DYSGERMINOMA - THE ROLE OF CONSERVATIVE SURGERY

Twenty-five cases of pure ovarian dysgerminoma treated at UCLA Medical Center between 1958 and 1992 were reviewed retrospectively. Patterns of recurrence and overall survival were analyzed with regard to primar y surgery (conservative versus nonconservative), use of adjuvant thera py, and stage of disease. Fourteen patients (56%) underwent conservati ve surgical therapy defined as preservation of the contralateral ovary , 10 patients (40%) had nonconservative primary surgery, and one patie nt (4%) had chemotherapy as primary treatment. Three patients (12%) re ceived adjuvant chemotherapy and nine patients (36%) received postoper ative radiation therapy. Fifteen patients (60%) had stage I disease, f our (16%) stage II, and three each (12%) had stage III and IV disease. Nine patients (36%) experienced recurrence of disease. Seven of these nine patients (78%) had stage I disease and all seven had undergone c onservative primary surgery with preservation of the contralateral ova ry. Six of the seven had received no adjuvant therapy. Only one of the se seven patients experienced recurrence in the preserved ovary. She w as found to have a dysgenetic ovary and an XY karyotype. Three patient s with recurrent disease had received radiation therapy after primary surgery. Twenty patients (80%) were alive without disease at follow-up , two patients (8%) were alive with disease, and three (12%) had died of disease. There was no statistically significant difference in recur rence rates between those patients treated with conservative surgery a nd those treated with nonconservative surgery, although the total numb er of patients with recurrences was greater in the former group. Our d ata suggest that a conservative surgical approach is the preferred tre atment in patients with pure dysgerminoma of the ovary who desire futu re fertility. Lack of adjuvant chemotherapy or radiation therapy, rath er than type of initial surgery, may be associated with a higher risk of recurrence. (C) 1996 Academic Press, Inc.