A review of the close surveillance policy for stage I female germ cell tumors of the ovary and other sites

Abstract

Ovarian germ cell tumors are rare but very curable at all stages of disease. There is good evidence that surveillance for stage I dysgerminomas is a safe option although many centers worldwide still advocate adjuvant chemotherapy for stage IA nondysgerminomatous tumors, despite the significant risk of developing long-term treatment side effects. Here, we review the safety of our ongoing surveillance program of all stage IA female germ cell tumors. Thirty-seven patients (median age 26, range 14-48 years) with stage I disease were referred to Mount Vernon and Charing Cross Hospitals between 1981 and 2003. Patients underwent surgery and staging followed by intense surveillance, which included regular tumor markers and imaging. The median period of follow-up was 6 years. Relapse rates for stage IA nondysgerminomatous tumors and dysgerminomas were 8 of 22 (36%) and 2 of 9 (22%), respectively, plus one patient with mature teratoma and glial implants also relapsed; 10 of these 11 patients (91%) were successfully cured with platinum-based chemotherapy. Only one patient died from chemoresistant disease. All relapses occurred within 13 months of initial surgery. The overall disease-specific survival of malignant ovarian germ cell tumors was 94%. Over 50% of patients who underwent fertility-sparing surgery went on to have successful pregnancies. We have confirmed again that surveillance of all stage IA ovarian germ cell tumors is very safe and that the outcome is comparable with testicular tumors. We question the need for potentially toxic adjuvant chemotherapy in nondysgerminoma patients who have greater than 90% chance of being salvaged with chemotherapy if they relapse later.

Collision Tumor: A Rare Case Report of Benign Teratoma and Mucinous Cystadenoma in the Same Ovary

“…Patterson might help in their preoperative diagnosis. They found that most of the collision tumors had radiologic clues such as the presence of nonfatty fluid in the cyst and a large solid component in the ovarian mass, which pointed toward the presence of two different tumors [20]. Such clues, in addition to frozen section analysis, could help in deciding on further management, particularly the type and extent of surgery.…”

Cancer of the ovary, fallopian tube, and peritoneum

“…This schedule is based on the experience managing seminomas in males and the reports by Patterson et al [112] and Dark et al [113]. This pragmatic follow-up schedule and has not been tested in randomized trials.…”

“…Patients who have Stage I tumors and who are offered surveillance need to be seen regularly and one option is to utilize the follow-up regimen presented above [113]. Patients who have had chemotherapy have a lower risk of recurrence and the frequency of CT scans can be reduced, which is similar to the approach for testicular germ cell tumors [112]. Each follow-up visit should involve taking a medical history, physical examination, and tumor marker determination.…”

Non-epithelial Ovarian Cancer: Elucidating Uncommon Gynaecological Malignancies

“…For unstaged tumours with good prognosis (dysgerminoma or grade 1 immature teratoma), surveillance alone is an option for those with normal tumour markers and postoperative imaging. However, patients with persistent disease on CT or raised tumour markers should ideally have staging surgery, as they could avoid adjuvant chemotherapy if stage 1A disease is confirmed (23). Avoidance of further surgery but proceeding with adjuvant chemotherapy with careful tumour marker monitoring is an alternative.…”