Dysgerminomas
Other Germ Cell Tumors
Current Clinical Trials

Dysgerminomas

Standard treatment options:

• For patients with stage III dysgerminoma, total abdominal hysterectomy and bilateral salpingo-oophorectomy are recommended with removal of as much gross tumor as can be done safely without resection of portions of the urinary tract or large segments of small or large bowel. Patients who wish to preserve fertility may be treated with unilateral salpingo-oophorectomy if chemotherapy is to be employed.[1-5]

  Chemotherapy with bleomycin/etoposide/cisplatin (BEP) can cure the majority of such patients. In a report of results from 2 Gynecologic Oncology Group (GOG) trials, 19 of 20 patients with incompletely resected tumor who were treated with BEP or PVB were diseasefree at a median follow-up of 26 months.[1] When there is bulky residual disease, it is common to give 3 to 4 courses of a cisplatin-containing combination such as PVB or BEP.[6-8] A randomized study in testicular cancer has shown that bleomycin is an essential component of the BEP regime when only 3 courses are administered.[9] Since chemotherapy with BEP appears to be less sterilizing than wide-field radiation, combination chemotherapy is the preferred treatment in the patient who still desires to have children.[1]

Standard treatment options:

• For patients with stage III germ cell tumors other than pure dysgerminoma, total abdominal hysterectomy and bilateral salpingo-oophorectomy is recommended with removal of as much tumor in the abdomen and pelvis as can be done safely without resection of portions of the urinary tract or large segments of small or large bowel. Patients who wish to preserve fertility can be treated with unilateral salpingo-oophorectomy.[1,3,4] For patients with extensive intra-abdominal disease whose clinical condition precludes debulking surgery, chemotherapy can be considered prior to surgery. Following maximal surgical debulking, 3 to 4 courses of cisplatin-containing combination chemotherapy are indicated.[2,6,10]

  Evidence suggests that second-look laparotomy is not beneficial in patients with initially completely resected tumors who receive cisplatin-based adjuvant treatment.[11] Patients who do not respond to a cisplatin/etoposide-based combination may still attain a durable remission with VAC or cisplatin/vinblastine/ifosfamide as salvage therapy.[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.[11] 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 or progressive teratoma has been described.

Treatment options under clinical evaluation:

• Patients with stage III germ cell tumors of the ovary, including pure dysgerminoma, are candidates for clinical trials.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III ovarian germ cell tumor ¹. 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 ².

References

1. 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]
   
   
2. 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]
   
   
3. Wu PC, Huang RL, Lang JH, et al.: Treatment of malignant ovarian germ cell tumors with preservation of fertility: a report of 28 cases. Gynecol Oncol 40 (1): 2-6, 1991.  [PUBMED Abstract]
   
   
4. Schwartz PE, Chambers SK, Chambers JT, et al.: Ovarian germ cell malignancies: the Yale University experience. Gynecol Oncol 45 (1): 26-31, 1992.  [PUBMED Abstract]
   
   
5. Low JJ, Perrin LC, Crandon AJ, et al.: Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumors. A review of 74 cases. Cancer 89 (2): 391-8, 2000.  [PUBMED Abstract]
   
   
6. 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]
   
   
7. 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]
   
   
8. Taylor MH, Depetrillo AD, Turner AR: Vinblastine, bleomycin, and cisplatin in malignant germ cell tumors of the ovary. Cancer 56 (6): 1341-9, 1985.  [PUBMED Abstract]
   
   
9. 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]
   
   
10. 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]
    
    
11. 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]