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

Dysgerminomas

Standard treatment options:

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  1. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy.
  2. 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.[1] 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:

  1. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy.
  2. 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.[4] (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.

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