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Ovarian Germ Cell Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage II Ovarian Germ Cell Tumors

Dysgerminomas

Standard treatment options:

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  1. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy.
  2. Unilateral salpingo-oophorectomy with adjuvant chemotherapy.

For patients with stage II dysgerminoma, total abdominal hysterectomy and bilateral salpingo-oophorectomy are usually performed. For the younger patient who wants to preserve fertility, a unilateral salpingo-oophorectomy may be considered standard therapy, depending on the age of the patient, and adjuvant chemotherapy should be given. (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information on fertility.)

These patients should receive adjuvant treatment. Options include radiation therapy or chemotherapy. A disadvantage of the former is loss of fertility resulting from ovarian failure. Experience with adjuvant chemotherapy is limited, but considering the effectiveness of chemotherapy in tumors other than dysgerminoma and its effectiveness in advanced-stage dysgerminoma, adjuvant chemotherapy is likely to be effective and to allow recovery of reproductive potential in patients with an intact ovary, fallopian tube, and uterus. Thus, adjuvant chemotherapy with the combination of bleomycin, etoposide, and cisplatin (BEP) has replaced radiation therapy except in the rare patient in whom chemotherapy is not considered appropriate.

Treatment options under clinical evaluation:

  • Patients with stage II germ cell tumors of the ovary are candidates for clinical trials.[1]

Other Germ Cell Tumors

Standard treatment options:

  1. Unilateral salpingo-oophorectomy with adjuvant chemotherapy.
  2. Second-look laparotomy.

For patients with stage II germ cell tumors other than pure dysgerminoma, unilateral salpingo-oophorectomy should be performed when fertility is to be preserved. Although there is considerable experience with the combination of vincristine, dactinomycin, and cyclophosphamide (VAC), especially when given in an adjuvant setting, BEP is more effective.[2,3,4] Patients who do not respond to a cisplatin-based combination may still attain a durable remission with VAC as salvage therapy.[1] Recurrence after three courses of BEP as adjuvant therapy is rare.[1] All patients who do not respond to standard therapy are candidates for clinical trials. When there is residual disease or elevated levels of alpha-fetoprotein or human chorionic gonadotropin after maximal surgical debulking, three or four courses of BEP combination chemotherapy are indicated.[5]

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