Ovarian germ cell tumor medical therapy

Ovarian germ cell tumor Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Epidemiology and Demographics
Risk Factors
Screening
Differentiating Ovarian germ cell tumor from other Diseases
Natural History, Complications and Prognosis
Diagnosis
Staging
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Surgery
Chemotherapy
Radiotherapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Ovarian germ cell tumor medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ovarian germ cell tumor medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Ovarian germ cell tumor medical therapy
CDC on Ovarian germ cell tumor medical therapy
Ovarian germ cell tumor medical therapy in the news
Blogs on Ovarian germ cell tumor medical therapy
Directions to Hospitals Treating Ovarian germ cell tumor
Risk calculators and risk factors for Ovarian germ cell tumor medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

• Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas.
• In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.
• In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.
• Platinum-based regimen is currently the most effective management.
  • This regimen is as following:
    • Bleomycin 30 Unit IV per dose be given on day 1, 8, and 15 of the cycle
      • It must be diluted in 50 ml of normal saline (NS) and over 10 minutes.
    • Etoposide 100 mg/m2 IV per day be given on days 1-5.
      • It must be diluted in 500 ml NS (concentration less than 0.4 mg/mL) and administered over one hour.
    • Cisplatin 20 mg/m2 IV per day be given on Days 1 through 5.
      • It must be diluted in 250 mL NS and administer over two hours.
      • No aluminum needles or intravenous sets be used for the administration.
  • This regimen is given every 21 days for three cycles (or four cycles in the presence of bulky residual disease after surgery.
  • Factors that should be monitored during the treatment:
    • Complete blood count (CBC) weekly during treatment
    • Liver function test (LFT) before each treatment cycle
    • Creatinin and electrolytes before each treatment cycle
    • Pulmonary function test before starting bleomycin and at repeated intervals

Medical Therapy

• The mainstay of therapy for ovarian germ cell tumor is chemotherapy.
• There is no pharmacologic therapy for the mature teratoma.

Stage I ovarian germ cell tumors

• Dysgerminomas

• Unilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy

• Other germ cell tumors

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

Stage II ovarian germ cell tumors

• Dysgerminomas

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

• Other germ cell tumors

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

Stage III ovarian germ cell tumors

• Dysgerminomas

• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

• Other germ cell tumors

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy

Stage IV ovarian germ cell tumors

• Dysgerminomas

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy

• Other germ cell tumors

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
• Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy