Role of lymphadenectomy and vincristine, actinomycin-D, and cyclophosphamide chemotherapy in malignant ovarian germ cell tumors

Purpose of investigation: The objective of this study was to review all malignant ovarian germ cell tumors (MOGCT) managed at the present center, focusing on the role of lymphadenectomy, and vincristine, actinomycin-D, cyclophosphamide (VAC) chemotherapy on treatment, and survival outcome. Materials and Methods: The authors performed a retrospective chart review of 77 patients managed for MOGCT between January 1986 and December 2012. Results: Median age at diagnosis was 26 years. The histologic subtypes included 47 (61.0%) immature teratoma, 16 (20.8%) yolk sac tumor, 9 (11.7%) dysgerminoma, and five (6.5%) mixed germ cell tumor. Of 65 patients with clinically early-stage tumors, 17 (26.1%) had lymphadenectomy performed, of which all had no lymph node metastasis on histology. The overall survival was 100% for both lymphadenectomy and no lymphadenectomy groups. Postoperative adjuvant chemotherapy was administered to 51 (66.2%) patients, 38 (74.5%) of whom received VAC chemotherapy. Complete response and overall cure rate of VAC regimen was 100% and 89.5%, respectively when used as first-line postoperative adjuvant treatment. Median follow-up period was 138 months and overall survival was 97.4%. Conclusions: Lymphadenectomy did not provide survival benefits in patients with clinically earlystage MOGCT. The VAC chemotherapy regimen can be considered as an option for primary postoperative treatment, especially in patients with early-stage disease.

Malignant ovarian germ cell tumors; Lymphadenectomy; Chemotherapy.

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