Treatment of recurrent malignant ovarian germ cell tumors(MOGCT) are complex and challenging.There is limited data on outomes of these patientsafter salvage therapy in real world setting.
This is a retrospective study of all patients diagnosed with recurrent MOGCT at our center between 2013-2017. Out of 43 patients 12 patients were excluded as they have not followed up after first visit..Clinico- pathological and treatment details of 31 patients were extracted from electronic medical records and were included in the analysis
Table-1
| VARIABLE | PATIENTS (%) |
| STAGE AT BASELINE IA IC III/IV UNKNOWN | 11(35%) 5 (16%) 5/ 3(16% / 9%) 7 (22%) |
| HISTOLOGY DYSGERMINOMA YOLKSAC TERATOMA MIXED GCT | 8(26%) 6(19%) 10(32%) 7(22%) |
| ADEQUACY OF TREATMENT AT BASELINE ADEQUATE INADEQUATE MISSING | 22 (71%) 8(26%) 1 (3%) |
| SITES OF RECCURENCE | PERITONEUM+ PELVIS-20 (65%) LYMPH NODE- 8 (25%) LIVER+ LUNG- 3 (9%) |
Baseline charechterstics initial stage,adequacy of treatment, Sites of recurrence and treatment were in tabular form
Salvage chemotherapy was given in all patients.Ten (33%)patients who were inadequately treated upfront at outside recieved BEP/ EP as salvage regimen in our centre .Other regimens used were VeIP 8 (25%), TIP 6 (19%) and VIP 4 (13%) Others 3(10%). After salvage chemotherapy 19 (61%) patients underwent second surgery, R0 resection was achieved in 13(42%) patients
After Median follow up of 66 months, 21 patients were alive (18 -with no disease, and 3 were alive with stable teratoma component) after salvage therapy, and 10 patients were dead.
Out of 13 patients with yolk sac histology( Pure yolk sac -6; Mixed GCT-7)only 6 could be salvaged.Those who could not be salvaged had effusions or extensive liver disease .Two patients out of 8 reccurent dysgerminoma had bulky multi station lymph nodal relapse could not be salvaged. The median PFS was after relapse was 26 months and median OS was 33 months post relapse.
Adequate treatment at initial diagnosis is of paramount importance along with active surveillance to minimize default rates especially in low middle-Income countries. 67% of our recurrent cases were effectively salvaged. If managed at experienced centres with multidisciplinary approach using salvage chemotherapy and surgery, majority of recurrences can result in long term cure.