Jjh. Low et al., Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumors - A review of 74 cases, CANCER, 89(2), 2000, pp. 391-398
BACKGROUND. Effective combination chemotherapy has improved the previously
dismal prognosis for malignant ovarian germ cell tumors (MOGCT) dramaticall
y. In young patients, conservative surgery with adjuvant chemotherapy has m
ade the preservation of fertility possible, even in patients with advanced
disease. The increase in cure rates has shifted the focus of recent studies
to the long term menstrual, reproductive, and gynecologic outcomes in thes
e patients.
METHODS, The current study is a retrospective review of 74 patients with MO
GCT treated by conservative surgery, retaining the uterus and contralateral
ovary to preserve ovarian function, with or without chemotherapy.
RESULTS. The mean age of the patients was 20.9 years (range, 10-35 years).
The histologic subtypes included 31 dysgerminomas (41.9%), 16 immature tera
tomas (21.6%), 13 endodermal sinus tumors (17.6%), 11 mixed germ cell tumor
s (14.9%), and 3 embryonal cell tumors (4.1%). There were 56 International
Federation of Gynecology and Obstetrics (FIGO) Stage I tumors (75.7%), 3 St
age II tumors, (4.1%), 11 Stage III tumors (14.9%), and 4 Stage nr tumors (
5.4%). Adjuvant chemotherapy was administered in 47 patients (63.5%). The o
verall mean follow-up period was 52.1 months. There were 7 recurrences (9.5
%) and 2 deaths (2.7%). Survival for patients with Stage I disease was 98.2
% and that for patients with advanced disease stages was 94.4%. During chem
otherapy 61.7% of patients developed amenorrhea but 91.5% of these women re
sumed normal menstrual function on completion of chemotherapy. Fourteen hea
lthy live births were recorded in the chemotherapy group and there were no
documented birth defects. There was 1 case of infertility (1.4%).
CONCLUSIONS. The surgical approach in young patients with MOGCT confined to
a single ovary should aim to preserve fertility. Advanced disease is not u
sually accompanied by contralateral ovarian disease and should not necessar
ily contraindicate conservative surgery. The majority of these patients who
have received combination chemotherapy resume normal ovarian function and
can expect a normal fertility rate and healthy offspring. (C) 2000 American
Cancer Society.