Adjuvant Chemotherapy for Stage I and Completely Resected Stage II and III Malignant Germ
TABLE 14. Adjuvant Chemotherapy for Stage I and Completely Resected Stage II and III Malignant Germ
Cell Tumors*
Institution Regimen No. Progression Free % of Total
GOG BEP 50 of 52 96
Stanford PVB 5 of 5 100
Cross Cancer Institute PVB 4 of 4 100
MD Anderson Cancer Center PVB 4 of 4 100
MD Anderson Cancer Center BEP 20 of 20 100
Total 83 of 85 98
*GOG indicates Gynecologic Oncology Group; BEP, cisplatin-etoposide-bleomycin combination; PVB, cisplatin-vinblastine-bleomycin combination.
Modified from Williams SD, Gershenson DM. Management of germ cell tumors of the ovary. In: Markman M, Hoskins WJ, eds. Cancer of the ovary. New York: Raven Press, 1993
TABLE 15. Chemotherapy of Patients with Incompletely Resected, Persistent, or Recurrent Malignant Germ
Cell Tumors*
Institution Regimen No. Prognosis Free % of Total
GOG PVB 47 of 89 53
Stanford PVB 4 of 4 100
Cross Cancer Institute PVB 8 of 10 80
MD Anderson Cancer Center PVB 7 of 11 64
MD Anderson Cancer Center BEP 5 of 6 83
Total 71 of 120 59
*GOG indicates Gynecologic Oncology Group; PVB, cisplatin-vinblastine-bleomycin combination; BEP, cisplatin-etoposide-bleomycin combination.
Modified from Williams SD, Gershenson DM. Management of germ cell tumors of the ovary. In: Markman M, Hoskins WJ, eds. Cancer of the ovary. New York: Raven Press, 1993
Survival is enhanced by complete cytoreduction of malignant germ cell tumors. Every effort should be made to resect the disease completely, but there is no need to remove reproductive organs not involved with the cancer. These tumors are virtually never bilateral. Thus, even patients with advanced disease who do not have involvement of the other ovary and the uterus should have those organs conserved. Because high cure rates are achieved with the use of multidrug chemotherapy, many patients will retain their reproductive capability.
Patients with malignant germ cell tumors of the ovary should undergo surgical staging similar to that for epithelial ovarian cancer. However, because most patients will require chemotherapy, reexploration for staging is not indicated unless the goal is to resect residual cancer completely. It is best to begin chemotherapy as soon as possible because tumors recur and grow rapidly.
The potential benefit of second-look laparotomy has been debated for several years. Recently, no benefit was found for second-look laparotomy except in incompletely resected immature teratomas, and its routine use in other malignant germ cell tumors cannot be justified.
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