Current approaches to diagnosis and treatment of ovarian germ cell malignancies

Ovarian germ cell malignancies are neoplasms derived from primitive germ cells of the embryonic gonad. These tumors are highly malignant, rapidly growing, and typically occur in young women. The prognosis for patients with ovarian non-dysgerminomatous germ cell malignancies was bleak before the introduction of modern combination chemotherapy. The evolution of modern chemotherapy transformed these virulent malignancies into highly curable ones. In the early 1970s, the combination of vincristine, actinomycin D, and cyclophosphamide (VAC) emerged as the first effective therapy. The efficacy of cisplatin, vinblastine, and bleomycin (PVB) was documented in treatment of men with testicular cancer and subsequently became standard treatment for women with ovarian germ cell malignancies. Bleomycin, etoposide, and cisplatin (BEP) are shown to have equal efficacy and less toxicity in the treatment of ovarian germ cell malignancies. Experience at Yale University suggested that patients with ovarian germ cell malignancies could be managed by using tumor histology to determine the type of chemotherapy, and determining treatment duration by serial assays of circulating tumor markers or by International Federation of Gynecologists and Obstetricians' staging. Preservation of reproductive function is appropriate for all patients with early stage disease and selected patients with more advanced disease.