Abstract
Malignant ovarian germ cell tumors are rare tumors that mainly affect patients of reproductive age. The aim of this study was to investigate the reproductive outcomes and fertility preservation strategies in malignant ovarian germ cell tumors after fertility-sparing surgery. Data in literature support that fertility-sparing surgery is associated with an excellent oncological outcome not only in early stages malignant ovarian germ cell tumors but also in advanced stages. Moreover, the possibility of performing conservative treatment should be considered even in case of relapse or advanced disease, given the high chemosensitivity. Indeed, available data have shown that menstrual function is maintained after platinum-based regimens in over 85–95% of patients with malignant ovarian germ cell tumors and rate of premature menopause reported in literature ranges between 3% and 7.4%, while premature ovarian failure rates are between 3.4% and 5%. Moreover, reproductive outcomes are about 80% with no increase in the risk of teratogenicity compared to general population. Therefore, conservative surgery for malignant ovarian germ cell tumors currently may represent a therapeutic option in patients who wish to preserve fertility but must be available for extended follow-up and after subscribing to informed consent.
Highlights
Malignant ovarian germ cell tumors (MOGCTs) are rare ovarian tumors accounting for approximately5% of all ovarian malignancies [1] with an estimated incidence of 0.5 per 100,000 women [2]
In case of macroscopic bilateral ovarian involvement, unilateral salpingo-oophorectomy with contralateral cystectomy is recommended, in order to maintain fertility and ovarian function [2]
High-dose chemotherapy (HDC) with peripheral blood progenitor cell (PBPC) support is considered an option for salvage treatment in patients with platin resistance [42]
Summary
Malignant ovarian germ cell tumors (MOGCTs) are rare ovarian tumors accounting for approximately. Subsequent studies have supported these data, showing that FSS is feasible and safe in early stages, and in advanced stage disease Due to their high chemosensitivity and the rare massive bilateral ovarian involvement, all stages MOGCTs can be treated with FSS with excellent results on both survival and reproductive outcome. A large population-based analysis from Surveillance, Epidemiology, and End Results (SEER) database, including data of 535 patients with all disease stages, from 1988 to 2001, was conducted by Chan et al They have reported a progressive increase in the use of FSS over the years, with a satisfactory survival rate both in early and advanced stages MOGCTs [8]. With a rate of uterine preservation of 79.8%, no impact on survival was found [31]
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