Ovarian germ cell malignancies: The Yale University experience

Abstract

Eighty-one patients with ovarian germ cell malignancies (immature teratoma 29, dysgerminoma 26, endodermal sinus tumors 15, mixed germ cell tumor 8, other 3) seen or consulted on at Yale University over a 15 year period are presented. Initial therapy was successful in 70 of 81 (86.4%) patients and 75 (92.6%) are currently alive and disease free. Early stage dysgerminomas may be safely treated with surgery whereas advanced disease is exquisitely sensitive to vincristine, actinomycin D, and cyclophosphamide (VAC) therapy. Early stage immature teratoma is uniformly successfully treated with short-term VAC whereas advanced disease requires longer treatment. Early stage endodermal sinus tumor (EST) and mixed germ cell tumors may be effectively treated with VAC or platinum-based therapy but advanced disease should be treated with paltinum-based regimens. Serial alpha fetoprotein assays should determine duration of therapy in tumors containing EST elements. Conservative surgery to preserve reproductive function is appropriate for all patients with early stage ovarian germ cell malignancies and selected patients with advanced disease.