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Primary treatment failure in patients with malignant ovarian germ cell neoplasms
M J Messing1, D M Gershenson, M Morris
1Department of Gynecology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Abstract:
Between 1970 and 1990, 160 patients with malignant non-dysgerminomatous ovarian germ cell tumors have been treated at our own institution. Primary therapy failed in 42 of these patients, who constitute the basis for this study. Seventeen patients had stage I disease, 5 stage II, 17 stage III, and 3 stage IV. Histologic type included 13 immature teratomas, 8 endodermal sinus tumors, and 21 mixed germ cell tumors. Primary therapy for 14 patients was surgery alone, for 23, surgery plus chemotherapy, for 2, surgery plus radiotherapy and for 3, all three modalities. Median progression-free survival from initial diagnosis lasted 6.8 months (range, 0.9-24 months). Thirty-four patients received chemotherapy as part of salvage; 5/11 (45%) who received VAC are disease-free, and 6/11 (55%) who received cisplatin combinations are disease-free. When primary VAC failed, 3/7 (43%) were salvaged with cisplatin combinations. When primary cisplatin combinations failed, 2/5 (40%) were salvaged. Twelve of the 42 patients (29%) are currently alive disease-free. Primary treatment failure was attributed to surgery alone for 14 patients (7 because of misdiagnosis), radiotherapy for 5, and toxicity for 1. Of the 22 patients who failed chemotherapy, 12 did so because of a suboptimal regimen, 3 because of possible dose-intensity problems, one because of non-compliance, and 6 for unexplained reasons. Patients with ovarian germ cell tumors have an excellent probability of cure with aggressive primary therapy, but successful salvage may be difficult when primary treatment fails.
Insights
Aggressive primary therapy offers a high cure rate for malignant ovarian germ cell tumors. However, salvage treatment can be challenging after initial treatment failure in these rare cancers.
Area of Science:
- Gynecologic Oncology
- Medical Oncology
- Pathology
Background:
- Malignant non-dysgerminomatous ovarian germ cell tumors are rare.
- Treatment outcomes for patients with primary therapy failure require further investigation.
Purpose of the Study:
- To analyze treatment outcomes for patients with malignant non-dysgerminomatous ovarian germ cell tumors who experienced primary treatment failure.
- To identify factors influencing successful salvage therapy.
Main Methods:
- Retrospective review of 42 patients with treatment failure from a cohort of 160 patients diagnosed between 1970 and 1990.
- Analysis of patient demographics, tumor histology, stage, primary treatment modalities, and salvage therapies.
- Evaluation of progression-free survival and disease-free survival rates.
Main Results:
- Twelve out of 42 patients (29%) achieved disease-free survival after salvage therapy.
- Chemotherapy regimens including VAC (Vincristine, Actinomycin-D, Cyclophosphamide) and cisplatin combinations showed varying success rates in salvage.
- Primary treatment failures were attributed to suboptimal surgery, radiotherapy, or chemotherapy regimens.
Conclusions:
- While aggressive primary therapy is crucial for cure, successful salvage of malignant ovarian germ cell tumors after treatment failure is difficult.
- Further research into optimized salvage chemotherapy regimens is warranted for improved patient outcomes.