Medline ® Abstract for Reference 13
of 'Treatment of malignant germ cell tumors of the ovary'
Neo-adjuvant chemotherapy in the treatment of advanced malignant germ cell tumors of ovary.
Talukdar S, Kumar S, Bhatla N, Mathur S, Thulkar S, Kumar L
Gynecol Oncol. 2014;132(1):28.
OBJECTIVE: In order to preserve fertility, we attempted neo-adjuvant chemotherapy (NACT) in patients of malignant ovarian germ cell tumor (MOGCT) with advance and bulky disease.
PATIENTS AND METHODS: Between January 1988 and December 2009, 23 patients received NACT. Patient's median age was 19years, ranging from 14 to 28years. FIGO stages III - 20 and IV - 3. Histology subtypes were: dysgerminoma, n=14, mixed GCT, n=6 and 3 had endodermal sinus tumor. Patients were planned for four cycles of BEP (bleomycin, etoposide and cisplatin) chemotherapy followed by fertility sparing surgery (unilateral salpingo-oophorectomy+omentectomy±lymphadenectomy).
RESULTS: Following NACT - 21 patients responded; complete (CR) - 16 and partial response (PR) - 5. One patient progressed and another was lost to follow-up after 2cycles. 18 of 21 responders underwent surgery; 13/18 had pathological CR, 5/18 had residual disease and achieved CR following 2 more cycles of BEP. 3 patients refused for surgery; 2 relapsed at 9 and 12months, and achieved second CR following salvage chemotherapy and surgery, third patient continues to be disease-free. Currently, 21 of 23 patients are alive and disease-free at a median follow-up of 74months. 18/21 patients have resumed menstruation and 10 eligible patients have delivered 13 full term healthy babies. These results are comparable to patients with advanced disease (n=43) treated with standard approach (initial surgery and adjuvant chemotherapy) during the same period.
CONCLUSION: NACT followed by fertility sparing surgery could be a reasonable option for patients of advanced MOGCT, not suitable for optimal cyto-reduction.
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi 110029, India.