Clinical Determinants Affecting Indications for Surgery and Chemotherapy in Recurrent Ovarian Granulosa Cell Tumor

Abstract

Background: Because reports on the management of recurrent granulosa cell tumor have been sparse, a consensus as to which patients should undergo surgical resection and which patients should be considered for chemotherapy has not been established. Methods: A total of 21 tumor recurrences in eight patients with granulosa cell tumor were reviewed. Results: Surgery was performed as the main treatment for 13 recurrences, while chemotherapy was chosen as the main treatment for eight recurrences. Complete tumor resection could be accomplished in 13 of 16 surgeries (81.3%), which include all the ten recurrences without involvement of liver or diaphragm and without ascites. The number of recurrent masses was significantly higher in the early recurrence group (progression free survival < 2 years) than in the late recurrence (progression free survival > 2 years). All cases with a solitary recurrent tumor at an extra-peritoneal site presented a significantly longer progression free survival. Conclusions: For patients with recurrent granulosa cell tumor, surgery may provide the best disease control. In cases with complete resection, the number of recurrent masses was the predictive factor for the next recurrence, and adjuvant chemotherapy might be considered in such cases.

Effectiveness of adjuvant systemic therapy following complete cytoreductive surgery in patients with recurrent granulosa cell tumours of the ovary

“…A research that examined 21 relapsed GCT cases in 8 patients suggested that adjuvant therapy may be of benefit in special higher risk situations, and that prognostic algorithms need to be identified at relapse to individualise treatment approaches and help to decide which cases would benefit from combination regimens 13 . Similar to our experience, they found that the number of tumour lesions, was a predictor of subsequent recurrence even when a total resection had been performed, and encouraged consideration of adjuvant chemotherapy for the sub-cohort of patients with multifocal and diffusely disseminated relapse.…”

Management of recurrent granulosa cell tumor of the ovary: Contemporary literature review and a proposal of hyperthermic intraperitoneal chemotherapy as novel therapeutic option

“…Sixteen to 23% of GCT ultimately develop recurrent disease and recurrence may be detected many years after the initial treatment, thus prolonged surveillance is necessary 2,4,6,17,21,22 . Shim et al .…”

“…Given the recurrence pattern of GCT, CRS seems a reasonable treatment option. The rate of optimal debulking for recurrent GCT has been reported as 81.3% (13 of 16) 6 . In this study, the authors considered a case with recurrence close to porta hepatis and peritoneal carcinomatosis to be inoperable.…”

“…However, 16–22.9% of patients have recurrence disease 2–4 . Recurrences are typically characterized by disseminated peritoneal metastasis with variable extent of disease 5,6 . The treatment of recurrent GCT can be chemotherapy, surgery, radiation or in combinations of these treatments 7 .…”

“…The treatment of recurrent GCT can be chemotherapy, surgery, radiation or in combinations of these treatments 7 . Although the literature suggests better prognosis in patients who received optimal cytoreductive surgery (CRS), it can be challenging for patients who have multiple metastasis sites 5–7 …”