SALVAGE SURGERY FOR CHEMOREFRACTORY OVARIAN GERM-CELL TUMORS

This study was undertaken to determine whether secondary surgical debu lking is beneficial for patients with malignant ovarian germ cell tumo rs (OGCT). Twenty patients with OGCT treated at our institution betwee n 1975 and 1992 were retrospectively identified and analyzed. Survival was analyzed using the life-table methods of Kaplan and Meier and the statistical significance of various perioperative factors was tested by both the log-rank and the Wilcoxon tests. Histologic tumor type inc luded 8 immature teratomas, 6 mixed tumors, 5 endodermal sinus tumors, and 1 dysgerminoma. After primary surgery, all patients received chem otherapy-non-platinum-based in 12 patients, platinum-based in 5, and b oth types in 3 patients. Treatment failure was classified as progressi on in 14 patients, persistence in 3, and recurrence in 3. Salvage surg ery consisted of exploratory laparotomy and tumor debulking in 18 pati ents, inguinal lymphadenectomy in 1, and thoracotomy and wedge resecti on in 1. Sixteen patients subsequently received salvage chemotherapy. At the time of analysis, 11 patients were alive disease-free, 1 was al ive with tumor, 6 had died of turner progression, and 2 had died of tr eatment-related complications. Survival of patients with immature tera toma who underwent salvage surgery was significantly better than survi val of those with other tumor cell types (P = 0.006). In conclusion, a lthough the role of secondary debulking in chemorefractory OGCT remain s undetermined, it may have some benefit for a select group of patient s, particularly those with immature teratoma. (C) 1994 Academic Press, Inc.