Is there a place for neoadjuvant chemotherapy in the management of advanced malignant germ cell tumors of ovary?

Abstract

5079 Background: There is limited data on the role of neoadjuvant chemotherapy (NACT) in advanced malignant ovarian germ cell tumors (MOGCT).We attempted NACT in 20 Pts of advanced MOGCT who were considered high risk for surgery (very poor general health; ECOG performance status, 3-4) in order to preserve fertility. Methods: Between 1988 and December 2009, 20 of 211 patients with MOGCT were considered unsuitable for exploratory laparotomy because of their high risk status. Pts median age was 19 yrs, ranging from 14-28 yrs. All had stage III (n=17) or IV (n=3) disease. Diagnosis was confirmed by FNAC /Biopsy & baseline tumor marker levels. 11 pts had dysgerminoma, 6 had mixed subtype & 3 had endodermal sinus tumor (EST). All were planned for four cycles of BEP chemotherapy followed by fertility sparing surgery (U/L salpingo-oophorectomy + omentectomy ± Lymphadenectomy). Results: 18 Pts were evaluable for treatment response & outcome. One Pt died after 1st cycle of CT due to progressive disease and another Pt was lost to FU after 2 cycles. Post 4 cycles of chemotherapy, 18 responded: CR-13, PR-5. 15 Pts underwent surgery with pathological CR in 13/15 (86.6%); 2 Pts had residual disease, both of them achieved CR following 2 cycles of salvage chemotherapy. Remaining three Pts refused for surgery; 2 out of 3 relapsed at 9 and 12 months, both achieved CR with salvage chemotherapy and subsequent fertility sparing surgery; third Pt continues to be alive and in good health. Currently 18 of 20 patients are alive and disease free and in one status is unknown at a median follow-up of 48 months (range: 12-96 months). All of them have resumed menstruation and 3 eligible Pts have delivered full term healthy babies. Conclusions: NACT followed by fertility sparing surgery is an effective treatment strategy for patients of advanced MOGCT who are high risk candidates for surgery.