Malignant ovarian germ cell tumors [MOGCT]are rare cancers occurring in young girls in the childbearing age groups. Even in advanced stages long term survival rates can be achieved with conservative fertility sparing surgery and chemotherapy.
This is a retrospective study of patients diagnosed with MOGCT between 2013- 2017. Data of 172 eligible patients were retrieved from electronic medical records. Clinico-pathologic features, treatment details were recorded and survival analysis was performed. Reproductive outcomes in terms of percentage of patients having successful pregnancy outcome after treatment were also analyzed.
The median age was 23 years (range 10-68). Sixty three (36.6%) had dysgerminoma, 35 (20.3%) had immature teratoma, 30 (17.4%) had mixed germ cell tumors, 36 (20.9%) had yolk sac tumors, and 8 (4.7%) had mature teratoma with somatic malignancy. FIGO stage distribution was as follows: stage I, 104(60.4%); stage II, 4 (2.3%); stage III, 49 (28.6%); and stage IV, 15 (8.7%).Fertility-sparing surgery was performed in 136 (79%) patients. Chemotherapy (adjuvant ors neoadjuvant) was received by 122 patients. 13 patients received EP, 106 patients received BEP and 3 patients (somatic transformation in teratoma) received Paclitaxel and carboplatin. In patients with advanced disease (stage III, IV) neoadjuvant chemotherapy (NACT) was received by 52 patients. In 136 (79%) patients fertility sparing surgery was performed, 41 of whom had received NACT. Febrile neutropenia was seen in 34 (27.8%) patients. Any grade bleomycin induced lung toxicity was seen in 22 (12.7%) patients resulting in omission of same in subsequent cycles. At a median follow-up of 56 months, the median progression-free survival (PFS) was 47 months and median overall survival (OS) was 55 months.117 patients resumed menstruation after completion of chemotherapy. 18 patients successfully conceived after treatment completion out of which 3 conceived using in vitro fertilization method.
Patients presenting with advanced MOGCT can be offered fertility sparing surgery after neoadjuvant chemotherapy with no detriment in oncological outcome.