Ovarian germ cell tumor medical therapy

Jump to navigation Jump to search

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

  • 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. The platinum-based regimen is currently the most effective management.

Medical Therapy

  • There is no pharmacologic therapy for the mature teratoma.
  • Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a and 1b dysgerminoma, and grade 1 immature teratomas.[1][2]
  • In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.
  • 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
    • The ovrall survival rate for the patients treated with this regimen is 87% to 98%.[3][4]

Treatment during pregnancy

  • In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.[5]
  • Etoposide use is associated with teratogenicity during the first trimester of the pregnancy and therefore should be avoided.[6]
  • Also its use is associated with neonatal delayed growth and bone marrow suppresssion.[7]
  • Paclitaxel-carboplatin or cisplatin-vinblastine-bleomycin may is recommended to be used during the preganacy.[6]

Stage I ovarian germ cell tumors

  • Dysgerminomas
  • Other germ cell tumors

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

References

  1. "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer. National comprehensive cancer network, 2011; http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf."
  2. Gershenson, D M; Morris, M; Cangir, A; Kavanagh, J J; Stringer, C A; Edwards, C L; Silva, E G; Wharton, J T (1990). "Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin". Journal of Clinical Oncology. 8 (4): 715–720. doi:10.1200/JCO.1990.8.4.715. ISSN 0732-183X.
  3. Segelov, E; Campbell, J; Ng, M; Tattersall, M; Rome, R; Free, K; Hacker, N; Friedlander, M L (1994). "Cisplatin-based chemotherapy for ovarian germ cell malignancies: the Australian experience". Journal of Clinical Oncology. 12 (2): 378–384. doi:10.1200/JCO.1994.12.2.378. ISSN 0732-183X.
  4. Dimopoulos, Meletios A.; Papadimitriou, Christos; Hamilos, Georgios; Efstathiou, Eleni; Vlahos, Georgios; Rodolakis, Alexandros; Aravantinos, Gerassimos; Kalofonos, Haralambos; Kouroussis, Charalambos; Gika, Dimitra; Skarlos, Dimosthenis; Bamias, Aristotle (2004). "Treatment of ovarian germ cell tumors with a 3-day bleomycin, etoposide, and cisplatin regimen: a prospective multicenter study". Gynecologic Oncology. 95 (3): 695–700. doi:10.1016/j.ygyno.2004.08.018. ISSN 0090-8258.
  5. Hubalek, Michael; Smekal-Schindelwig, Caecilia; Zeimet, Alain G.; Sergi, Consolato; Brezinka, Christoph; Mueller-Holzner, Elisabeth; Marth, Christian (2007). "Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma". Archives of Gynecology and Obstetrics. 276 (2): 179–183. doi:10.1007/s00404-007-0328-2. ISSN 0932-0067.
  6. 6.0 6.1 Amant, Frédéric; Halaska, Michael J.; Fumagalli, Monica; Dahl Steffensen, Karina; Lok, Christianne; Van Calsteren, Kristel; Han, Sileny N.; Mir, Olivier; Fruscio, Robert; Uzan, Cathérine; Maxwell, Cynthia; Dekrem, Jana; Strauven, Goedele; Mhallem Gziri, Mina; Kesic, Vesna; Berveiller, Paul; van den Heuvel, Frank; Ottevanger, Petronella B.; Vergote, Ignace; Lishner, Michael; Morice, Philippe; Nulman, Irena (2014). "Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting". International Journal of Gynecologic Cancer. 24 (3): 394–403. doi:10.1097/IGC.0000000000000062. ISSN 1048-891X.
  7. Cardonick, Elyce; Iacobucci, Audrey (2004). "Use of chemotherapy during human pregnancy". The Lancet Oncology. 5 (5): 283–291. doi:10.1016/S1470-2045(04)01466-4. ISSN 1470-2045.

Template:WikiDoc Sources