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Current Strategy for the Treatment of Ovarian Germ Cell Tumors: Role of Extensive Surgery

  • Gynecologic Cancers (RJ Morgan, Section Editor)
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Opinion Statement

The necessity and extent of comprehensive surgical staging (CSS) and lymphadenectomy in the treatment of malignant ovarian germ cell tumors (MOGCTs) is still controversial. However, it is uniformly agreed that CSS with lymphadenectomy is crucial to follow up patients without adjuvant chemotherapy in stage I MOGCTs. Considering the chemotherapy-sensitive nature of MOGCTs, fertility-sparing cytoreductive surgery (FSCS) seems a reasonable approach in initial treatment for patients with advanced stage. When encountered with bilateral MOGCTs, debulking is surely granted if there is no desire for fertility. Both ovaries completely replaced by neoplastic tissue composed the most challenging situation especially when patients require childbearing potential. In dysgerminoma histology, which usually has good prognosis, residual disease could be left to spare fertility. USO of the largest and more heterogeneous ovarian mass and a biopsy of the contralateral lesion may be considered if the patients are compliant to regular follow-up. NACT followed by interval FSCS may be a reasonable option in patients with extensive disease, when initial debulking is not an option or where the poor general condition or clinical findings suggest an increased risk of surgical morbidity or preclude fertility-sparing surgery. This is currently not the standard of care but deserves future study. In some rare situation, when any remaining ovarian tissue means high risk, BSO may be performed with the uterus preserved for possible assisted reproduction with donor egg. Treatment failure occurs in a small group of MOGCTs after primary treatment. A good number of recurrences can be salvaged with selected salvage surgery, especially when optimal secondary cytoreduction can be achieved. Immature teratoma is a subtype of MOGCTs where secondary cytoreduction may have a strong role to play.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Brown J, Friedlander M, Backes FJ, et al. Gynecologic Cancer Intergroup (GCIG) consensus review for ovarian germ cell tumors. Int J Gynecol Cancer. 2014;24:S48–54. This consensus guideline represents a summary of recommendations for diagnosis and management that has been agreed upon by cooperative groups worldwide.

    Article  PubMed  Google Scholar 

  2. Kumar S, Shah JP, Bryant CS, et al. The prevalence and prognostic impact of lymph node metastasis in malignant germ cell tumors of the ovary. Gynecol Oncol. 2008;110:125–32.

    Article  PubMed  Google Scholar 

  3. Messing MJ, Gershenson DM, Morris M, Burke TW, et al. Primary treatment failure in patients with malignant ovarian germ cell neoplasms. Int J Gynecol Cancer. 1992;2:295–300.

    Article  CAS  PubMed  Google Scholar 

  4. Mangili G, Sigismondi C, Gadducci A, Cormio G, Scollo P, Tateo S, et al. Outcome and risk factors for recurrence in malignant ovarian germ cell tumors: a MITO-9 retrospective study. Int J Gynecol Cancer. 2011;21:1414–21. This study investigated the outcome of patients with MOGCTs and defined the risk factors for recurrence.

    Article  PubMed  Google Scholar 

  5. Murugaesu N, Schmid P, Dancey G, Agarwal R, Holden L, McNeish I, et al. Malignant ovarian germ cell tumors: identification of novel prognostic markers and long-term outcome after multimodality treatment. J Clin Oncol. 2006;24(30):4862–6.

    Article  PubMed  Google Scholar 

  6. Lin KY, Bryant S, Miller DS, Kehoe SM, Richardson DL, Lea JS. Malignant ovarian germ cell tumor—role of surgical staging and gonadal dysgenesis. Gynecol Oncol. 2014;134:84–9. This study evaluated the effect of comprehensive surgical staging and gonadal dysgenesis on the outcomes of patients with MOGCTs.

    Article  PubMed  Google Scholar 

  7. Parkinson CA, Hatcher HM, Earl HM, Ajithkumar TV. Multidisciplinary management of malignant ovarian germ cell tumours. Gynecol Oncol. 2011;121:625–36. This review summarized available literatures concerning multidisciplinary management of MOGCTs.

    Article  CAS  PubMed  Google Scholar 

  8. Chan JK, Tewari KS, Waller S, Cheung MK, Shin JY, Osann K, et al. The influence of conservative surgical practices for malignant ovarian germ cell tumors. J Surg Oncol. 2008;98:111–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chan JK, Munro EG, Cheung MK, et al. Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstet Gynecol. 2007;109:12–9.

    Article  PubMed  Google Scholar 

  10. Gershenson DM. Current advances in the management of malignant germ cell and sex cord-stromal tumors of the ovary. Gynecol Oncol. 2012;125:515–7. This review focused on several advances in MOGCTs while putting them into context with the historical background.

    Article  PubMed  Google Scholar 

  11. Ibrahim Egemen E, Salih T, Rifat G, Muzaffer B, Goksu G, Yusuf Y, et al. Long-term oncological and reproductive outcomes of fertility-sparing cytoreductive surgery in females aged 25 years and younger with malignant ovarian germ cell tumors. J Obstet Gynaecol Res. 2014;40(3):797–805. This study evaluated the long-term oncological outcomes of young patients with MOGCTs and found either primary or secondary FSCS followed by ACT feasible and safe.

    Article  Google Scholar 

  12. Weinberg LE, Lurain JR, Singh DK, Schink JC. Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors. Gynecol Oncol. 2011;121:285–9.

    Article  PubMed  Google Scholar 

  13. Lu KH, Gershenson DM. Update on the management of ovarian germ cell tumors. J Reprod Med. 2005;50:417–25.

    PubMed  Google Scholar 

  14. Ki Heon L, In Ho L, Byoung Gie K, Joo Hyun N, Won Kyu K, Soon Beom K, et al. Clinicopathologic characteristics of malignant germ cell tumors in the ovaries of Korean women: a Korean Gynecologic Oncology Group Study. Int J Gynecol Cancer. 2009;19:84–7.

    Article  Google Scholar 

  15. Siriwan T, Jitti H, Sumonmal M, et al. Malignant ovarian germ cell tumors: clinico-pathological presentation and survival outcomes. Acta Obstet Gynecol Scand. 2010;89(2):182–9.

    Article  Google Scholar 

  16. Mangili G, Sigismondi C, Lorusso D, Cormio G, Scollo P, Viganò R, et al. Is surgical restaging indicated in apparent stage IA pure ovarian dysgerminoma? The MITO group retrospective experience. Gynecol Oncol. 2011;121(2):280–4.

    Article  CAS  PubMed  Google Scholar 

  17. Palenzuela G, Martin E, Meunier A, Beuzeboc P, Laurence V, Daniel O, et al. Comprehensive staging allows for excellent outcome in patients with localized malignant germ cell tumor of the ovary. Ann Surg. 2008;248:836–41.

    Article  PubMed  Google Scholar 

  18. Kasenda B, Harter P, Hirsch T, et al. Para-aortic lymph node metastasis in malignant dysgerminoma of the ovary. Acta Obstet Gynecol Scand. 2009;88:1288–90.

    Article  PubMed  Google Scholar 

  19. Oltmann SC, Garcia NM, Barber R, Hicks B, Fischer AC. Pediatric ovarian malignancies: how efficacious are current staging practices? J Pediatr Surg. 2010;45:1096–102.

    Article  PubMed  Google Scholar 

  20. Mahdi H, Swensen RE, Hanna R, et al. Prognostic impact of lymphadenectomy in clinically early stage malignant germ cell tumour of the ovary. Br J Cancer. 2011;105:493–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Liu Q, Ding X, Yang J, Cao D, Shen K, Lang J, et al. The significance of comprehensive staging surgery in malignant ovarian germ cell tumors. Gynecol Oncol. 2013;131:551–4. This study evaluated the clinical significance of fertility-preserving CSS in the treatment of MOGCTs and found CSS only defined the stages, not bringing survival benefits.

    Article  PubMed  Google Scholar 

  22. Billmire D, Vinocur C, Rescorla F, et al. Outcome and staging evaluation in malignant germcell tumors of the ovary in children and adolescents: an intergroup study. J Pediatr Surg. 2004;39:424–9.

    Article  CAS  PubMed  Google Scholar 

  23. Park J-Y, Kim D-Y, Suh D-S, Kim J-H, Kim Y-M, Kim Y-T, et al. Outcomes of pediatric and adolescent girls with malignant ovarian germ cell tumors. Gynecol Oncol. 2015;137:418–22. In this study, all patients received FSCS followed by BEP chemotherapy and the oncologic outcomes were excellent.

    Article  PubMed  Google Scholar 

  24. Pectasides D, Pectasides E, Kassanos D. Germ cell tumors of the ovary. Cancer Treat Rev. 2008;34:427–41.

    Article  CAS  PubMed  Google Scholar 

  25. Lai CH, Chang TC, Hsueh S, Wu TI, Chao A, Chou HH, et al. Outcome and prognostic factors in ovarian germ cell malignancies. Gynecol Oncol. 2005;96:784–91.

    Article  PubMed  Google Scholar 

  26. Lee CW, Song MJ, Park ST, Ki EY, Lee SJ, Lee KH, et al. Residual tumor after the salvage surgery is the major risk factors for primary treatment failure in malignant ovarian germ cell tumors: a retrospective study of single institution. World J Surg Oncol. 2011;9:123–30. This study evaluated the clinicopathologic characteristics of MOGCTs and determined that primary treatment failure was associated with the residual disease after the salvage surgery.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gershenson DM. Management of ovarian germ cell tumors. J Clin Oncol. 2007;25:2938–43.

    Article  CAS  PubMed  Google Scholar 

  28. Ghaemmaghami F, Hasanzadeh M, Karimi Zarchi M, Fallahi A. Nondysgerminomatous ovarian tumors: clinical characteristics, treatment, and outcome. A case-controlled study. Int J Surg. 2008;6:382–6.

    Article  PubMed  Google Scholar 

  29. Bafna UD, Umadevi K, Kumaran C, Nagarathna DS, Shashikala P, Tanseem R. Germ cell tumors of the ovary: is there a role for aggressive cytoreductive surgery for nondysgerminomatous tumors? Int J Gynecol Cancer. 2001;11:300–4.

    Article  CAS  PubMed  Google Scholar 

  30. Li J, Yang W, Wu X. Prognostic factors and role of salvage surgery in chemorefractory ovarian germ cell malignancies: a study in Chinese patients. Gynecol Oncol. 2007;105:769–75. This large study explored the role of salvage surgery in patients with chemorefractory MOGCTs, revealing that optimal cytoreduction during salvage surgery brought benefits to chemorefractory patients.

    Article  PubMed  Google Scholar 

  31. Cicin I, Eralp Y, Saip P, et al. Malignant ovarian germ cell tumors: a single-institution experience. Am J Clin Oncol. 2009;32:191–6.

    Article  PubMed  Google Scholar 

  32. Slayton RE, Park RC, Silverberg SG, Shingleton H, Creasman WT, Blessing JA. Vincristine, dactinomycin and cyclophosphamide in the treatment of malignant germ cell tumors of the ovary. A Gynecologic Oncology Group Study (a final report). Cancer. 1985;56:243–8.

    Article  CAS  PubMed  Google Scholar 

  33. Williams SD, Blessing JA, Moore DH, Homesley HD, Adcock L. Cisplatin, vinblastine and bleomycin in advanced and recurrent ovarian germ cell tumors. Ann Intern Med. 1989;111:22–7.

    Article  CAS  PubMed  Google Scholar 

  34. Mahdi H, Kumar S, Seward S, et al. Prognostic impact of laterality in malignant ovarian germ cell tumors. Int J Gynecol Cancer. 2011;21:257–62.

    PubMed  Google Scholar 

  35. Roychoudhuri R, Putcha V, Moller H. Cancer and laterality: a study of the five major paired organs. Cancer Causes Control. 2006;17:655–62.

    Article  PubMed  Google Scholar 

  36. Sigismondi C, Scollo P, Ferrandina G, Candiani M, Angioli R, Vigano R, et al. Management of bilateral malignant ovarian germ cell tumors a MITO-9 retrospective study. Int J Gynecol Cancer. 2015;25:203–7. This study evaluated clinical characteristic and management of patients bilateral MOGCTs.

    Article  PubMed  Google Scholar 

  37. Shobhana T, Sunesh K, Neerja B, Mathur S, Thulkar S, Lalit K. Neo-adjuvant chemotherapy in the treatment of advanced malignant germ cell tumors of ovary. Gynecol Oncol. 2014;132:28–32. This study attempted NACT in patients of MOGCTs with advance and bulky disease with the conclusion that NACT followed by fertility-sparing surgery could be an option for advanced MOGCT.

    Article  Google Scholar 

  38. AL Husaini H, Soudy H, El Din Darwish A, Ahmed M, Eltigani A, AL Mubarak M, et al. Pure dysgerminoma of the ovary: a single institutional experience of 65 patients. Med Oncol. 2012;29(4):2944–8.

    Article  Google Scholar 

  39. Raveendran A, Gupta S, Bagga R, Saha SC, Gainder S, Dhaliwal LK, et al. Advanced germ cell malignancies of the ovary: should neo-adjuvant chemotherapy be the first line of treatment? J Obstet Gynaecol. 2010;30(1):53–5.

    Article  CAS  PubMed  Google Scholar 

  40. Gueye A, Narducci F, Baranzelli MC, Collinet P, Farine O, Fournier C, et al. Malignant ovarian germ cell tumours: a trial of 36 cases. Gynecol Obstet Fertil. 2007;35(5):406–19.

    Article  CAS  PubMed  Google Scholar 

  41. Jonson AL, Geller MA, Dickson EL. Gonadal dysgenesis and gynecologic cancer. Obstet Gynecol. 2010;116:550–2.

    Article  PubMed  Google Scholar 

  42. Rezk Y, Sheinfeld J, Chi DS. Prolonged survival following salvage surgery for chemorefractory ovarian immature teratoma: a case report and a review of the literature. Gynecol Oncol. 2005;96:883–7. In this report, a case of advanced IMT that was salvaged by secondary cytoreduction following failure of both primary therapy and salvage chemotherapy is described, and the available literature is reviewed.

    Article  PubMed  Google Scholar 

  43. Lorusso D, Malaguti P, Trivellizzi IN, Scambia G. Unusual liver locations of growing teratoma syndrome in ovarian malignant germ cell tumors. Gynecol Oncol Rep. 2011;1:24–5.

    Article  Google Scholar 

  44. Ihara T, Ohama K, Satoh H, Fujii T, Nomura K, Fujiwara A. Histologic grade and karyotype of immature teratoma of the ovary. Cancer. 1984;54(12):2988–94.

    Article  CAS  PubMed  Google Scholar 

  45. Gershenson DM, del Junco G, Silva EG, Copeland LJ, Wharton JT, Rutledge FN. Immature teratoma of the ovary. Obstet Gynecol. 1986;68(5):624–9.

    CAS  PubMed  Google Scholar 

  46. Williams SD, Blessing JA, DiSaia PJ, Major FJ, Ball III HG, Liao SY. Second-look laparotomy in ovarian germ cell tumors: the gynecologic oncology group experience. Gynecol Oncol. 1994;52(3):287–91.

    Article  CAS  PubMed  Google Scholar 

  47. Munkarah A, Gershenson DM, Levenback C, Silva EG, Messing MJ, Morris M, et al. Salvage surgery for chemorefractory ovarian germ cell tumors. Gynecol Oncol. 1994;55(2):217–23.

    Article  CAS  PubMed  Google Scholar 

  48. Busmanis I, Tay SK. Recurrent immature teratoma: lack of correlation between serum level and immunohistochemical detection of serum alpha-fetoprotein. Pathology. 1998;30(1):77–9.

    Article  CAS  PubMed  Google Scholar 

  49. Li H, Hong W, Zhang R, Wu L, Liu L, Zhang W. Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma. Chin Med J. 2002;115(10):1496–500.

    PubMed  Google Scholar 

  50. Wu XH, Han LY, Xu X, Li Z. Recurrent immature teratoma of the ovary: a case report of radical secondary cytoreduction with replacement of the aortic bifurcation. Gynecol Oncol. 2004;95(3):746–9.

    Article  PubMed  Google Scholar 

  51. Vicus D, Beiner ME, Clarke B, et al. Ovarian immature teratoma: treatment and outcome in a single institutional cohort. Gynecol Oncol. 2011;123(1):50–3.

    Article  PubMed  Google Scholar 

  52. Seo S, Matsumoto Y, Tsukioka M, Sumi T, Wakasa K, Ishiko O. Presentation of a patient who underwent fertility-sparing surgeries for contralateral recurrence of ovarian immature teratoma with gliomatosis peritonei. Jpn Clin Med. 2013;4:37–40.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Pallavi V. Reddihalli, Anbukkani Subbian, K. Umadevi, Praveen S. Rathod, Shobha Krishnappa, Shakuntala P. Nanaiah, Uttam D. Bafna. Immature teratoma of ovary—outcome following primary and secondary surgery: study of a single institution cohort. Eur J Obstet Gynecol Reprod Biol. 2015;192:17–21. This study analyzed the clinical presentation, treatment, primary and secondary debulking, and outcomes with focus on recurrences in ovarian immature teratoma.

    Article  Google Scholar 

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Acknowledgments

This article is supported by the Foundation for the Young Scientists from Shanghai Municipal Health Bureau (Year 2013), and the Yang-fan Program for Young Scientists from Shanghai Municipal Science and Technology Commission (Grant No. 14YF1401200).

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Authors and Affiliations

  1. Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, China

    Jin Li MD, PhD & Xiaohua Wu MD, PhD

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Jin Li MD, PhD & Xiaohua Wu MD, PhD

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  1. Jin Li MD, PhD
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Correspondence to Xiaohua Wu MD, PhD.

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Li, J., Wu, X. Current Strategy for the Treatment of Ovarian Germ Cell Tumors: Role of Extensive Surgery. Curr. Treat. Options in Oncol. 17, 44 (2016). https://doi.org/10.1007/s11864-016-0416-2

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