Stage II Ovarian Germ Cell Tumors
Dysgerminomas
Other Germ Cell Tumors
Current Clinical Trials
Dysgerminomas
Standard treatment options:
- For patients with stage II dysgerminoma, total abdominal hysterectomy and
bilateral salpingo-oophorectomy are usually performed. However, for the
younger patient anxious to preserve fertility, a unilateral
salpingo-oophorectomy can be considered standard therapy at this time; adjuvant
chemotherapy should be given.
These patients should receive adjuvant treatment. Options include radiation
therapy or chemotherapy. A disadvantage of the former is loss of fertility due
to ovarian failure. Experience with adjuvant chemotherapy is limited, but
considering the effectiveness of chemotherapy in tumors other than dysgerminoma
and in advanced stage dysgerminoma, it is likely to be effective and to allow
recovery of reproductive potential in patients with an intact ovary, tube, and
uterus. Thus, adjuvant cisplatin, etoposide, and bleomycin have replaced
radiation therapy except in the rare patient in whom chemotherapy is not
considered appropriate.
Other Germ Cell Tumors
Standard treatment options:
- For patients with stage II germ cell tumors other than pure dysgerminoma,
unilateral salpingo-oophorectomy should be performed when fertility is to be
preserved. Although there is considerable experience with VAC
(vincristine/dactinomycin/cyclophosphamide), especially when given in an
adjuvant setting, combinations containing bleomycin, etoposide, and cisplatin
(BEP) are more effective.[1-3] Patients who do not respond to a
cisplatin-based combination may still attain a durable remission with VAC as
salvage therapy.[4] Recurrence after 3 courses of BEP as adjuvant therapy is
rare.[4] All patients who do not respond to standard therapy are candidates
for clinical trials. When there is residual disease or elevated levels of AFP
or HCG after maximal surgical debulking, 3 or 4 courses of BEP combination
chemotherapy are indicated.[5]
Evidence suggests that second-look laparotomy is not beneficial in patients
with initially completely resected tumors who receive cisplatin-based adjuvant
treatment.[6] Second-look surgery may be of benefit for a minority of patients
whose tumor was not completely resected at the initial surgical procedure and
who had teratomatous elements in their primary tumor.[6,7] Surgical resection
of residual masses detected by clinical examination, by radiographic
procedures, or at re-exploration should be undertaken since reversion to germ
cell tumor has been described.
Treatment options under clinical evaluation:
- Patients with stage II germ cell tumors of the ovary are candidates for
clinical trials.[4]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II ovarian germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
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]
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Pinkerton CR, Pritchard J, Spitz L: High complete response rate in children with advanced germ cell tumors using cisplatin-containing combination chemotherapy. J Clin Oncol 4 (2): 194-9, 1986.
[PUBMED Abstract]
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Gershenson DM, Morris M, Cangir A, et al.: Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin. J Clin Oncol 8 (4): 715-20, 1990.
[PUBMED Abstract]
-
Williams SD, Blessing JA, Moore DH, et al.: Cisplatin, vinblastine, and bleomycin in advanced and recurrent ovarian germ-cell tumors. A trial of the Gynecologic Oncology Group. Ann Intern Med 111 (1): 22-7, 1989.
[PUBMED Abstract]
-
Williams SD, Birch R, Einhorn LH, et al.: Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med 316 (23): 1435-40, 1987.
[PUBMED Abstract]
-
Williams SD, Blessing JA, DiSaia PJ, et al.: Second-look laparotomy in ovarian germ cell tumors: the gynecologic oncology group experience. Gynecol Oncol 52 (3): 287-91, 1994.
[PUBMED Abstract]
-
Gershenson DM: The obsolescence of second-look laparotomy in the management of malignant ovarian germ cell tumors. Gynecol Oncol 52 (3): 283-5, 1994.
[PUBMED Abstract]
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