Treatment options for patients with all stages of ovarian epithelial cancer have consisted of surgery followed by chemotherapy.
Patients diagnosed with stage III and stage IV disease are treated with surgery and chemotherapy; however, the outcome is generally less favorable for patients with stage IV disease. The role of surgery for patients with stage IV disease is unclear, but in most instances, the bulk of the disease is intra-abdominal, and surgical procedures similar to those...
Total abdominal hysterectomy and bilateral salpingo-oophorectomy.
Unilateral salpingo-oophorectomy with adjuvant chemotherapy.
For patients with stage III dysgerminoma, total abdominal hysterectomy and bilateral salpingo-oophorectomy are recommended with removal of as much gross tumor as can be done safely without resection of portions of the urinary tract or large segments of the small or large bowel. Patients who want to preserve fertility may be treated with unilateral salpingo-oophorectomy if chemotherapy is to be employed.[1,2,3,4,5] (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information on fertility.)
Combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP) can cure the majority of such patients. In a report of results from two Gynecologic Oncology Group (GOG) trials, 19 of 20 patients with incompletely resected tumors who were treated with BEP or cisplatin, vinblastine, and bleomycin (PVB) were disease free at a median follow-up of 26 months. When there is bulky residual disease, it is common to give three to four courses of a cisplatin-containing combination such as PVB or BEP.[6,7,8] A randomized study in testicular cancer has shown that bleomycin is an essential component of the BEP regime when only three courses are administered. Because chemotherapy with BEP appears to be less sterilizing than wide-field radiation, combination chemotherapy is the preferred treatment in the patient who wants to preserve fertility.
Treatment options under clinical evaluation:
Patients with stage III germ cell tumors of the ovary are candidates for clinical trials.
Other Germ Cell Tumors
Standard treatment options:
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.
For patients with stage III germ cell tumors other than pure dysgerminoma, total abdominal hysterectomy and bilateral salpingo-oophorectomy is recommended with removal of as much tumor in the abdomen and pelvis as can be done safely without resection of portions of the urinary tract or large segments of the small or large bowel. Patients who wish to preserve fertility can be treated with unilateral salpingo-oophorectomy.[1,3,4] For patients with extensive intra-abdominal disease whose clinical condition precludes debulking surgery, chemotherapy can be considered prior to surgery. Following maximal surgical debulking, three to four courses of cisplatin-containing combination chemotherapy are indicated.[2,6,10] (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information on fertility.)
Evidence suggests that second-look laparotomy is not beneficial in patients with initially completely resected tumors who receive cisplatin-based adjuvant treatment. Patients who do not respond to a cisplatin/etoposide-based combination may still attain a durable remission with a combination of vincristine, dactinomycin, and cyclophosphamide (VAC) or a combination of cisplatin, vinblastine, and ifosfamide as salvage therapy. Second-look surgery may be of benefit for a minority of patients whose tumor was not completely resected at the initial surgical procedure and who had teratomatous elements in their primary tumor. Surgical resection of residual masses detected by clinical examination, by radiographic procedures, or at re-exploration should be undertaken since reversion to germ cell tumor or progressive teratoma has been described.