J Gynecol Oncol.  2016 May;27(3):e26. 10.3802/jgo.2016.27.e26.

Tailored therapy and long-term surveillance of malignant germ cell tumors in the female genital system: 10-year experience

• Zhao Q
• Yang J
• Cao D
• Han J
• Xu K
• Liu Y
• Shen K

• KMID: 2363320
• DOI: http://doi.org/10.3802/jgo.2016.27.e26

Abstract

OBJECTIVE
To explore the appropriate treatment of malignant germ cell tumor (MGCT) in the female genital system, and to analyze the factors influencing both therapeutic response and survival outcome.
METHODS
A cohort of 230-Chinese women diagnosed with MGCT of the genital system was retrospectively reviewed and prospectively followed. The demographic and pathological features, extent of disease and surgery, treatment efficiency, recurrence and survival were analyzed.
RESULTS
MGCTs from different genital origins shared a similar therapeutic strategy and response, except that all eight vaginal cases were infantile yolk sac tumors. The patients' cure rate following the initial treatment, 5-year overall survival and disease-free survival (DFS) were 85.02%, 95.00%, and 86.00%, respectively. Although more extensive excision could enhance the remission rate; it did not improve the patients' survival. Instead, the level of the medical institution, extent of surgery and disease were independent prognostic factors for relapse (p<0.05). Approximately 20% of patients had recurrent or refractory disease, more than half of whom were in remission following secondary cytoreductive surgery with salvage chemotherapy.
CONCLUSION
Fertility-sparing surgery with or without standardized PEB/PVB (cisplatin, etoposide/vincristine, and bleomycin) chemotherapy is applicable for female MGCTs of different origins. Comprehensive staging is not required; nor is excessive debulking suggested. Appropriate cytoreduction by surgery and antineoplastic medicine at an experienced medical institution can bring about an excellent prognosis for these patients.

Keyword

Female Genital System; Malignant Germ Cell Tumor; Prognosis; Therapeutic Uses

MeSH Terms

Adolescent
Adult
Aged
Child
Child, Preschool
Combined Modality Therapy
Cytoreduction Surgical Procedures
Female
Genital Neoplasms, Female/diagnosis/mortality/pathology/*therapy
Humans
Infant
Middle Aged
Neoplasms, Germ Cell and Embryonal/diagnosis/mortality/pathology/*therapy
Prognosis
Recurrence
Survival Analysis
Young Adult