Premium
Treatment of nondysgerminomatous ovarian germ cell tumors
Author(s) -
Mitchell Paul L.,
AlNasiri Nazar,
A'Hern Roger,
Fisher Cyril,
Horwich Alan,
Pinkerton C. Ross,
Shepherd John H.,
Gallagher Chris,
Slevin Maurice,
Harper Peter,
Osborne Richard,
Mansi Jeanine,
Oliver Timothy,
Gore Martin E.
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19990515)85:10<2232::aid-cncr19>3.0.co;2-4
Subject(s) - medicine , germ cell tumors , chemotherapy , endodermal sinus tumor , stage (stratigraphy) , retrospective cohort study , confidence interval , gastroenterology , surgery , paleontology , biology
BACKGROUND Combination chemotherapy has dramatically improved the prognosis of patients with nondysgerminomatous ovarian germ cell tumors (NDOGCT). However, guidelines are needed for the identification of patients at risk of relapse. METHODS The authors performed a retrospective analysis of women with NDOGCT managed during the period 1970–1994 at the Royal Marsden Hospital and other hospitals of the London Gynaecological Oncology Group. RESULTS Sixty‐nine women were included; their median follow‐up was 5.7 years (minimum, 12 months). The median age was 21 years (range, 4–44 years), with a histology of immature teratoma (IT) for 17 patients, endodermal sinus tumor (EST) for 20 patients, and mixed tumors for 32 patients. Thirty‐five patients (51%) had Stage I disease. Nine patients with Stage I tumors were observed without further therapy (six with IT and three with mixed tumors), and one relapsed. Seven patients received non‐platinum‐based chemotherapy, and four relapsed. A total of 52 patients were treated with platinum‐based chemotherapy, with relapse free and overall survival rates of 87% (95% confidence interval [CI], 73–93%) and 84% (95% CI, 70–91%), respectively. Of these patients, relapse was seen in 0 of 9 IT patients, 1 of 25 patients with mixed tumors, and 6 of 18 EST patients. With α‐fetoprotein (AFP) > 1000 kU/L, relapse was seen in 6 of 18 patients compared with 1 of 33 relapses with lower AFP levels. In multivariate analysis, including all patients who received chemotherapy, AFP >1000kU/L ( P = 0.001) and non‐platinum‐based chemotherapy ( P = 0.005) were associated with relapse. When only patients given platinum‐based treatment were considered, EST histology ( P = 0.003) and AFP >1000 kU/L ( P = 0.003) were associated with relapse in univariate analysis; however, these factors were linked. No malignant tumor was found at second‐look surgery performed on 24 patients. Of 26 women assessable for fertility, 24 subsequently recommenced regular menstrual function, and 11 patients had pregnancies. CONCLUSIONS Platinum‐based chemotherapy has been confirmed to be effective in the management of patients with NDOGCT. Relapses were principally seen among patients with AFP >1000 kU/L or pure EST histology. Efforts to improve outcome need to focus on patients with EST, whereas less intensive management strategies may be appropriate for some patients with IT. Cancer 1999;85:2232–44. © 1999 American Cancer Society.