[Pure ovarian dysgerminoma. Evaluation of experiences and definition of a therapeutic strategy]

The authors present a series of 10 pure dysgerminoma of the ovary treated between 1976 and 1984; mean age = 19.5 years, range 15-46 years. All patients had initial surgery: 8 annexectomies for 5 stages Ia and 3 stages IIIc nodal disease, 1 hysterectomy with bilateral adnexectomy for a 46 year old stade Ib patient and 1 case of salvage surgery for a progressive disease after a single adnexectomy. Two patients had no adjuvant therapy after initial adnexectomy (stage Ia tumors less than 10 cm in diameter). Four patients received a prophylactic subdiaphragmatic radiation therapy (3 stages Ia tumors larger than 10 cm, 1 stage Ib disease). Three patients received an irradiation for a subdiaphragmatic bulky disease and a prophylactic supradiaphragmatic irradiation (stage IIIc nodal disease). Two patients received chemotherapy, one for recurrence, the other for progressive disease. The authors discuss the therapeutic indications of pure dysgerminoma of the ovary, especially the conservative management of young patients wishing to preserve an hormonal and obstetric future and the value of radiologic and serologic follow-up. Recent data in the literature underline the efficacy of new combinations of cytotoxic agents and their role as an adjuvant of surgery in early as well as in advanced stages.