MALIGNANT GERM-CELL TUMORS OF THE OVARY - 20-YEAR REPORT OF LAC-USC WOMENS HOSPITAL

Thirty-six patients with malignant germ cell tumors (GCT) of the ovary were treated during the period from 1971 to 1990. Twenty-five of thes e patients underwent initial surgery at this institution; 11 were refe rred after initial surgery. Endodermal sinus tumor (EST) was the most common subtype (N = 13), followed by immature teratoma (IMT) (N = 11), dysgerminoma (N = 9), and mixed germ cell tumor (N = 3). Eight of nin e patients with dysgerminoma and 14 of 27 patients with non-dysgermino matous germ cell tumors had stage I disease. Surgical staging resulted in a change of stage in 10 of 31 patients; seven were upstaged, and t hree were downstaged. Thirty-five of 36 patients are alive with no evi dence of disease at a median follow-up of 47 months (range 12-210 mont hs). Two of nine patients with dysgerminoma received postoperative rad iotherapy; two additional patients required radiotherapy for recurrenc e. Twenty-five of 27 patients with non-dysgerminomatous tumors were tr eated with combination chemotherapy. Second-look laparotomy was done i n 18 patients, four of whom had positive results. Three of the four pa tients with positive second-look laparotomy results remain free of dis ease after salvage chemotherapy; the fourth patient died of progressiv e grade 3 IMT. Nineteen of 27 patients undergoing fertility-preserving surgery have resumed normal menses, and four of these have delivered normal infants. The other eight patients remain on oral contraceptives . We conclude that surgical staging provided important information in this study of 36 patients with ovarian germ cell malignancies. As note d by many previous reports, combination chemotherapy (developed during the past 20 years) has dramatically improved prognosis for this group of patients. Second-look laparotomy (SLL), especially for patients wi th advanced disease, was able to identify patients requiring additiona l therapy. Most patients with this disease can retain their normal, un involved ovary with preservation of normal menstrual and reproductive function.