Ovarian germ cell tumor medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]
Overview
Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas. The platinum-based regimen is currently the most effective management. Among ovarian germ cell tumors, only dysgerminoma is radiosensitive. Radiotherapy is not anymore the first option of treatment for dysgerminoma considering its association with ovarian failure development.
Medical Therapy
- There is no pharmacologic therapy for the mature teratoma.
- Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a and 1b dysgerminoma, and grade 1 immature teratomas.[1][2]
- In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.
- Platinum-based regimen is currently the most effective management.
- This regimen is as following:
- Bleomycin 30 Unit IV per dose be given on day 1, 8, and 15 of the cycle
- It must be diluted in 50 ml of normal saline (NS) and over 10 minutes.
- Etoposide 100 mg/m2 IV per day be given on days 1-5.
- Cisplatin 20 mg/m2 IV per day be given on Days 1 through 5.
- It must be diluted in 250 ml NS and administer over two hours.
- No aluminum needles or intravenous sets be used for the administration.
- Bleomycin 30 Unit IV per dose be given on day 1, 8, and 15 of the cycle
- This regimen is given every 21 days for three cycles (or four cycles in the presence of bulky residual disease after surgery.
- Factors that should be monitored during the treatment:
- Complete blood count (CBC) weekly during treatment
- Liver function test (LFT) before each treatment cycle
- Creatinin and electrolytes before each treatment cycle
- Pulmonary function test before starting bleomycin and at repeated intervals
- The overall survival rate for the patients treated with this regimen is 87% to 98%.[3][4]
- This regimen is as following:
- Another regimen for the treatment of ovarian germ cell tumors is the combination of Vincristine, dactinomycin, and cyclophosphamide (VAC); however, Platinum-based regimen are now preferred because of a lower relapse rate and shorter treatment time.[5]
Treatment during pregnancy
- In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.[6]
- Etoposide use is associated with teratogenicity during the first trimester of the pregnancy and therefore should be avoided.[7]
- Also its use is associated with neonatal delayed growth and bone marrow suppression.[8]
- Paclitaxel-carboplatin or cisplatin-vinblastine-bleomycin is recommended to be used during the pregnancy.[7]
- Chemotherapy during the second and third trimester of pregnancy has not been observed to be associated with increased risk of fetal abnormalities.[9]
- Miscarriage rate following chemotherapeutic treatment has been reported to be the same as for general population.[10]
Chemotherapy for malignant ovarian germ cell tumors and ovarian function
The long term effects of chemotherapy on ability of ovary for future pregnancies has been studied and the results are as following:
- In one study, 83% of cases treated for these tumors, resumed regular period during follow ups.[11]
- In another study, regular menses resumed in 100% of patients within 1 year of chemotherapy completion.[12]
- Infertility rate for women who has been treated chemo-therapeutically for these tumors has been reported between 5% and 10%.[11][13]
Raditherapy
- Not all the ovarian germ cell tumors are radiosensitive.[14]
- Dysgerminoma is a radiosensitive tumor.
- Radiotherapy is not the first option for treating dysgerminoma and it reserved for patients for whom chemotherapy is contraindicated for whatever reason.
- Whole abdominal radiotherapy is used for the treatment of dysgerminoma, however, it may be associated with ovarian failure.[15]
References
- ↑ "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer. National comprehensive cancer network, 2011; http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf."
- ↑ Gershenson, D M; Morris, M; Cangir, A; Kavanagh, J J; Stringer, C A; Edwards, C L; Silva, E G; Wharton, J T (1990). "Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin". Journal of Clinical Oncology. 8 (4): 715–720. doi:10.1200/JCO.1990.8.4.715. ISSN 0732-183X.
- ↑ Segelov, E; Campbell, J; Ng, M; Tattersall, M; Rome, R; Free, K; Hacker, N; Friedlander, M L (1994). "Cisplatin-based chemotherapy for ovarian germ cell malignancies: the Australian experience". Journal of Clinical Oncology. 12 (2): 378–384. doi:10.1200/JCO.1994.12.2.378. ISSN 0732-183X.
- ↑ Dimopoulos, Meletios A.; Papadimitriou, Christos; Hamilos, Georgios; Efstathiou, Eleni; Vlahos, Georgios; Rodolakis, Alexandros; Aravantinos, Gerassimos; Kalofonos, Haralambos; Kouroussis, Charalambos; Gika, Dimitra; Skarlos, Dimosthenis; Bamias, Aristotle (2004). "Treatment of ovarian germ cell tumors with a 3-day bleomycin, etoposide, and cisplatin regimen: a prospective multicenter study". Gynecologic Oncology. 95 (3): 695–700. doi:10.1016/j.ygyno.2004.08.018. ISSN 0090-8258.
- ↑ Williams, S; Blessing, J A; Liao, S Y; Ball, H; Hanjani, P (1994). "Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group". Journal of Clinical Oncology. 12 (4): 701–706. doi:10.1200/JCO.1994.12.4.701. ISSN 0732-183X.
- ↑ Hubalek, Michael; Smekal-Schindelwig, Caecilia; Zeimet, Alain G.; Sergi, Consolato; Brezinka, Christoph; Mueller-Holzner, Elisabeth; Marth, Christian (2007). "Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma". Archives of Gynecology and Obstetrics. 276 (2): 179–183. doi:10.1007/s00404-007-0328-2. ISSN 0932-0067.
- ↑ 7.0 7.1 Amant, Frédéric; Halaska, Michael J.; Fumagalli, Monica; Dahl Steffensen, Karina; Lok, Christianne; Van Calsteren, Kristel; Han, Sileny N.; Mir, Olivier; Fruscio, Robert; Uzan, Cathérine; Maxwell, Cynthia; Dekrem, Jana; Strauven, Goedele; Mhallem Gziri, Mina; Kesic, Vesna; Berveiller, Paul; van den Heuvel, Frank; Ottevanger, Petronella B.; Vergote, Ignace; Lishner, Michael; Morice, Philippe; Nulman, Irena (2014). "Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting". International Journal of Gynecologic Cancer. 24 (3): 394–403. doi:10.1097/IGC.0000000000000062. ISSN 1048-891X.
- ↑ Cardonick, Elyce; Iacobucci, Audrey (2004). "Use of chemotherapy during human pregnancy". The Lancet Oncology. 5 (5): 283–291. doi:10.1016/S1470-2045(04)01466-4. ISSN 1470-2045.
- ↑ Khi C, Low JJ, Tay EH, Chew SH, Ho TH (2002). "Malignant ovarian germ cell tumors: the KK Hospital experience". Eur. J. Gynaecol. Oncol. 23 (3): 251–6. PMID 12094965.
- ↑ Zanetta, Gerardo; Bonazzi, Cristina; Cantù, Maria Grazia; Bini†, Sergio; Locatelli, Anna; Bratina, Giorgio; Mangioni, Costantino (2001). "Survival and Reproductive Function After Treatment of Malignant Germ Cell Ovarian Tumors". Journal of Clinical Oncology. 19 (4): 1015–1020. doi:10.1200/JCO.2001.19.4.1015. ISSN 0732-183X.
- ↑ 11.0 11.1 Gershenson, D M (1988). "Menstrual and reproductive function after treatment with combination chemotherapy for malignant ovarian germ cell tumors". Journal of Clinical Oncology. 6 (2): 270–275. doi:10.1200/JCO.1988.6.2.270. ISSN 0732-183X.
- ↑ Weinberg, Lori E.; Lurain, John R.; Singh, Diljeet K.; Schink, Julian C. (2011). "Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors". Gynecologic Oncology. 121 (2): 285–289. doi:10.1016/j.ygyno.2011.01.003. ISSN 0090-8258.
- ↑ Low JJ, Perrin LC, Crandon AJ, Hacker NF (July 2000). "Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumors. A review of 74 cases". Cancer. 89 (2): 391–8. PMID 10918171.
- ↑ Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN (May 2003). "Pathology and classification of ovarian tumors". Cancer. 97 (10 Suppl): 2631–42. doi:10.1002/cncr.11345. PMID 12733128.
- ↑ Mitchell, Michele Follen; Gershenson, David M.; Soeters, Robbert-Paul; Eifel, Patricia J.; Delclos, Luis; Wharton, J. Taylor (1991). "Long-term effects of radiation therapy on patients with ovarian dysgerminoma". Cancer. 67 (4): 1084–1090. doi:10.1002/1097-0142(19910215)67:4<1084::AID-CNCR2820670436>3.0.CO;2-E. ISSN 0008-543X.