Malignant Ovarian Germ Cell Tumors Research Articles

Effects of cancer chemotherapy on gonadal function and reproductive capacity

Effects of cancer chemotherapy on gonadal function and reproductive capacity

Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin.

Since 1984, we have treated 26 patients with malignant ovarian germ cell tumors with a combination of bleomycin, etoposide (VP-16), and cisplatin (BEP) at The University of Texas MD Anderson Cancer Center (UTMDACC). The median age of the patients was 19 years (range, 8 to 32). All patients underwent initial surgery (unilateral salpingo-oophorectomy in 14, unilateral salpingo-oophorectomy plus abdominal hysterectomy in one, and bilateral salpingo-oophorectomy with or without hysterectomy in 11 patients). Twenty patients had no residual disease, three had less than or equal to 2 cm (one each, dysgerminoma, mixed, and immature teratoma), and three had more than 2 cm lesions (two dysgerminomas, one endodermal sinus tumor). Fourteen patients had pure dysgerminoma (five, stage I; one, stage II; six, stage III; and two, recurrent), and 12 had nondysgerminomatous tumors (five, stage I; two, stage II; three, stage III; and two, recurrent). All four patients with clinically measurable disease had a complete response. All four patients who underwent second-look laparotomy had negative findings. Twenty-five patients (96%) remain in sustained remission 10.4 to 54.4 months from the start of chemotherapy. One patient died of progressive disease 14 months after beginning chemotherapy. We conclude that the BEP regimen has excellent activity and acceptable toxicity in patients with malignant ovarian germ cell tumors.

Sequential combination chemotherapy for malignant germ cell tumors of the ovary.

Fourteen patients with malignant ovarian germ cell tumors were treated postoperatively with a short-term, sequential regimen combining cisplatin, vincristine, methotrexate, bleomycin, dactinomycin, cyclophosphamide, etoposide, Adriamycin (Adria Laboratories, Columbus, OH), and vinblastine (POMB/ACE/PAV). Two patients had Stage I disease, Five had Stage II, five had Stage III, and two had Stage IV. The histologic diagnosis was immature teratoma in five cases (two cases were Grade 2 and three cases were Grade 3) endodermal sinus tumor in two cases, dysgerminoma in three cases, and mixed germ cell tumors in four cases. The chemotherapy regimen appeared to be highly effective against all histologic types, including advanced stages, with 12 of 14 (86%) overall sustained remissions. The median duration of treatment was 5 months. The toxicity of the regimen, which contained low total doses of cisplatin and bleomycin, was only moderate. After a median follow-up of 53+ months, 13 patients were alive without evidence of disease. The results and toxicity obtained were compared with those from other currently used regimens. Also, some comments on initial surgery and second-look surgery are given.

Menstrual and reproductive function after treatment with combination chemotherapy for malignant ovarian germ cell tumors.

Forty patients who had been treated for malignant ovarian germ cell tumors completed a questionnaire designed to evaluate their menstrual and reproductive function. All patients met the following eligibility criteria: (1) successful treatment with combination chemotherapy, and (2) retention of a normal contralateral ovary and uterus. Median age at diagnosis was 15 years (range, 6 to 29), and median age at the time of interview was 25.5 years (range, 14 to 40). Patients had received a variety of chemotherapeutic regimens, the most common of which was a combination of vincristine, dactinomycin, and cyclophosphamide (N = 28). Since discontinuation of chemotherapy, one patient remains premenarchal, and 27 patients have maintained regular menses. The other 12 patients have had menstrual difficulties, but in only three were the problems considered to be serious. Of the 16 patients who have attempted to become pregnant since completing chemotherapy, 11 have delivered 22 healthy infants, none of whom had major birth defects. Only one patient has had persistent problems with infertility. In summary, it appears that the majority of patients who receive combination chemotherapy for malignant ovarian germ cell tumors can anticipate normal menstrual function and a reasonable probability of having normal offspring.

Chemotherapy of germ-cell ovarian tumours: First-line treatment with etoposide, bleomycin and cisplatin or carboplatin

Of 9 patients with malignant ovarian germ-cell tumours (OGCT) treated with combination chemotherapy between 1980 and 1985, 8 are alive and disease-free at 6–62 months. All patients received etoposide and bleomycin and 8 out of 9 also received a platinum analogue; in one case carboplatin, in a second carboplatin plus cisplatin, and in the remainder, cisplatin. In one patient treated prior to the introduction of carboplatin, poor renal function precluded the use of cisplatin. Two patients with Stage III dysgerminomas are disease-free at 44 and 62 months after receiving chemotherapy followed by radiotherapy to the whole abdomen or pelvis. Of 7 patients with non-dysgerminomatous OGCT, including 2 dysgerminomas with raised serum alphafetoprotein, 6 are disease-free at 6–56 months. On the basis of these observations and experience reported elsewhere, surveillance after removal of the primary tumour is proposed for early-stage dysgerminoma, and chemotherapy is suggested for advanced presentations as an alternative to surgery and post-operative radiotherapy. Combination chemotherapy is indicated for all stages of non-dysgerminomatous OGCT.

Vinblastine, bleomycin, and cisplatin in malignant germ cell tumors of the ovary

Fourteen patients with malignant ovarian germ cell tumors were treated with vinblastine, bleomycin, and cisplatin. A complete clinical response was achieved in all 14 patients; however, 1 patient had small macroscopic disease present at second-look laparotomy. One patient died of bleomycin pulmonary toxicity. The remaining 13 patients are alive and free of disease from 20 months to 8 years and 8 months after initial diagnosis. Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels were monitored in all patients and were found to be reliable indicators of response to treatment and disease status. The uninvolved ovary was preserved in seven patients without compromising the response to treatment, and one patient subsequently became pregnant. Vinblastine, bleomycin, and cisplatin chemotherapy appears to be a safe, effective combination and is recommended as the primary treatment of choice in the management of patients with malignant ovarian germ cell tumors.

Malignant ovarian germ cell tumors: A review of thirty-six cases

Thirty-six patients with malignant ovarian germ cell tumors were treated between 1972 and 1983, including 16 with immature teratoma, five with endodermal sinus tumor, seven with dysgerminoma, and eight with mixed germ cell tumors. The median age at presentation was 18 years and mean primary tumor diameter was 18 cm. Twenty-five of the 27 patients who were treated with multiple-agent chemotherapy underwent second-look procedures, only two of which revealed persistent malignancy. No patients have developed recurrence after a negative second-look operation. Two of the three patients with failure of initial chemotherapeutic regimens had complete remissions with second regimens. Two patients have died of malignancy, one who presented with a Stage IA mixed germ cell tumor and one noncompliant patient with a Stage IA, grade 2 immature teratoma. The other 34 patients are alive without evidence of disease from 21 to 141 months, with a median follow-up of 68 months. These data confirm that multiple-agent chemotherapy has dramatically improved the prognosis for patients with malignant nondysgerminomatous ovarian germ cell tumors.

Malignant ovarian germ cell tumors: A review of 37 cases

Malignant ovarian germ cell tumors: A review of 37 cases

A new serologic diagnostic method for malignant ovarian germ cell tumors: Detection of antibodies to large glycopeptides

bloody (n = 4), or unproductive and bloody (n = 2) punctures. In one patient the fetus, with diabetic macrosomia, was punctured in the arm and the needle was, therefore, reinserted. In one of the IO (5%) hemorrhagic liquor samples the presence of fetal blood was shown by the Kleihauer technique; in this case (amniotomy for assessment of surfactant at term) puncture was effected at the placental margin: no further attempts were made. In 12 (6%) cases liquor could not be obtained: In two only blood was aspirated, one subject was grossly obese, two had oligohydramnios, and in one a fibroid was present on the anterior aspect of the uterus. In at least three of the other six failures (in early amniocenteses) the liquor compartment had been reached: in one of these patients four insertions were of no avail, and this patient was the only one in whom even delayed repeat puncture remained unproductive. Three amniocenteses had to be repeated because of failure of the cell culture to proliferate. Four chromosomal anomalies (trisomy 18, Robertsonian translocation, two cases of monosomy 45,X0) were diagnosed and in one patient the diagnosis of hygroma colli could be corrected to encephalocele. There were six cases of pathologic a-fetoprotein values with (known) central nervous system defects. Apart from the interruptions, there were two (1%) fetal losses. One of these occurred 2 hours after an easy amniocentesis for the assessment of pulmonary surfactant (34 weeks) in a woman with a dorsally located placenta and was due to abruptio placentae. In the other patient placental solution occurred 2 weeks after an uncomplicated amniocentesis performed at 16 weeks for cell culture; vaginal bleeding started at 18 weeks and solution of the lower half of the dorsally located placenta was visualized echographically. The fetus died one week later, after a second episode of bleeding. In none of these cases was an etiologic relationship between the procedure and the fetal death apparent. No maternal complications were observed. In our hands, amniocentesis performed under continuous real-time echography yielded almost one sample per needle insertion. However, it remains to be shown whether this technique enhances fetal safety or whether the fetal risk is inherent in the clinical situation itself and, therefore, must be considered to be irreducible even when the insertion-to-sample ratio is brought down to one (l/l).

Treatment of Malignant Ovarian Germ Cell Tumors Response to Vincristine, Dactinomycin, and Cyclophosphamide (Preliminary Report)

Treatment of Malignant Ovarian Germ Cell Tumors Response to Vincristine, Dactinomycin, and Cyclophosphamide (Preliminary Report)

Treatment of Malignant Ovarian Germ Cell Tumors Response to Vincristine, Dactinomycin, and Cyclophosphamide (Preliminary Report)

Treatment of Malignant Ovarian Germ Cell Tumors Response to Vincristine, Dactinomycin, and Cyclophosphamide (Preliminary Report)