General Information About Ovarian Germ Cell Tumors
Germ cell tumors of the ovary are uncommon, but aggressive, tumors, which are seen most often in young women or adolescent girls. These tumors are frequently unilateral and are generally curable if found and treated early. The use of combination chemotherapy after initial surgery has dramatically improved the prognosis for many women with these tumors.[1-3]Dysgerminomas
One series found a 10-year survival rate of 88.6% following conservative surgery for patients with dysgerminoma confined to the ovary; less than 10 cm in size; with an intact, smooth capsule unattached to other organs; and without ascites. A number of patients had one or more successful pregnancies following unilateral salpingo-oophorectomy. Even patients with incompletely resected dysgerminoma can be rendered disease-free following chemotherapy with bleomycin, etoposide, and cisplatin (BEP) or a combination of cisplatin, vinblastine, and bleomycin, also known as PVB.Other Germ Cell Tumors
A report of 35 cases of germ cell tumors, half of which were advanced stage or recurrent or progressive disease, demonstrated a 97% sustained remission at 10 months to 54 months after the start of a combination of BEP. Two Gynecologic Oncology Group trials reported that 89 of 93 patients with stage I, II, or III disease who had completely resected tumors were disease-free after three cycles of BEP.[1,3]
Endodermal sinus tumors of the ovary are particularly aggressive. A review of the literature in 1979 prior to the widespread use of combination chemotherapy found only 27% of 96 patients with stage I endodermal sinus tumor alive at 2 years after diagnosis. More than 50% of the patients died within a year of diagnosis.
Patients with mature teratomas usually experience long-term survival, but survival for patients with immature teratomas following surgery only is related to the grade of the tumor, especially its neural elements. In a series of 58 patients with immature teratoma treated before the modern chemotherapeutic era, recurrence was reported in 18% of the patients with grade 1 disease, in 37% of the patients with grade 2 disease, and in 70% of the patients with grade 3 disease. Similar findings have been reported by others.
Some studies have found that size and histology were the major factors determining prognosis for patients with malignant mixed germ cell tumors of the ovary.[6,8] Prognosis was poor for patients with large tumors when more than one-third of the tumor was composed of endodermal sinus elements, choriocarcinoma, or grade 3 immature teratoma. When the tumor was smaller than 10 cm in diameter, the prognosis was good regardless of the composition of the tumor.[8,9]References
- Gershenson DM: Update on malignant ovarian germ cell tumors. Cancer 71 (4 Suppl): 1581-90, 1993. [PUBMED Abstract]
- Segelov E, Campbell J, Ng M, et al.: Cisplatin-based chemotherapy for ovarian germ cell malignancies: the Australian experience. J Clin Oncol 12 (2): 378-84, 1994. [PUBMED Abstract]
- Williams S, Blessing JA, Liao SY, et al.: Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group. J Clin Oncol 12 (4): 701-6, 1994. [PUBMED Abstract]
- Thomas GM, Dembo AJ, Hacker NF, et al.: Current therapy for dysgerminoma of the ovary. Obstet Gynecol 70 (2): 268-75, 1987. [PUBMED Abstract]
- Williams SD, Blessing JA, Hatch KD, et al.: Chemotherapy of advanced dysgerminoma: trials of the Gynecologic Oncology Group. J Clin Oncol 9 (11): 1950-5, 1991. [PUBMED Abstract]
- Norris HJ, Zirkin HJ, Benson WL: Immature (malignant) teratoma of the ovary: a clinical and pathologic study of 58 cases. Cancer 37 (5): 2359-72, 1976. [PUBMED Abstract]
- Gallion H, van Nagell JR Jr, Powell DF, et al.: Therapy of endodermal sinus tumor of the ovary. Am J Obstet Gynecol 135 (4): 447-51, 1979. [PUBMED Abstract]
- Kurman RJ, Norris HJ: Malignant germ cell tumors of the ovary. Hum Pathol 8 (5): 551-64, 1977. [PUBMED Abstract]
- Murugaesu N, Schmid P, Dancey G, et al.: Malignant ovarian germ cell tumors: identification of novel prognostic markers and long-term outcome after multimodality treatment. J Clin Oncol 24 (30): 4862-6, 2006. [PUBMED Abstract]