CURRENT APPROACHES TO DIAGNOSIS AND TREATMENT OF OVARIAN GERM-CELL MALIGNANCIES

Ovarian germ cell malignancies are neoplasms derived from primitive ge rm cells of the embryonic gonad. These tumors are highly malignant, ra pidly growl ng, and typically occur in young women. The prognosis for patients with ovarian non-dysgerminomatous germ cell malignancies was bleak before the introduction of modern combination chemotherapy. The evolution of modern chemotherapy transformed these virulent malignanci es into highly curable ones. In the early 1970s, the combination of vi ncristine, actinomycin D, and cyclophosphamide (VAC) emerged as the fi rst effective therapy. The efficacy of cisplatin, vinblastine, and ble omycin (PVB) was documented in treatment of men with testicular cancer and subsequently became standard treatment for women with ovarian ger m cell malignancies. Bleomycin, etoposide, and cisplatin (BEP) are sho wn to have equal efficacy and less toxicity in the treatment of ovaria n germ cell malignancies. Experience at Yale University suggested that patients with ovarian germ cell malignancies could be managed by usin g tumor histology to determine the type of chemotherapy, and determini ng treatment duration by serial assays of circulating tumor markers or by International Federation of Gynecologists and Obstetricians' stagi ng. Preservation of reproductive function is appropriate for all patie nts with early stage disease and selected patients with more advanced disease.