Malignant ovarian tumors in children: 22 years of experience at a single institution

Purpose: Malignant ovarian tumors of childhood are relatively rare and thus , management is still unclear. We reviewed our experience with these tumors to evaluate their histopathologic characteristics, treatment, and outcome. Patients and Methods: From January 1975 to December 1997, 56 patients had t heir malignant ovarian tumors diagnosed, treated, and followed-up in our in stitution. All tumors were completely excised when possible; otherwise, bio psy was performed. Staging was made according to Federation Internationale de Gynecologie Oncologique classification. Chemotherapy was recommended for all patients. Twelve cases were treated with vincristine, actinomycin, cyc lophosphamide (VAC)before 1986; 12 with cisplatin, vinblastine, and bleomyc in (PVB) from 1986 to 1989; and 23 with the bleomycin, etoposide, and cispl atin (BEP) regimen from 1989 to present. The Kaplan-Meier survival method w as used to calculate the survival. The log-rank test was used to compare gr oups with respect to survival. Results: Age range was 0 to 16 years (median 11 yrs; average 9.8 yrs). Only two patients were younger than 1 year. The most common presenting symptom was abdominal pain, occurring in 27 patients (48.2%). Thirty-three patients (60%) had total one-sided salpingo-oophorectomy and three patients had bil ateral salpingo-oophorectomy. Nineteen patients had stage I, 15 had stage I I, 19 had stage LII, and 3 had stage IV disease. Dysgerminoma was the most common type. Overall survival (OAS) and event-free survival were 68% (media n follow-up time: 71 mos) and 57%, respectively, after 22 years. Histopatho logy was not correlated with survival. Two important predictors for surviva l are age (P < 0.0001) and treatment protocol (P = 0.013). The BEP protocol was superior to the other regimens. The OAS was 74.6% in BEP, 55% in PVB, and 63.6% in VAC regimens. Conclusion: Although age at diagnosis and treatment with BEP regimen have m ajor roles in determining prognosis of the ovarian tumors in childhood, for patients with advanced ovarian germ cell tumors, intensification of chemot herapy or the development of new approaches is necessary.