This complementary and alternative medicine (CAM) information summary provides an overview of the Gonzalez regimen as a treatment for people with cancer. The summary includes a brief history of the science and philosophies of care that have influenced development of the regimen, the results of research and clinical studies, and side effects that have been associated with this treatment approach.
This summary contains the following key information:
The Gonzalez regimen is a complex cancer treatment...
Unilateral salpingo-oophorectomy with adjuvant chemotherapy.
For patients with stage IV dysgerminoma, total abdominal hysterectomy and bilateral salpingo-oophorectomy is recommended with removal of as much gross tumor in the abdomen and pelvis as can be done safely without resection of portions of the urinary tract or large segments of small or large bowel, although unilateral salpingo-oophorectomy should be considered in patients who wish to preserve fertility.[1,2] Chemotherapy with bleomycin/etoposide/cisplatin (BEP) can cure the majority of such patients. Stage IV dysgerminoma is not treated with radiation therapy, but rather with chemotherapy, preferably with three to four courses of cisplatin-containing combination chemotherapy such as BEP. A second-look operation following treatment is rarely beneficial. (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information on fertility.)
Treatment options under clinical evaluation:
Patients with stage IV 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 IV germ cell tumors other than pure dysgerminoma, total abdominal hysterectomy and bilateral salpingo-oophorectomy is recommended with removal of as much tumor from the abdomen and pelvis as can be done safely without resection of the kidney or large segments of the small or large bowel. Patients who wish to preserve fertility can be treated with unilateral salpingo-oophorectomy. Following maximal surgical debulking, three to four courses of cisplatin-containing combination chemotherapy are indicated.[3,4] For patients with extensive intra-abdominal disease whose clinical condition precludes debulking surgery, chemotherapy can be considered prior to surgery. Patients who do not respond to a cisplatin/etoposide-based combination may still attain a durable remission with VAC or cisplatin/vinblastine/ifosfamide as salvage therapy. (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information on fertility.)
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.[5,6] 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.