Treatment of malignant ovarian germ cell tumors and preservation of fertility

Objective: To explore the prognostic factors, as well as the menstrual and reproductive outcomes, of malignant ovarian germ cell tumors following a fertility-preserving treatment. Methods: A total of 145 patients with malignant ovarian germ cell tumors who had undergone fertility-preserving management in the past 20 years were analyzed retrospectively. The correlative factors for survival, recurrence, and reproductive status were evaluated. The median follow-up time was 9.5 years. Thirty-five cases suffered from dysgerminoma, 31 cases from endodermal sinus tumor, 63 cases from immature teratoma, two cases from embryonal carcinoma, 13 cases from mixed germ cell tumor, and one case had malignant struma. The overall five-year survival rate was 90.3%, whereas the ten-year survival rate was 89.2%. The five-year survival rates for the different stages were as follows: Stage I, 98.1%; Stage II, 5/5; Stage III, 73.3%; and recurrence, 64.1%. The five-year survival rates were 100% for dysgerminoma, 84.1% for endodermal sinuse tumors, 92.0% for immature teratoma, one of two cases for embryonal carcinoma, 76.9% for mixed germ cell tumors, and one case of malignant struma. Results: Thirty-five babies were delivered, whereas seven induced abortions were performed during the follow-up. The important prognostic factors included the International Federation of Gynecology and Obstetrics (FIGO) stage and standard chemotherapy. No statistical significance in the five-year survival rates was determined among the different histological types, surgery types, chemotherapy courses, and chemotherapy regimen. Fertility-preserving treatment should be considered for ovarian germ cell tumors without the limitation of the FIGO stage. Conclusion: Chemotherapy does not influence the menses, pregnancy, or offspring. Recurrent cases could obtain a good prognosis after the proper treatment.

Malignant ovarian germ cell tumor; Fertility; Surgery; Chemotherapy

[1] Gershenson D.M., Junco G.D., Copeland L.J., Rutledge F.N.: “Mixed germ cell tumors of the ovary”. Obstet. Gynecol., 1983, 64, 200.

[2] William S.D., Blessing J.A., Moore D.A., Homesley H.D., Adcock L.: “Cisplatin, vinblastine, and bleomycin in advanced and recurrent ovarian germ-cell tumors. A tial of the Gynecologic Oncology Group”. Ann. Inter. Med., 1989, 111, 22.

[3] 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. Oncol., 1994, 12, 701.

[4] Gershenson D.M., Morris M., Congir A., Cangir A., Kavanagh J.J., Stringer C.A. et al.: “Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin”. J. Clin. Oncol., 1990, 8, 715.

[5] Weinberg L.E., Lurain J.R., Singh D.K., Schink J.C.: “Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors”. Gynecol. Oncol., 2011, 121, 285.

[6] Williams S.D., Kauderer J., Burnett A.F., Lentz S.S., Aghajanian C., Armstrong D.K.: “Adjuvant therapy of completely resected dysgerminoma with carboplatin and etoposide: a trial of the gynecologic oncology group”. Gynecol. Oncol., 2004, 95, 496.

[7] Vicus D., Beiner M.E., Klachook S., Le L.W., Laframboise S., Mackay H.: “A singe institutional experience”. Gynecol. Oncol., 2010, 117, 23.

[8] Lai C.H., Chang T.C., Hsueh S., Wu T.I., Chao A., Chou H.H. et al.: “Outcome and prognostic factors in ovarian germ cell malignancies”. Gynecol. Oncol., 2005, 96, 784.

[9] Smith H.O., Berwic M., Verschraegen C.F., Wiggins C., Lansing L., Muller C.Y. et al.: “Incidence and survival rates for female malignant germ cell tumors”. Obstet. Gynecol., 2006, 107, 1075.

[10] Beiner M.E., Gotlieb W.H., Korach Y., Shrim A., Stockheim D., Segal Y. et al.: “Cystectomy for immature teratoma of the ovary”. Gynecol. Oncol., 2004, 93, 381.

[11] Bailey J., Church: “Management of germ cell tumours of ovary”. Rev. Gynaecol. Pract., 2005, 5, 201.

[12] Gershenson D.M., Miller A.M., Champion V.L., Monahan P.O., Zhao Q., Cella D. et al.: “Reproductive and sexual function after platinum-based chemotherapy in long-term ovarian germ cell tumor survivors: A Gynecologic Oncology Group Study”. J. Clin. Oncol., 2007, 25, 2792.

[13] Jin Y., Pan L.Y., huang H.F., Shen K., Wu M., Yang J.X. et al.: “Comprehensive staging surgery in treatment of malignant ovarian germ cell tumor”. Zhonghua Fu Chan Ke Za Zhi, 2005, 40, 826.

[14] Kollmannsberger C., Beyer J., Liersch R., Schoeffski P., Metzner B., Hartmann J.T. et al.: “Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: A study of the German Testicular Cancer Study Group”. J. Clin. Oncol., 2004, 22, 108.

[15] Miki T., Mizutani Y., Nonomura N., Nomoto T., Nakao M., Saiki S. et al.: “Irinotecan plus cisplatin has substantial antitumor effect as salvage chemotherapy against germ cell tumors”. Cancer, 2002, 95, 1879.

[16] Giorgi U.D., Rosti G., Papiani G., Aieta M., Fochessati F., Paoluzzi L. et al.: “Weely gemcitabine, paclitaxel, oxaliplatin combination chemotherapy in patients with cisplatin- refractory germ cell tumor”. Am. J. Clin. Oncol., 2004, 27, 457.

[17] Zanetta G., Bonazzi C., Cantu M.G., Binidagger S., Locatelli A., Bratina G. et al.: “Survival and reproductive function after treatment of malignant germ cell ovarian tumors”. J. Clin. Oncol., 2001, 19, 1015.

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

[19] Tangir J., Zelterman D., Ma W.G., Schwartz P.E.: “Reproductive function after conservative surgery and chemotherapy for malignant germ cell tumors of the ovary”. Obstet. Gynecol., 2003, 101, 251.