility in young patients can be preserved without compromising outcome.

Malignant ovarian germ cell tumours; Fertility preserving surgery; Cisplatin-based chemotherapy; Menstrual function; Survival

[1] Talerman A.: "Germ cell tumors of the ovary". In: Kurman R.J.,(ed.), Blaustein 's Pathology of the Female Tract. New York, Springer-Verlag, 1987, 268.

[2] Benedet J.L., Bender H., Jones H. 3"', Ngan H.Y., Pecorelli S.: "FIGO staging classifications and clinical practice guidelines in the management of gynaecologic cancers: FIGO Committee on Gynecologic Oncology". Int. J. Gynaecol. Obstet., 2000, 70, 209.

[3] Gershenson D.M., Morris M., Cangir A., Kavanagh J.J., Stringer C.A., Edwards C.L. et al.: "Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin". J. Clin. Oneal., 1990, 8, 715.

[4] Segelov E., Campbell J., Ng M., Tattersall M., Rome R., Free K. et al.: "Cisplatin-based chemotherapy for ovarian gem沁ell malignancies: The Australian experience". J. Clin. Oneal., 1994, 12, 378.

[5] Williams S., Blessing J.A., Liao S.Y., Ball H., Hanjani P.: "Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group". J. Clin. Oneal., 1994, 12, 701.

[6] Williams S.D., Blessing J.A., Moore D.H., Homesley H.D., Adcock L.: "Cisplatin, vinblastine, and bleomycin in advanced and recurrent ovarian germ-cell tumors. A trial of the Gynecologic Oncology Group". Ann. Intern. Med., 1989, 111, 22.

[7] Williams S.D., Blessing J.A., Hatch K.D., Homesley H.D.: "Chemotherapy of advanced dysgerminoma: trials of the Gynecologic Oncology Group". J. Clin. Oneal., 1991, 9, 1950.

[8] Schwartz P.E., Chambers S.K., Chambers J.T., Kohom E, Meintosh S.: "Ovarian germ cell malignancies: the Yale University experience". Gynecol. Oneal., 1992, 45, 26.

[9] Williams S.D., Gershenson D.M., Horowitz C.J., Silva E.: "Ovarian germ-cell tumors". In: Hoskins W.J., Perez C.A., Young R.C., (eds.), Principles and Practice of Gynaecologic Oncology. Philadelphia, Williams & Wilkins, 2000, 1059.

[10] Cusido M.T., Jorda B., Gonzalez J., Garcia A., Xercavins J.: "Ovarian germ cell tumors". Eur. J. Gynaecol. Oneal., 1998, 19 (2), 130.

[11] Khi C., Low J.J., Tay E.H., Chew S.H., Ho T.H.: "Malignant ovarian germ cell tumors: the KK Hospital Experience". Eur. J Gynaecol. Oneal., 2002, 23 (3), 251.

[12] Ayhan A., Bildirici I., Guenalp S., Yuce K.: "Pure dysgermmoma of the ovary: a review of 45 well staged cases". Eur J. Gynaecol. Oneal., 2000, 21, 98.

[13] Zanetta G., Bonazzi C., Cantu M.G., Bini S., Locatelli A, Bratina G. et al.: "Survival and reproductive function after treatment of malignant germ cell ovarian tumors". J Clin. Oneal., 2001, 19, 1015.

[14] Low J.J., Perrin L.C., Crandon A.J., Hacker N.F.: "Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumors". Cancer, 2000, 89, 391.

[15] Mitchell P.L., Al-Nasiri N., A'Hern R., Fisher C., Horwich A., Pinkerton C.R. et al.: "T reatment of nondysgerminomatous ovarian germ cell tumors". Cancer, 1999, 85 (10), 2232.