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Menstrual Recovery and Reproductive Outcomes After Fertility-Sparing Surgery and Adjuvant Chemotherapy for Malignant
Aroontorn Pichatechaiyoot1, Rakchai Buhachat1, Wanapa Naphatthalung2
1Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Aim:
To evaluate menstrual recovery, reproductive outcomes, and survival following fertility-sparing surgery and platinum-based chemotherapy in women with malignant ovarian germ cell tumors (MOGCTs).
Methods:
We retrospectively reviewed women aged 15-40 years with MOGCT treated at a university hospital (2001-2012). All underwent fertility-sparing surgery and platinum-based chemotherapy. Menstrual and reproductive outcomes were assessed through structured interviews and compared with age-matched controls. Survival outcomes were analyzed by Kaplan-Meier method.
Results:
Among 1934 ovarian cancer cases, 209 (10.8%) were MOGCT; 44 patients met inclusion criteria and were matched to 44 controls. Median age was 21 years; dysgerminoma was the most common histology (40.9%), and 70.4% had Stage I disease. All received bleomycin, etoposide, and cisplatin (median 4 cycles). After a median follow-up of 55 months, 97.7% resumed menstruation. Compared with baseline and controls, cycles were shorter (4 vs. 5 days, p = 0.026), lighter (2 vs. 3 pads/day, p = 0.004-0.047), and longer in interval (29.2 vs. 26.4 days, p < 0.001). Of 17 patients attempting conception, 9 achieved 10 pregnancies, with a pregnancy rate of 52.9% and live-birth rate of 90.9%, without congenital anomalies. Only one recurrence occurred, with 10-year progression-free and overall survival of 95.3% and 97.9%, respectively.
Conclusions:
Fertility-sparing surgery followed by platinum-based chemotherapy was associated with excellent long-term survival, high rates of menstrual recovery, and favorable reproductive outcomes in young women with MOGCT. These findings support current international recommendations for fertility-preserving treatment in selected patients and provide long-term evidence from a Southeast Asian cohort.
