Malignant ovarian germ cell tumors: Long-term outcome—A single-institution experience.

Abstract

e15537 Background: Limited information is available from developing countries on long term outcome of patients with malignant ovarian germ cell tumors (MOGCT). Methods: Between 1988 and 2009, 211 Pts (median age 20 yrs, range 6-54) were diagnosed to have MOGCT. 114 (54%) pts had stage I-II and 89 (42.2%) had stage III-IV dis. Dysgerminoma was the most common subtype (n = 84), followed by endodermal sinus tumor, EST (n=44), immature teratoma, IT (n=40), mixed GCT (n=34), embryonal carcinoma (n=3) and choriocarcinoma (n=2). 191 Pts underwent upfront surgery and 20 received neoadjuvant chemotherapy (CT).Pts in the adjuvant Gr (nil residual dis.) received 3 cycles of CT while those in advanced dis. Gr (residual dis. +ve) or recurrent dis. Gr received 4 cycles and/or 2 cycles after documentation of CR. Adjuvant Gr (n=108): 78 pts received CT: BEP (n=75), PVB (n =3); 21 pts were kept only on surveillance, in view of stage IA dysgerminoma (n=18), & stage IA, grade-I IT (n=3); 6 refused further treatment and 2 were lost to FU. Advanced Dis. Gr (n=69): 68 pts received CT: BEP (n=58), PVB (n=10). 2 pts, one in each group received radiotherapy (RT) for dysgerminoma. Recurrent Dis. Gr: 26 (12.3%) pts had recurrence and were treated with salvage CT; 2 of them also received RT. Results: Adjuvant Gr: 101/108 (93.5%) are in continuous CR; 1 died of CT toxicity, 1 died of unrelated cause and 1 with EST relapsed 15 months after CT and died of Prog. dis.and in 4 pts dis. status is unknown.Advanced Dis. Gr: 53/69 (76.8%) responded; CR-40 and PR-13;10 died of Prog. dis., 1 died of CT toxicity and 5 were lost to FU. Currently, 42/53 (79.2%) are alive and dis. free. Recurrent Gr: 18/26 (69.2%) responded; CR- 16 and PR-2; 5 died of Prog. dis. and 3 were lost to FU. At present, 16/18 responders are alive and dis. free. 119/130 eligible pts resumed menstruation and of married women, 30 have conceived. Currently, 163 of 211 pts (77.2%) are alive and dis. free at a mean FU of 106.5 months (range: 12-160 months). The probability of overall survival for all pts is 87% at 120 months. Outcome was superior for “Nil residual” (p=0.0001) and stage I and II dis. (p=0.0001) while EST carried a poor outcome (p <0.05). Conclusions: MOGCT has excellent survival and reproductive outcome with conservative surgery and platinum-based chemotherapy.