Germ cell tumors of the ovary, uncommon but aggressive tumors seen most often in young women or adolescent girls, are frequently unilateral, and are generally curable if found and treated early. Use of combination chemotherapy after initial surgery has dramatically improved the prognosis for many women with these tumors.[1-3] Although long-term survival is the rule for mature teratoma, survival for immature teratoma 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, Norris et al. reported recurrence in 18% with grade 1 disease, in 37% with grade 2 disease, and in 70% with grade 3 disease, and similar findings have been reported by others.[4] 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. Over 50% died within a year of diagnosis.[5]

Other studies found that size and histology were the major factors determining prognosis for patients with malignant mixed germ cell tumors of the ovary.[4,6] Prognosis was poor for large tumors when more than one-third of the tumor was composed of endodermal sinus elements, choriocarcinoma or grade 3 immature teratoma. On the other hand, when the tumor was less than 10 cms in diameter, the prognosis was good regardless of the composition of the tumor.[6]

For dysgerminoma confined to the ovary, less than 10 centimeters in size, with an intact, smooth capsule unattached to other organs and without ascites, the 10-year survival following conservative surgery was 88.6% in a series, and a number of patients had 1 or more successful pregnancies following unilateral salpingo-oophorectomy.[7] Even patients with incompletely resected dysgerminoma can be rendered disease free following BEP (bleomycin/etoposide/cisplatin) or PVB (cisplatin/vinblastine/bleomycin) chemotherapy.[8] 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 to 54 months after the start of BEP chemotherapy.[1] Also, reported results of 2 Gynecologic Oncology Group (GOG) trials show that 89 of 93 patients with stages I, II, and III disease who had completely resected tumors were disease free after 3 cycles of BEP.[1,3] However, in a similar nonseminomatous germ cell tumor of the testis, the combination of bleomycin, etoposide, and carboplatin (CEB) was inferior to BEP in a randomized multicenter trial comparing BEP to CEB in 598 patients with good-risk nonseminomatous testicular germ cell tumors.[9]

References

1. Gershenson DM: Update on malignant ovarian germ cell tumors. Cancer 71 (4 Suppl): 1581-90, 1993.  [PUBMED Abstract]
   
   
2. 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]
   
   
3. 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]
   
   
4. 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]
   
   
5. 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]
   
   
6. Kurman RJ, Norris HJ: Malignant germ cell tumors of the ovary. Hum Pathol 8 (5): 551-64, 1977.  [PUBMED Abstract]
   
   
7. Thomas GM, Dembo AJ, Hacker NF, et al.: Current therapy for dysgerminoma of the ovary. Obstet Gynecol 70 (2): 268-75, 1987.  [PUBMED Abstract]
   
   
8. 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]
   
   
9. Horwich A, Sleijfer DT, Fosså SD, et al.: Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide, and carboplatin in good-prognosis metastatic nonseminomatous germ cell cancer: a Multiinstitutional Medical Research Council/European Organization for Research and Treatment of Cancer Trial. J Clin Oncol 15 (5): 1844-52, 1997.  [PUBMED Abstract]
   
   

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