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.
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.
- It must be diluted in 500 ml NS (concentration less than 0.4 mg/mL) and administered over one hour.
- 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 ovrall survival rate for the patients treated with this regimen is 87% to 98%.[3][4]
- This regimen is as following:
Treatment during pregnancy
- In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.[5]
- Etoposide use is associated with teratogenicity during the first trimester of the pregnancy and therefore should be avoided.[6]
- Also its use is associated with neonatal delayed growth and bone marrow suppresssion.[7]
- Paclitaxel-carboplatin or cisplatin-vinblastine-bleomycin may is recommended to be used during the preganacy.[6]
Stage I ovarian germ cell tumors
- Dysgerminomas
- Unilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
- Other germ cell tumors
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
Stage II ovarian germ cell tumors
- Dysgerminomas
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Other germ cell tumors
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
Stage III ovarian germ cell tumors
- Dysgerminomas
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Other germ cell tumors
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
Stage IV ovarian germ cell tumors
- Dysgerminomas
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Other germ cell tumors
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
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.
- ↑ 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.
- ↑ 6.0 6.1 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.