SURVEILLANCE POLICY FOR STAGE-I OVARIAN GERM-CELL TUMORS

Purpose: Surveillance for stage 1 male germ cell rumors (GCT) is well established as a standard practice; however, such a policy has not bee n evaluated for women with equivalent tumors, This study was designed to evaluate the management of grade II or higher stage Ia tumors by cl ose surveillance to minimize treatment, while reserving chemotherapy f or patients with residual or recurrent disease. Patients and Methods: Between 1973 and 1995, 24 patients with malignant stage Ia ovarian GCT were enrolled onto a surveillance program. The group consisted of nin e patients with dysgerminoma, nine with pure immature teratoma, and si x with endodermal sinus tumor (with or without immature teratoma). Tre atment consisted of surgical resection without adjuvant chemotherapy, followed by a surveillance program of clinical, serologic, and radiolo gic review, and included a second-look procedure for patients enrolled after 1982. Results: All but one patient are alive and in remission a fter a median follow-up of 6.8 years. The 5-year overall survival is 9 5%, and the 5-year disease-free survival is 68%. Eight patients have r equired chemotherapy for recurrent disease or second primary ovarian G CT. This includes three patients with grade II immature teratoma and t hree patients with dysgerminoma, and a further two women with dysgermi noma who developed contralateral (presumed second primary) dysgerminom a 4.5 and 5.2 years after their first tumor. All but one, who died of a pulmonary embolus, have been successfully salvaged with chemotherapy . Conclusion: Our experience emphasizes that patients with true stage Ia ovarian GCT are adequately managed by surgical resection followed b y careful clinical, radiologic, and serologic surveillance. These pati ents do not require adjuvant chemotherapy or radiotherapy, thus avoidi ng the potential complications of secondary leukemia and infertility. (C) 1997 by American Society of Clinical Oncology.