Surveillance policy for stage I ovarian germ cell tumors

Surveillance for stage I male germ cell tumors (GCT) is well established as a standard practice; however, such a policy has not been evaluated for women with equivalent tumors. This study was designed to evaluate the management of grade II or higher stage Ia tumors by close surveillance to minimize treatment, while reserving chemotherapy for patients with residual or recurrent disease.

Between 1973 and 1995, 24 patients with malignant stage Ia ovarian GCT were enrolled onto a surveillance program. The group consisted of nine patients with dysgerminoma, nine with pure immature teratoma, and six with endodermal sinus tumor (with or without immature teratoma). Treatment consisted of surgical resection without adjuvant chemotherapy, followed by a surveillance program of clinical, serologic, and radiologic review, and included a second-look procedure for patients enrolled after 1982.

All but one patient are alive and in remission after a median follow-up of 6.8 years. The 5-year overall survival is 95%, and the 5-year disease-free survival is 68%. Eight patients have required chemotherapy for recurrent disease or second primary ovarian GCT. This includes three patients with grade II immature teratoma and three patients with dysgerminoma, and a further two women with dysgerminoma who developed contralateral (presumed second primary) dysgerminoma 4.5 and 5.2 years after their first tumor. All but one, who died of a pulmonary embolus, have been successfully salvaged with chemotherapy.

Our experience emphasizes that patients with true stage Ia ovarian GCT are adequately managed by surgical resection followed by careful clinical, radiologic, and serologic surveillance. These patients do not require adjuvant chemotherapy or radiotherapy, thus avoiding the potential complications of secondary leukemia and infertility.