Reproductive function after treatment of ovarian germ cell malignancy

This study was undertaken to evaluate the reproductive and oncologic outcomes of patients diagnosed with Ovarian Germ Cell Malignancy (OGCM) who underwent fertility preserving surgery and adjuvant chemotherapy treated in Gynaecology Oncology Unit, Sultanah Bahiyah Hospital, Kedah, Malaysia.

We retrospectively reviewed 33 patients who had fertility preserving surgery and adjuvant chemotherapy in our center from 2000 - 2010. Gynaecology oncology record and histopathology database were reviewed. Patients were contacted, assessed and interviewed via telephone using standardized questionnaire to assess their menstrual, reproductive function and disease status after treatment, post therapeutic status of pregnancy or delivery and overall survival.

Thirty three patients diagnosed with OGCM underwent unilateral salphingo oophorectomy and staging surgery followed by adjuvant chemotherapy (BEP regimen). The mean age at presentation was 19.8 years (range, 9 -34 years). Histological subtypes were 21.2% dysgerminoma, 21.2% immature teratoma, 42.4% yolk sac tumour and 15.2% mixed germ cell tumour. After treatment, 71.4% resumed their menstrual cycles within 6 months. During follow up, 5 patients conceived with 5 live birth deliveries and 3 miscarriages (3 patients had two pregnancies). The overall survival rate was 87.9% with median follow up of 45.2 months. 30.3% of patient had disease recurrence with median disease free interval of 5 months while 6.0% had disease progression despite of adjuvant chemotherapy. One of the most important adverse prognostic factors for recurrence and disease progression is Yolk sac tumour (non DSG/IMT) histotype.

Fertility preserving surgery and adjuvant chemotherapy appear to have little effect on fertility and menstrual cycle with a good overall survival. Patients diagnosed with histopathological yolk sac tumour element had poor outcome and perhaps need more aggressive and longer adjuvant therapy.