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Topal A, Erturk I, Koseoglu C, Dumludag A, Kuzu ÖF, Durmaz P, Akdag G, Keskin GSY, Karadurmus N. The Role of High Dose Chemotherapy with Autologous Hematopoietic Cell Transplant in Relapsed/Refractory Ovarian Germ Cell Tumors: A Single Center Experience. Clin Genitourin Cancer 2024; 22:102106. [PMID: 38852437 DOI: 10.1016/j.clgc.2024.102106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE We aimed to investigate response rates, survival analyses and factors affecting survival in patients with relapsed or refractory ovarian germ cell tumours who had previously received multiple lines of treatment, including high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT). METHODS This study was designed as a cross-sectional, retrospective study. RESULTS Twenty-one patients were included. After HDC + ASCT, complete response (CR) was observed in 11 patients (52.3%), partial response (PR) in 3 patients (14.3%), stable disease (SD) in 3 patients (14.3%) and progressive disease (PD) in 4 patients (19.1%). TRM was observed in 1 patient. Median follow-up was 51.7 months. Median PFS and OS after HDC + ASCT were calculated to be 6.0 months and 14.8 months, respectively. CONCLUSIONS Salvage HDC + ASCT is an effective option in the treatment of relapsed/refractory ovarian germ cell tumours, offering the potential for prolonged survival and cure.
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Affiliation(s)
- Alper Topal
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye.
| | - Ismail Erturk
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Caglar Koseoglu
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Aysegul Dumludag
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Ömer Faruk Kuzu
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Pelin Durmaz
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Goncagul Akdag
- Department of Medical Oncology, Kartal Dr. Lütfi Kirdar City Hospital, Health Science University, Istanbul, Turkey
| | - Gul Sema Yildiran Keskin
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
| | - Nuri Karadurmus
- Gulhane Research & Training Hospital, Department of Internal Medicine, Division of Medical Oncology, Ankara, Türkiye
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Moss E, Taylor A, Andreou A, Ang C, Arora R, Attygalle A, Banerjee S, Bowen R, Buckley L, Burbos N, Coleridge S, Edmondson R, El-Bahrawy M, Fotopoulou C, Frost J, Ganesan R, George A, Hanna L, Kaur B, Manchanda R, Maxwell H, Michael A, Miles T, Newton C, Nicum S, Ratnavelu N, Ryan N, Sundar S, Vroobel K, Walther A, Wong J, Morrison J. British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: Recommendations for practice update 2024. Eur J Obstet Gynecol Reprod Biol 2024; 300:69-123. [PMID: 39002401 DOI: 10.1016/j.ejogrb.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Esther Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | | | - Adrian Andreou
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Christine Ang
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London NHS Trust, 60 Whitfield Street, London W1T 4E, UK
| | | | | | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Lynn Buckley
- Beverley Counselling & Psychotherapy, 114 Holme Church Lane, Beverley, East Yorkshire HU17 0PY, UK
| | - Nikos Burbos
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital Colney Lane, Norwich NR4 7UY, UK
| | | | - Richard Edmondson
- Saint Mary's Hospital, Manchester and University of Manchester, M13 9WL, UK
| | - Mona El-Bahrawy
- Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | | | - Jonathan Frost
- Gynaecological Oncology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Bath BA1 3NG, UK; University of Exeter, Exeter, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | | | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
| | - Baljeet Kaur
- North West London Pathology (NWLP), Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London and Barts Health NHS Trust, UK
| | - Hillary Maxwell
- Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2JY, UK
| | - Agnieszka Michael
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX and University of Surrey, School of Biosciences, GU2 7WG, UK
| | - Tracey Miles
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Claire Newton
- Gynaecology Oncology Department, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Shibani Nicum
- Department of Oncology, University College London Cancer Institute, London, UK
| | | | - Neil Ryan
- The Centre for Reproductive Health, Institute for Regeneration and Repair (IRR), 4-5 Little France Drive, Edinburgh BioQuarter City, Edinburgh EH16 4UU, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham and Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, UK
| | - Katherine Vroobel
- Department of Cellular Pathology, Royal Marsden Foundation NHS Trust, London SW3 6JJ, UK
| | - Axel Walther
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Jason Wong
- Department of Histopathology, East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK
| | - Jo Morrison
- University of Exeter, Exeter, UK; Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
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Bergamini A, Ramaswami R, Froeling F, Papanastasopoulos P, Short D, Aguiar X, Savage PM, Sarwar N, Kaur B, Saso S, Fotopoulou C, Sharma A, Rustin GJS, Seckl M. Fertility outcomes following surgery and multiagent chemotherapy in malignant ovarian germ cell tumor survivors: a survey study. Int J Gynecol Cancer 2023; 33:1750-1756. [PMID: 37931975 DOI: 10.1136/ijgc-2023-004699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE To assess fertility outcomes in long-term survivors of malignant ovarian germ cell tumors treated with fertility-sparing surgery with or without additional chemotherapy. METHODS Women diagnosed and treated for malignant ovarian germ cell tumors at Charing Cross Hospital or Mount Vernon Cancer Centre between 1977 and 2015 were included. Questionnaires assessing fertility issues were sent to patients treated with fertility-sparing surgery. Fertility outcomes were evaluated according to the treatment received. The effect of the mean total dose of cyclophosphamide and cisplatin was assessed. RESULTS A total of 146 patients were sent the questionnaire; 77 (56.5%) patients were included in the analysis. A total of 49 (64%) patients received platinum-based chemotherapy after surgery, 39 (79.6%) of these with cisplatin, vincristine, methotrexate, bleomycin, actinomycin D, cyclophosphamide, and etoposide, while 10 (20.4%) with bleomycin, etoposide, and cisplatin. After any treatment, 39/46 patients (85%) became pregnant: the conception rate was not different between those receiving surgery only and those receiving also chemotherapy (85.7% vs 84.4%, p=1.0). Live birth rate was 80.4% (37/46), with no statistically significant difference between the treatment groups (p=0.42). Median age of women achieving conception was 29 years (IQR 26-33). The probability of live birth at 5 years was 48% and 40% for patients in the surgery only and chemotherapy group, respectively (p=0.55). Infertility and miscarriage rates did not differ significantly between the two treatment groups (p=0.30 and p=0.32). The mean doses of cisplatin and cyclophosphamide received by patients failing and achieving conception were not different (p=0.10, p=0.47). CONCLUSIONS Our results suggest that fertility may not be hampered in patients with malignant ovarian germ cell tumor treated with fertility-sparing surgery or receiving additional chemotherapy.
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Affiliation(s)
- Alice Bergamini
- Department of Medical Oncology, Charing Cross Hospital, London, UK
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milano, Lombardia, Italy
| | - Ramya Ramaswami
- Department of Medical Oncology, Charing Cross Hospital, London, UK
| | - Fieke Froeling
- Department of Medical Oncology, Charing Cross Hospital, London, UK
- Wolfson Wohl Cancer Research Centre and Beatson West of Scotland Cancer Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Dee Short
- Department of Medical Oncology, Charing Cross Hospital, London, UK
| | - Xianne Aguiar
- Department of Medical Oncology, Charing Cross Hospital, London, UK
| | - Philip M Savage
- Department of Medical Oncology, Charing Cross Hospital, London, UK
- Department of Medical Oncology, Brighton and Sussex University Hospitals NHS Trust, Worthing, UK
| | - Naveed Sarwar
- Department of Medical Oncology, Charing Cross Hospital, London, UK
| | - Baljeet Kaur
- Department of Medical Oncology, Charing Cross Hospital, London, UK
- Department of Histopathology, Charing Cross Hospital, London, UK
| | - Srdjan Saso
- Department of Gynecologic Oncology, Hammersmith Hospitals NHS Trust, London, UK
| | | | - Anand Sharma
- Department of Medical Oncology, Mount Vernon and Watford NHS Trust, Watford, UK
| | | | - Michael Seckl
- Department of Medical Oncology, Charing Cross Hospital, London, UK
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Park M, Suh JK, Lee JA, Park HJ, Park EY, Yoo CW, Lim MC, Park SY, Park BK. Excellent Outcomes in Children, Adolescents, and Young Adults with Ovarian Germ Cell Tumors Treated by Either Reduced- or Standard-Dose Bleomycin. Cancers (Basel) 2023; 15:5290. [PMID: 37958463 PMCID: PMC10647703 DOI: 10.3390/cancers15215290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
To investigate the outcomes of children, adolescents, and young adults (AYAs) with malignant ovarian germ cell tumors (MOGCTs), we analyzed the data of 61 patients aged ≤39 years diagnosed with MOGCT between 2006 and 2022. Among 59 patients who received chemotherapy after initial diagnosis, 57 received BEP (standard dose of bleomycin with 30 units per week, n = 13) or bEP (reduced dose of bleomycin with 15 units/m2 on day 1, n = 44). The 5-year overall survival (OS) and event-free survival (EFS) rates were 98.3% and 84.9%, respectively. Reduced bleomycin dose did not adversely affect survival. Normalization of tumor markers within 3 months after surgery was significantly associated with better EFS (p < 0.01). Of the 59 surviving patients, 8 experienced surgery-related menopause, while 49 demonstrated menstrual recovery. After completion of chemotherapy, there was no significant difference in pulmonary function regarding bleomycin dose, and no overt nephrotoxicity. Approximately 60% and 25% of survivors experienced peripheral neuropathy at the end of chemotherapy and after 1 year, respectively (p < 0.01). Children and AYAs with MOGCT have favorable survival rates with minimal long-term toxicity, which are not influenced by a reduced bleomycin dose. Rapid normalization of tumor markers is associated with improved outcomes.
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Affiliation(s)
- Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (M.P.); (J.K.S.); (J.A.L.); (H.J.P.)
| | - Jin Kyung Suh
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (M.P.); (J.K.S.); (J.A.L.); (H.J.P.)
| | - Jun Ah Lee
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (M.P.); (J.K.S.); (J.A.L.); (H.J.P.)
| | - Hyeon Jin Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (M.P.); (J.K.S.); (J.A.L.); (H.J.P.)
| | - Eun Young Park
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Chong Woo Yoo
- Department of Pathology, Center for Gynecologic Cancer, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Myong Cheol Lim
- Gynecologic Cancer Branch, Center for Gynecologic Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (M.C.L.); (S.-Y.P.)
| | - Sang-Yoon Park
- Gynecologic Cancer Branch, Center for Gynecologic Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (M.C.L.); (S.-Y.P.)
| | - Byung Kiu Park
- Department of Pediatrics, Seoul Metropolitan Seonam Hospital, Seoul 08049, Republic of Korea
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Chen S, Chen F, Xu X. Case Report: Primary endodermal sinus tumor on the abdominal wall near the right liver: a diagnostic pitfall. Front Oncol 2023; 13:1185129. [PMID: 37920168 PMCID: PMC10619900 DOI: 10.3389/fonc.2023.1185129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/05/2023] [Indexed: 11/04/2023] Open
Abstract
Background Endodermal sinus tumors are rare, especially extragonadal endodermal sinus tumors, which often occur in the midline of the brain, neck, chest, and abdomen. Case summary We present the case of a 37-year-old woman with a mass on the right edge of the liver. Color Doppler ultrasound, computed tomography, and magnetic resonance imaging examinations were performed before the operation. Given these results and the elevation of alpha-fetoprotein, the diagnosis of hepatocellular carcinoma was made. Postoperative pathological examination indicated an endodermal sinus tumor on the abdominal wall near the right liver. The causes of misdiagnosis were analyzed, and the related literature was reviewed. Conclusion Primary endodermal sinus tumors on the abdominal wall near the right liver are easily misdiagnosed as hepatocellular carcinoma due to liver compression and elevated alpha-fetoprotein. The key point of differentiation is the wide basal connection between the tumor and the abdominal wall near the liver. In addition, the enhancement mode of endodermal sinus tumors is different from the enhancement pattern of hepatocellular carcinoma. Core tip Extragonadal endodermal sinus tumors often occur in the midline of the body. Here, we present a case of a primary endodermal sinus tumor on the abdominal wall near the right liver for the first time.
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Affiliation(s)
- Shuo Chen
- Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feng Chen
- Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao Xu
- Department of Radiology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, China
- Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing, Zhejiang, China
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Zhang X, Yang J, Xiang Y, Pan L, Wu M, Cao D, Yang J. Advanced ovarian yolk sac tumor: upfront surgery or neoadjuvant chemotherapy followed by interval debulking? Int J Gynecol Cancer 2023:ijgc-2023-004624. [PMID: 37696647 DOI: 10.1136/ijgc-2023-004624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To compare surgery and survival outcomes between neoadjuvant chemotherapy and primary debulking surgery in patients with advanced ovarian yolk sac tumor. METHODS In this retrospective cohort analysis, patients with stage III to IV ovarian yolk sac tumor or mixed germ cell tumors containing yolk sac tumor elements, and who underwent surgery at Peking Union Medical College Hospital between January 2011 and December 2021, were identified. Patient characteristics, treatment, and survival data were analyzed between the two groups. RESULTS A total of 40 patients were enrolled: 19 patients received neoadjuvant chemotherapy followed by interval surgery, and 21 patients were treated with primary debulking surgery. After neoadjuvant chemotherapy, the surgical conditions of patients were improved. All patients achieved cytoreduction to R0 or R1 at interval surgery. No statistical difference was found in 3-year disease-free survival and overall survival between the neoadjuvant chemotherapy group and the primary debulking surgery group (log rank p=0.4 and 0.94). Patients had less blood loss (328.4 vs 1285.7 mL, p=0.029), lower transfusion volume (1044.4 vs 3066.7 mL, p=0.011), and fewer peri-operative complications (15.8% vs 47.6%, p=0.032) at the interval debulking surgery after neoadjuvant chemotherapy compared with patients who underwent primary debulking surgery. CONCLUSION For patients with advanced-stage ovarian yolk sac tumor, neoadjuvant chemotherapy followed by interval surgery is an alternative option, especially for those who cannot tolerate the primary debulking surgery because of high tumor burden and vulnerable status.
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Affiliation(s)
- Xinyue Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jie Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Ayyash M, Miller M, Hijaz M. Evaluation of a microperforate hymen leading to the incidental diagnosis of a borderline ovarian tumour. BMJ Case Rep 2022; 15:e252017. [PMID: 36319036 PMCID: PMC9628543 DOI: 10.1136/bcr-2022-252017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Microperforate hymens are rare anatomical variants with an unknown incidence and very few reported cases. Borderline ovarian tumours are similarly uncommon, with an incidence of approximately 0.002%-0.006%. The concurrent presence of a microperforate hymen and a borderline ovarian tumour is therefore exceedingly unique with no documented cases to date. In this report, we review the case of a nulliparous woman in her late 20s who initially presented with an inability to have penetrative intercourse. A subocclusive hymenal variant was noted on examination and further imaging work-up resulted in the incidental discovery of a large ovarian mass subsequently noted to be a borderline ovarian tumour. Herein, we review contemporary approaches to the diagnosis and management of both hymenal variants and borderline ovarian tumours, and discuss fertility-sparing strategies for young women diagnosed with ovarian neoplasms.
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Affiliation(s)
- Mariam Ayyash
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Madison Miller
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Miriana Hijaz
- Department of Women's Health, Division of Gynecologic Oncology, Henry Ford Health System, Detroit, Michigan, USA
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Qin L, Wang B, Wang Z, He D. Clinicopathological features, prognosis, and fertility outcomes in Chinese Han women treated for ovarian yolk sac tumor: A retrospective case series study from two tertiary-care academic medical centers. Medicine (Baltimore) 2022; 101:e29868. [PMID: 35866762 PMCID: PMC9302259 DOI: 10.1097/md.0000000000029868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Ovarian yolk sac tumor (YST) is a very rare malignant tumor in young women. This study aimed to explore the clinicopathological prognostic characteristics and reproductive outcomes of Chinese Han patients. METHODS To describe a case series study, we reviewed the clinicopathological data of 50 YST patients treated from 2 tertiary medical academic medical centers from January 2009 to December 2019. The Akaike information criterion was used to select variables. The influence of relevant characteristics on prognosis factors was analyzed by the Cox proportional hazard model. RESULTS The median follow-up time was 64.5 months (range from 3 to 124 months). The median age was 22.7 years (3 to 34 years). Abdominal pain (54.0%) or mass (42.0%) were the most common clinical symptoms in the early stage of diagnosis. The tumors were located bilaterally in 4 cases. 27 patients, 7 patients, 13 patients, and 3 patients were in stage I, II, III, and IV, respectively. Twenty-one stage I patients and 12 stage II to IV patients underwent fertility-preserving surgery. Of the 50 patients who received postoperative chemotherapy, 49 received the BEP regimen. At the last follow-up, 92% of the patients were still alive. The overall survival rate and disease-free survival rate were 91.6% and 90.6%, respectively. Recurrence occurred in 7 (14%) patients with a median survival time of 16.7 months (range from 3 to 50 months). Six patients had recurrence in the abdominal space. The percentage of Ki67 (P = .01) and tumor size (P = .03) were 2 important prognostic factors in multivariate analysis. In terms of survival outcomes, fertility-preserving surgery can be equivalent to radical surgery. Sixteen patients tried to conceive, and 6 patients with advanced-stage succeeded in 10 pregnancies. Of these, 6 patients successfully gave birth to 6 healthy babies. CONCLUSIONS The diagnosis of YST of childbearing age is very rare. Because the failure of primary treatment is related to the residual disease after salvage surgery, the fertility and survival results of patients undergoing fertility-preserving surgery are promising.
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Affiliation(s)
- Li Qin
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous prefecture, Enshi, Hubei, China
| | - Bo Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zaiping Wang
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous prefecture, Enshi, Hubei, China
| | - Du He
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous prefecture, Enshi, Hubei, China
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Gang S, Yang HB, Kim HY. A 17-year experience on bilaterality of ovarian germ cell tumors in pediatric population and its clinical implications: A single-center study. J Pediatr Surg 2022; 57:1221-1227. [PMID: 35387741 DOI: 10.1016/j.jpedsurg.2022.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Since the incidence of ovarian germ cell tumor (GCT) in pediatric population is low, there is little information regarding this tumor. A synchronous and metachronous bilateral mass is not infrequently observed in GCT patients. It is important to prevent early ovarian failure and preserve fertility. METHODS We retrospectively reviewed the medical records of 112 patients less than 18 years surgically treated for ovarian GCT between 2008 and 2021 at the Department of Pediatric surgery of the Seoul National University Hospital (SNUH). Among these, 13 patients (11.6%) had bilateral masses. In metachronous masses, the recurrence period and therapeutic approach were evaluated. When ovarian failure was a concern, fertility preservation was attempted. RESULTS Mean age was 8.1 ± 4.0 years. Patients with a bilateral mass were older (p = 0.004). Follow-up was 39.6 ± 40.6 months. Five patients had a synchronous mass, and 8 patients experienced metachronous recurrence. Two patients with a synchronous mass had a metachronous neoplasm (n = 1) and recurrence (n = 1). Patients with metachronous recurrence started menstruation except for two patients who had not reached puberty. The mean recurrence interval was 45.9 ± 38.6 months. Ovum banking was requested for 6 patients and performed in 2. CONCLUSIONS During our 17 years of experience, bilaterality was observed in 11.6% of GCT patients. Metachronous mass occurs after 5 years. A longer follow-up plan is needed for early detection. Our multidisciplinary approach to preserve fertility seemed to be successful with close cooperation with gynecologists.
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Affiliation(s)
- Sujin Gang
- Department of Pediatric Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hee-Beom Yang
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Pediatric Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea.
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Non-Epithelial Ovarian Cancers: How Much Do We Really Know? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031106. [PMID: 35162125 PMCID: PMC8834485 DOI: 10.3390/ijerph19031106] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023]
Abstract
Non-epithelial ovarian cancers (NEOC) are a group of uncommon malignancies that mainly includes germ cell tumours (GCT), sex cord-stromal tumours (SCST), and some extremely rare tumours, such as small cell carcinomas and sarcomas. Each of these classifications encompasses multiple histologic subtypes. The aetiology and molecular origins of each sub-group of NEOC require further investigation, and our understanding on the genetic changes should be optimised. In this article, we provide an update on the clinical presentation, pathology, genetics, treatment and survival of the main histological subtypes of the GCT and the SCST, as well as of ovarian small cell carcinomas. We also discuss miRNA expression profiles of NEOC and report the currently active clinical trials that include NEOC.
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Afectación pulmonar extensa como presentación de un tumor del saco vitelino ovárico. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37497311 PMCID: PMC10369609 DOI: 10.1016/j.opresp.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Canlorbe G, Chabbert-Buffet N, Uzan C. Fertility-Sparing Surgery for Ovarian Cancer. J Clin Med 2021; 10:jcm10184235. [PMID: 34575345 PMCID: PMC8466872 DOI: 10.3390/jcm10184235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022] Open
Abstract
(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.
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Affiliation(s)
- Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France;
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
- Correspondence:
| | - Nathalie Chabbert-Buffet
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France;
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
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Alrjoub MM, Sindiani A, Alshriedeh O, Amarin Z. Pregnancy and Delivery After Ovarian Yolk Sac Tumor: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932091. [PMID: 34408122 PMCID: PMC8382024 DOI: 10.12659/ajcr.932091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 24-year-old
Final Diagnosis: Primary infertility • yolk sac tumor
Symptoms: Abdomen distension • infertility
Medication: —
Clinical Procedure: Salpingo-oophorectomy
Specialty: Obstetrics and Gynecology • Oncology • Pathology
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Affiliation(s)
- Mo'ath M Alrjoub
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Amer Sindiani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ola Alshriedeh
- Medical Student, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Zouhair Amarin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Establishment and characterization of an ovarian yolk sac tumor patient-derived xenograft model. Pediatr Surg Int 2021; 37:1031-1040. [PMID: 34031745 DOI: 10.1007/s00383-021-04895-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The lack of appropriate preclinical models of ovarian yolk sac tumor (OYST) is currently hindering the pursuit of new methods of treatment and investigation of the pathogenesis of the disease. We developed and characterized an OYST patient-derived xenograft (PDX) model in this study. METHODS Tumor fragments from a patient with an OYST were implanted subcutaneously into BALB/c Nude mice. Engrafted xenografts were compared with the original tumor according to histology, immunohistochemistry, humanized identified, and drug efficacy testing with in vivo treatment programs. RESULTS There was a high degree of histologic and immunohistochemical (IHC) resemblance between the established PDX model and its corresponding human tumors. Bleomycin, etoposide, and cisplatin (JEB) chemotherapy regimens were effective in clinical patients and were effective in the OYST PDX model; therefore, the effect of PDX intervention was consistent with clinical outcomes of OYSTs. CONCLUSION We have successfully established an OYST PDX model. This OYST model preserves the basic molecular features of the primary human tumor, thereby providing a valuable method to preclinically evaluate new treatments and explore disease pathogenesis.
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Utama MS, Kurniadi A, Prahastiwi AACY, Adibrata AA. Role of Radiotherapy in Recurrent Intra-Abdominal Yolk Sac Tumor. Case Rep Oncol 2021; 14:1010-1018. [PMID: 34326736 PMCID: PMC8299403 DOI: 10.1159/000517022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 01/10/2023] Open
Abstract
Yolk sac tumor (YST) is a rare malignant germ cell tumor with no appropriate treatment strategy to date. However, patients are treated on a case-to-case basis as per various case reports that have been published. Here, we present a case of 27-year-old female patient who presented to us with chief complaints of severe abdominal pain associated with leucorrhea. She previously had a similar pain episode, which was then evaluated by a multidisciplinary team. She was diagnosed with YST. After that, she underwent 6 cycles of chemotherapy, but there was no improvement. Then the medical oncologist referred her to performed radiotherapy. Then, the radiation oncologist decided to give her curative radiotherapy of 3D-CRT. After completing her sessions, she felt better and clinically improving. After that, she was discharged and scheduled a follow-up visit for first evaluation. At her follow-up visit, she was feeling well, and we decided to have an abdominal MRI.
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Affiliation(s)
- Marhendra Satria Utama
- Radiation Oncology Sub Division, Department of Radiology, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Andi Kurniadi
- Gynecology Oncology Sub Division, Department of Obstetrics and Gynecology, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Antony A Adibrata
- Medical Education Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Real-World Study of Cisplatin, Etoposide, and Bleomycin Chemotherapy Regimen in Gestational Trophoblastic Neoplasia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6661698. [PMID: 34258277 PMCID: PMC8249144 DOI: 10.1155/2021/6661698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Objective Little observational data exist regarding the use of cisplatin, etoposide, and bleomycin (BEP) chemotherapy regimen in patients with gestational trophoblastic neoplasia (GTN). Methods This is a retrospective study of 95 patients with GTN in our center from June/2010 to June/2018. All patients received at least 2 cycles of BEP chemotherapy. The primary outcomes were the rate of complete remission (CR) and overall survival (OS). The secondary outcomes were disease-free survival (DFS), pregnancy rates after BEP exposure, drug resistance rate, and other adverse events. Results Of the 95 patients included, 66 (69.5%) patients received BEP as primary treatment and 29 (30.5%) were Salvage chemotherapy. The median age at diagnosis was 37 years (range 29.75-46) and 34 years (range 27-40) in two groups, respectively. The median WHO prognostic scores were 6 (range 3.5-8), and 77.32% of patients were FIGO stage III-IV in the primary treatment group. The median WHO prognostic scores were 5 (range 3-9), and 66.55% of patients were FIGO stage III-IV in the salvage treatment group. Median cycles of BEP treatment were 4 (3, 5) and 3 (2, 4) in two groups, respectively. In the primary chemotherapy group, 18.2% received additional hysterectomy, 4.5% received UAE for vaginal bleeding, and 1.52% received whole-brain radiotherapy. In the salvage chemotherapy group, 20.7% received hysterectomy, 6.9% received lobectomy, 3.4% received hysteroscopic lesion resection, and 3.4% received whole-brain radiotherapy. CR rates to initial chemotherapy were 86.4%, including 87.9% in the primary chemotherapy group and 82.8% in the salvage chemotherapy group. No predictive factor of chemotherapy resistance was identified. The rate of 5 year-DFS was 96.52% (95% CI 86.78-99.12) in the primary chemotherapy group and 92.44% (95% CI 73.02-98.06) in the salvage chemotherapy group. The rate of 5 year-OS was 98.31% (95% CI 88.57-99.76) and 95.65% (95% CI 79.93-99.38) in the two groups, respectively. During the treatment, neutropenia, thrombocytopenia, anemia, and liver dysfunction occurred in 80.3%, 6.1%, 25.8%, and 50% primary chemotherapy patients and 82.8%, 31%, 10.3%, and 86.2% salvage chemotherapy patients. In patients with fertility requirements, live birth rates were 100% (10/10) in primary chemotherapy patients and 80% (4/5) in salvage chemotherapy patients. Conclusions BEP regimen was effective in the treatment of GTINs. The treatment was well tolerated, with no safety concerns on patients' fertility.
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Schmidtova S, Dorssers LCJ, Kalavska K, Gillis AJM, Oosterhuis JW, Stoop H, Miklikova S, Kozovska Z, Burikova M, Gercakova K, Durinikova E, Chovanec M, Mego M, Kucerova L, Looijenga LHJ. Napabucasin overcomes cisplatin resistance in ovarian germ cell tumor-derived cell line by inhibiting cancer stemness. Cancer Cell Int 2020; 20:364. [PMID: 32774158 PMCID: PMC7397611 DOI: 10.1186/s12935-020-01458-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cisplatin resistance of ovarian yolk sac tumors (oYST) is a clinical challenge due to dismal patient prognosis, even though the disease is extremely rare. We investigated potential association between cisplatin resistance and cancer stem cell (CSC) markers in chemoresistant oYST cells and targeting strategies to overcome resistance in oYST. Methods Chemoresistant cells were derived from chemosensitive human oYST cells by cultivation in cisplatin in vitro. Derivative cells were characterized by chemoresistance, functional assays, flow cytometry, gene expression and protein arrays focused on CSC markers. RNAseq, methylation and microRNA profiling were performed. Quail chorioallantoic membranes (CAM) with implanted oYST cells were used to analyze the micro-tumor extent and interconnection with the CAM. Tumorigenicity in vivo was determined on immunodeficient mouse model. Chemoresistant cells were treated by inhibitors intefering with the CSC properties to examine the chemosensitization to cisplatin. Results Long-term cisplatin exposure resulted in seven-fold higher IC50 value in resistant cells, cross-resistance to oxaliplatin and carboplatin, and increased migratory capacity, invasiveness and tumorigenicity, associated with hypomethylation of differentially methylated genes/promotors. Resistant cells exhibited increased expression of prominin-1 (CD133), ATP binding cassette subfamily G member 2 (ABCG2), aldehyde dehydrogenase 3 isoform A1 (ALDH3A1), correlating with reduced gene and promoter methylation, as well as increased expression of ALDH1A3 and higher overall ALDH enzymatic activity, rendering them cross-resistant to DEAB, disulfiram and napabucasin. Salinomycin and tunicamycin were significantly more toxic to resistant cells. Pretreatment with napabucasin resensitized the cells to cisplatin and reduced their tumorigenicity in vivo. Conclusions The novel chemoresistant cells represent unique model of refractory oYST. CSC markers are associated with cisplatin resistance being possible targets in chemorefractory oYST.
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Affiliation(s)
- Silvia Schmidtova
- Department of Molecular Oncology, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy of Sciences, Dubravska cesta 9, 845 05 Bratislava, Slovakia.,Translational Research Unit, Faculty of Medicine, Comenius University, Klenova 1, 833 10 Bratislava, Slovakia
| | - Lambert C J Dorssers
- Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Katarina Kalavska
- Department of Molecular Oncology, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy of Sciences, Dubravska cesta 9, 845 05 Bratislava, Slovakia.,Translational Research Unit, Faculty of Medicine, Comenius University, Klenova 1, 833 10 Bratislava, Slovakia.,2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Klenova 1, 833 10 Bratislava, Slovakia
| | - Ad J M Gillis
- Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - J Wolter Oosterhuis
- Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Hans Stoop
- Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Svetlana Miklikova
- Department of Molecular Oncology, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy of Sciences, Dubravska cesta 9, 845 05 Bratislava, Slovakia
| | - Zuzana Kozovska
- Department of Molecular Oncology, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy of Sciences, Dubravska cesta 9, 845 05 Bratislava, Slovakia
| | - Monika Burikova
- Department of Molecular Oncology, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy of Sciences, Dubravska cesta 9, 845 05 Bratislava, Slovakia
| | - Katarina Gercakova
- Department of Molecular Oncology, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy of Sciences, Dubravska cesta 9, 845 05 Bratislava, Slovakia
| | - Erika Durinikova
- Department of Molecular Oncology, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy of Sciences, Dubravska cesta 9, 845 05 Bratislava, Slovakia
| | - Michal Chovanec
- Translational Research Unit, Faculty of Medicine, Comenius University, Klenova 1, 833 10 Bratislava, Slovakia.,2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Klenova 1, 833 10 Bratislava, Slovakia
| | - Michal Mego
- Translational Research Unit, Faculty of Medicine, Comenius University, Klenova 1, 833 10 Bratislava, Slovakia.,2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Klenova 1, 833 10 Bratislava, Slovakia
| | - Lucia Kucerova
- Department of Molecular Oncology, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy of Sciences, Dubravska cesta 9, 845 05 Bratislava, Slovakia
| | - Leendert H J Looijenga
- Department of Pathology, Laboratory for Experimental Patho-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
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Veneris JT, Mahajan P, Frazier AL. Contemporary management of ovarian germ cell tumors and remaining controversies. Gynecol Oncol 2020; 158:467-475. [DOI: 10.1016/j.ygyno.2020.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022]
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Sessa C, Schneider DT, Planchamp F, Baust K, Braicu EI, Concin N, Godzinski J, McCluggage WG, Orbach D, Pautier P, Peccatori FA, Morice P, Calaminus G. ESGO-SIOPE guidelines for the management of adolescents and young adults with non-epithelial ovarian cancers. Lancet Oncol 2020; 21:e360-e368. [PMID: 32615119 DOI: 10.1016/s1470-2045(20)30091-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/15/2020] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
The European Society of Gynaecological Oncology and the European Society for Paediatric Oncology jointly developed clinically relevant and evidence-based guidelines for the management of adolescents and young adults aged 15 to 25 years with non-epithelial ovarian cancers, including malignant ovarian germ cell tumours, sex cord-stromal tumours, and small cell carcinoma of the ovary of hypercalcaemic type. The developmental process of these guidelines is based on a systematic literature review and critical appraisal process involving an international multidisciplinary developmental group consisting of experts from relevant disciplines (paediatric oncology, paediatric surgery, medical oncology, pathology, psycho-oncology, gynaecological oncology, and reproductive endocrinology). Given the specific and often complex issues involved in treating this group of patients, fertility sparing surgery and decrease of acute and long-term toxicities from treatment were important criteria for guidelines definition. Prior to publication, the guidelines were reviewed by 54 independent international practitioners in cancer care delivery.
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Affiliation(s)
- Cristiana Sessa
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | | | | | - Katja Baust
- Paediatric Oncology, University Hospital Bonn, Bonn, Germany
| | - Elena Ioana Braicu
- Gynaecologic Oncology, Charité-Universitätsmedizin Berlin, Humboldt-Universitätzu Berlin, Berlin Institute of Health, Institute of Gynecology, Berlin, Germany
| | - Nicole Concin
- Gynaecologic Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan Godzinski
- Paediatric Surgery, Marciniak Hospital, Medical University, Wroclaw, Poland
| | | | | | | | - Fedro A Peccatori
- Gynaecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Philippe Morice
- Gynaecologic Oncology, Institut Gustave Roussy, Villejuif, France
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Morrison A, Nasioudis D. Reproductive outcomes following fertility-sparing surgery for malignant ovarian germ cell tumors: A systematic review of the literature. Gynecol Oncol 2020; 158:476-483. [PMID: 32513565 DOI: 10.1016/j.ygyno.2020.05.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Investigate the reproductive outcomes of patients diagnosed with malignant ovarian germ cell tumors (MOGCTs) following fertility-sparing surgery (FSS). METHODS A systematic review of the Pubmed/Medline, EMBASE and Web-of-Science databases between January 1st 1990 and February 28th 2020 was performed. Full articles reporting on at least 10 patients with MOGCT who underwent FSS and provided data on fertility or pregnancy outcomes were included. RESULTS A total of 47 studies that included 2189 patients with MOGCT who underwent FSS were included. Rate of chemotherapy use was 79.9% while cumulative relapse rate was 8.7%. Based on 1110 patient from 27 studies rate of premature ovarian failure was 3.7%. Fecundity rate was 24.6% (n = 1980, from 42 studies), while 80.6% of patients attempting pregnancy had at least one pregnancy (n = 474, from 27 studies). Based on 294 live births, the rate of preterm delivery was 3% while among 261 live infants, only 3 (1.2%) malformations were reported. CONCLUSIONS The majority of patients with MOGCTs have normal menstrual and reproductive function following FSS. Fecundity and pregnancy outcomes are comparable to the general population.
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Affiliation(s)
- Aimee Morrison
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dimitrios Nasioudis
- Division of Gynecologic Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Molecular Pathways and Targeted Therapies for Malignant Ovarian Germ Cell Tumors and Sex Cord-Stromal Tumors: A Contemporary Review. Cancers (Basel) 2020; 12:cancers12061398. [PMID: 32485873 PMCID: PMC7353025 DOI: 10.3390/cancers12061398] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
Non-epithelial ovarian tumors are heterogeneous and account for approximately 10% of ovarian malignancies. The most common subtypes of non-epithelial ovarian tumors arise from germ cells or sex cord and stromal cells of the gonads. These tumors are usually detected at an early stage, and management includes surgical staging and debulking. When indicated for advanced disease, most respond to chemotherapy; however, options for patients with refractory disease are limited, and regimens can be associated with significant toxicities, including permanent organ dysfunction, secondary malignancies, and death. Targeted therapies that potentially decrease chemotherapy-related adverse effects and improve outcomes for patients with chemotherapy-refractory disease are needed. Here, we review the molecular landscape of non-epithelial ovarian tumors for the purpose of informing rational clinical trial design. Recent genomic discoveries have uncovered recurring somatic alterations and germline mutations in subtypes of non-epithelial ovarian tumors. Though there is a paucity of efficacy data on targeted therapies, such as kinase inhibitors, antibody–drug conjugates, immunotherapy, and hormonal therapy, exceptional responses to some compounds have been reported. The rarity and complexity of non-epithelial ovarian tumors warrant collaboration and efficient clinical trial design, including high-quality molecular characterization, to guide future efforts.
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Choi MC, Chung YS, Lee JW, Kwon BS, Park BK, Kim SI, Shim SH, Lee KB, Seong SJ, Lee SJ, Lee SH, Yoo HJ, Song T, Kim MK, Baek MH, Kang S, Kim YM. Feasibility and efficacy of gonadotropin-releasing hormone agonists for the prevention of chemotherapy-induced ovarian insufficiency in patients with malignant ovarian germ cell tumours (KGOG 3048R). Eur J Cancer 2020; 133:56-65. [PMID: 32442924 DOI: 10.1016/j.ejca.2020.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/23/2020] [Accepted: 03/29/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study assessed the effects of gonadotropin-releasing hormone agonists (GnRHa) on the prevention of chemotherapy-induced ovarian insufficiency among young patients with malignant ovarian germ cell tumour (MOGCT) receiving chemotherapy. METHODS This multicentre, retrospective study was conducted at 15 sites affiliated with the Korean Gynecologic Oncology Group and enrolled 354 patients between January 1995 and September 2018. Among them, 227 patients were included in this study and divided into two groups according to the use of GnRHa during chemotherapy (GnRHa versus no GnRHa groups). The primary objective was to compare the rates of menstrual resumption between the two groups. We also assessed the clinical determinants affecting menstrual resumption among the study groups. RESULTS There were no significant differences between the GnRHa (n = 63) and no GnRHa (n = 164) groups regarding age at diagnosis, parity, ethnicity, age at menarche, body mass index, International Federation of Gynecology and Obstetrics stage, mode of surgery and surgery type. The rate of menstrual resumption after chemotherapy was 100% (63 of 63) in the GnRHa group and 90.9% (149 of 164) in the no GnRHa group (p = 0.013). The mean periods from last chemotherapy to menstrual resumption were 7.4 and 7.3 months in the GnRHa and no GnRHa groups, respectively. GnRHa co-administration during chemotherapy reduced the likelihood of amenorrhoea after chemotherapy, although statistical significance was not confirmed in the univariate analysis (odds ratio: 0.276; 95% confidence interval, 0.004-1.317; p = 0.077). CONCLUSION Temporary ovarian suppression with GnRHa during chemotherapy does not significantly increase the chances of menstrual resumption in young patients with MOGCT.
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Affiliation(s)
- Min C Choi
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
| | - Young S Chung
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Byung S Kwon
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Byung K Park
- Center for Pediatric Oncology, National Cancer Center, Goyang, South Korea
| | - Se I Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea
| | - Kwang-Beom Lee
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seok J Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, South Korea
| | - Sung J Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - San H Lee
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Heon-Jong Yoo
- Department of Obstetrics and Gynecology, Chungnam National University, School of Medicine, Daejeon, South Korea
| | - Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min K Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Min-Hyun Baek
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Sokbom Kang
- Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Perry MF, Jackson AL, Herzog TJ, Billingsley CC. Early diagnosis and treatment challenges of endodermal sinus tumors: A case report. Case Rep Womens Health 2020; 27:e00198. [PMID: 32300538 PMCID: PMC7152713 DOI: 10.1016/j.crwh.2020.e00198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background Ovarian endodermal sinus tumors (ESTs) are rapidly growing and highly malignant tumors that respond well to chemotherapy. They can be difficult to diagnose and delayed diagnosis can worsen prognosis. Case We present the case of a 20-year-old woman with an EST initially misdiagnosed as a tubo-ovarian abscess who then experienced rapid progression within weeks of initial presentation and was subsequently found to have unresectable advanced stage disease. Conclusion ESTs are extremely aggressive and require prompt referral and early treatment with chemotherapy. Presenting symptoms of pain and a mass can lead to a broad range of differential diagnoses. In such patients, early consideration of tumor markers is warranted. This case report reviews the key aspects for prompt diagnosis and rapid treatment of these tumors, which significantly impacts the prognosis. Delayed diagnosis of endodermal sinus tumors can worsen prognosis. Certain radiological signs are specific for endodermal sinus tumors. Broad differentials and early tumor markers may decrease time to diagnosis.
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Affiliation(s)
- Madeline F Perry
- University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Amanda L Jackson
- Division of Gynecologic Oncology, University of Cincinnati, Cincinnati, OH, United States
| | - Thomas J Herzog
- Division of Gynecologic Oncology, University of Cincinnati, Cincinnati, OH, United States
| | - Caroline C Billingsley
- Division of Gynecologic Oncology, University of Cincinnati, Cincinnati, OH, United States
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Johansen G, Dahm-Kähler P, Staf C, Flöter Rådestad A, Rodriguez-Wallberg KA. Fertility-sparing surgery for treatment of non-epithelial ovarian cancer: Oncological and reproductive outcomes in a prospective nationwide population-based cohort study. Gynecol Oncol 2019; 155:287-293. [DOI: 10.1016/j.ygyno.2019.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 12/18/2022]
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Lu T, Qi L, Ma Y, Lu G, Zhang X, Liu P. Primary yolk sac tumor of the endometrium: a case report and review of the literatures. Arch Gynecol Obstet 2019; 300:1177-1187. [PMID: 31549219 DOI: 10.1007/s00404-019-05309-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/14/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Yolk sac tumor (YST) is a malignant tumor derived from germ cells and usually occurs in the gonads. Extra-gonadal YST is most commonly seen in the vagina of children, but rarely in the cervix, vulva and endometrium. Primary YST of endometrium was extremely rare, standard treatment was still controversial and no guideline was established so far. The aim of the present study was to provide a comprehensive understanding and systematic thought for the management of primary YST of endometrium. METHODS A systematic research of the literature was conducted in Scopus, PubMed database and Cochrane Library, including case reports and case series. We summarized clinical characteristics, treatments and prognosis of all collected cases. We collected data regarding patients, serum AFP level, initial symptoms, surgical information, postoperative chemotherapy and radiotherapy. A new case was also discussed. RESULTS We found only 26 cases have been reported previously. We reported a new case of primary endometrial YST in a 27-year-old woman, and in this case, we creatively performed bilaterally ovarian preservation and used DC (docetaxel and carboplatin) regimen of postoperative chemotherapy, we achieved a relatively good prognosis during the follow-up period of 14 months. CONCLUSION Primary YST of endometrium, kind of highly malignant germ cell tumors, was extremely rare, of which initial symptom is usually abnormal vaginal bleeding. Standard treatment was still controversial and no guideline was established so far. Surgery combining with postoperative chemotherapy was considered effective for treatment of primary endometrial YST. Decision on whether to preserve ovaries in young patient with early stage needs careful consideration, comprehensive preoperative assessment and full communication. Intraoperative biopsy and strict postoperative follow-up are recommended. However, standard chemotherapy regimen and feasibility of postoperative radiotherapy remains to be discussed.
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Affiliation(s)
- Tao Lu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Liping Qi
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Yanhui Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Guojiao Lu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Xiaolei Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China.
| | - Peishu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China.
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Reproductive outcomes following treatment for a gynecological cancer diagnosis: a systematic review. J Cancer Surviv 2019; 13:269-281. [DOI: 10.1007/s11764-019-00749-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/22/2019] [Indexed: 01/06/2023]
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Lockley M, Stoneham SJ, Olson TA. Ovarian cancer in adolescents and young adults. Pediatr Blood Cancer 2019; 66:e27512. [PMID: 30350916 DOI: 10.1002/pbc.27512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/11/2018] [Accepted: 09/29/2018] [Indexed: 12/17/2022]
Abstract
The diagnosis of ovarian cancer in adolescents and young adults is always challenging. Many issues exist, and most important of these may be access to care with an appropriate provider. A range of histologies occur in the ovaries, and their frequency changes markedly as patients progress from adolescence to young adulthood. The very curable germ cell tumors of adolescence slowly give way to aggressive carcinomas, which require a different treatment approach. Special consideration is needed for treatment of toxicity. In an ideal world, centers consisting of pediatric, medical, and gynecological oncologists may be the most appropriate to care for these complex and diverse patients.
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Affiliation(s)
- Michelle Lockley
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Oncology, University College London Hospital, London, UK
| | - Sara J Stoneham
- Department of Oncology, University College London Hospital, London, UK
| | - Thomas A Olson
- Department of Paediatrics and Child Health, University College London Hospital, London, UK
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
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Dunn TN, Khazaeian K, Coffey DM, Rohozinski J, Kovanci E, Edwards CL, Tung CS. Successful yolk-sac tumor treatment with fertility-sparing partial oophorectomy. Gynecol Oncol Rep 2019; 27:22-24. [PMID: 30581951 PMCID: PMC6293018 DOI: 10.1016/j.gore.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 12/05/2022] Open
Abstract
Yolk-sac tumors account for about 20% of ovarian germ cell tumors and occur predominantly in women below 35 years of age. Modern evidence-based treatment strategies have ensured long term post-treatment survival, but with increased survival, attention has been turned to an urgent need for developing fertility sparing treatment strategies. In this report we describe the successful treatment of a young woman who was able to conceive and deliver two children, in spite of the loss of one ovary two years prior to being diagnosed with an ovarian yolk-sac tumor on the remaining ovary.
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Affiliation(s)
- Timothy N. Dunn
- Department of OB/GYN, University of Alabama-Birmingham, 1700 6th Ave S, Woman & Infants Center Rm 5328, Birmingham, AL 35233, USA
| | - Kamyar Khazaeian
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA
| | - Donna M. Coffey
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA
| | - Jan Rohozinski
- Department of OB/GYN, Division of Gynecologic Oncology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
- Wake Forest School of Medicine, Institute for Regenerative Medicine, Winston-Salem, NC 27157, USA
| | - Ertug Kovanci
- Houston Fertility Specialists, 7900 Fannin Street, Suite 4400, Houston, TX 77054, USA
| | - Creighton L. Edwards
- Department of OB/GYN, Division of Gynecologic Oncology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Celestine S. Tung
- Department of OB/GYN, Division of Gynecologic Oncology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
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Ceppi L, Galli F, Lamanna M, Magni S, Dell'Orto F, Verri D, Delle Marchette M, Lissoni AA, Sina F, Giuliani D, Grassi T, Landoni F, Bonazzi CM, Fruscio R. Ovarian function, fertility, and menopause occurrence after fertility-sparing surgery and chemotherapy for ovarian neoplasms. Gynecol Oncol 2019; 152:346-352. [DOI: 10.1016/j.ygyno.2018.11.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/06/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
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30
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Tomao F, Di Pinto A, Sassu CM, Bardhi E, Di Donato V, Muzii L, Petrella MC, Peccatori FA, Panici PB. Fertility preservation in ovarian tumours. Ecancermedicalscience 2018; 12:885. [PMID: 30679952 PMCID: PMC6345054 DOI: 10.3332/ecancer.2018.885] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 12/14/2022] Open
Abstract
A considerable number of patients with a cancer diagnosis are of childbearing age and have not satisfied their desire for a family. Despite ovarian cancer (OC) usually occurring in older patients, 3%-14% are diagnosed at a fertile age with the overall 5-year survival rate being 91.2% in women ≤44 years of age when it is found at 1A-B stage. In this scenario, testing the safety and the efficacy of fertility sparing strategies in OC patients is very important overall in terms of quality of life. Unfortunately, the lack of randomised trials to validate conservative approaches does not guarantee the safety of fertility preservation strategies. However, evidence-based data from descriptive series suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. This conservative surgery helps to maintain organ function, giving patients of childbearing age the possibility to preserve their fertility. We hereby analysed the main evidence from the international literature on this topic in order to highlight the selected criteria for conservative management of OC patients, including healthy BRCA mutations carriers.
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Affiliation(s)
- Federica Tomao
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Di Pinto
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Carolina Maria Sassu
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Erlisa Bardhi
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Violante Di Donato
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Ludovico Muzii
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | | | | | - Pierluigi Benedetti Panici
- Department of Gynaecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Thomakos N, Malakasis A, Machairiotis N, Zarogoulidis P, Rodolakis A. Fertility Sparing Management in Non-Epithelial Ovarian Cancer. Which Patients, What Procedure and What Outcome? J Cancer 2018; 9:4659-4664. [PMID: 30588250 PMCID: PMC6299391 DOI: 10.7150/jca.26674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 09/15/2018] [Indexed: 12/18/2022] Open
Abstract
Non epithelial ovarian tumors represent a small group of rare gynecological cancers but they have a high incidence in young childbearing women. The recent years fertility preservation surgeries have become a common practice in specific ovarian malignancies when the patients wish to maintain their fertility. Specific types of non-epithelial ovarian tumors can be managed with fertility sparing operations with a similar outcome to more radical intervention but due to the rarity of these tumors the extent of the operation remains in some cases controversial. Moreover, the reproductive outcome of the women that had these conservative operations seems to be very promising. In our review we try to summarize the data regarding the fertility sparing management of all types of non-epithelial ovarian cancers and what procedure should be performed in each case. Finally we have accumulated the data concerning the reproductive outcome of patients that had undergone this type of surgery.
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Affiliation(s)
- Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens, Greece
| | - Anastasios Malakasis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens, Greece
| | - Nikolaos Machairiotis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens, Greece
| | - Paul Zarogoulidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens, Greece
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Neoadjuvant Bleomycin, Etoposide, and Cisplatin (BEP) Chemotherapy in the Treatment of Extensively Advanced Yolk Sac Tumors: A Single Center Experience. Int J Gynecol Cancer 2018; 28:713-720. [DOI: 10.1097/igc.0000000000001209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
ObjectiveThis study aimed to investigate the role of neoadjuvant bleomycin, etoposide, and cisplatin (BEP) regimen in patients with extensively advanced yolk sac tumors (YSTs).MethodsBetween July 1982 and December 2015, a total of 58 patients with YST were initially treated at our institution, among which 18 were evaluated to be inoperable and received neoadjuvant BEP regimen. They were either too debilitated by the disease [Eastern Cooperative Oncology Group Performance Status Scale (ECOG ps) ≥2] to undergo a major surgery or were with too extensively disseminated lesions to be optimally debulked. This cohort of patients was retrospectively reviewed.ResultsOne or 2 cycles of BEP regimen were prescribed to the majority of patients preoperatively. At the completion of neoadjuvant chemotherapy, 17 of them had ECOG ps of 1 or less. Seventeen (94.4%) exhibited clinical partial tumor regression, and 1 (5.6%) had clinical stable disease. Pathological complete tumor regression was observed in 2 (11.1%) patients, whereas the remaining 16 (88.9%) had nearly complete pathological regression. Seventeen patients were cytoreduced to no macroscopic residual disease; the remaining 1 was cytoreduced to macroscopic residual disease of 2 cm or less. No major surgical complications occurred. After a median follow-up of 83.5 months, 17 patients were free of recurrence. Five-year disease-free survival and overall survival were both 94.4%. Fertility-sparing surgery was carried out in all the 17 patients with the desire to preserve their fertility, and 5 infants were delivered in 6 patients who attempted conception.ConclusionsOne or 2 cycles of neoadjuvant BEP regimen followed by cytoreductive surgery offer a chance for cure in extensively advanced patients with YSTs and help pave the way for fertility-sparing surgery.
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Makris GM, Fotiou A, Chrelias G, Battista MJ, Chrelias C. Giving Birth After Fertility Sparing Treatment for a Yolk Sac Tumour: Case Report. J Clin Diagn Res 2017; 11:QD12-QD13. [PMID: 28969219 DOI: 10.7860/jcdr/2017/25820.10524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 05/23/2017] [Indexed: 11/24/2022]
Abstract
Yolk Sac Tumours (YSTs) of the ovary, also called Endodermal Sinus Tumours (ESTs), are the second most common Malignant Ovarian Germ Cell Tumours (MOGCTs), after dysgerminomas. YSTs occur primarily in children and young women. We present a case report of a 20-year-old woman who had been diagnosed with YST (tumour diameter of 29 cm). The patient underwent fertility sparing surgery and was subsequently treated with adjuvant chemotherapy (four cycles of bleomycin, etoposide and cisplatin). Two years after the diagnosis of YST, she successfully gave birth to a healthy girl (birth weight 3,500 g, Apgar score of 9-10 and a spontaneous vaginal delivery). During pregnancy, she had microscopic hematuria and bilateral nephrolithiasis, was ultrasonographically diagnosed. The conception after fertility sparing treatment of YST is possible and the birth of a healthy child is feasible. There are no current guidelines for surveillance of such patients during pregnancy; however, structured pregnancy surveillance in such survivors seems necessary.
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Affiliation(s)
- Georgios-Marios Makris
- Head, Department of Obstetrics and Gynecology, Athens Euroclinic Hospital, Athens, Greece
| | - Alexandros Fotiou
- Resident, Department of Obstetrics and Gynecology, Athens Euroclinic Hospital, Athens, Greece
| | - Georgios Chrelias
- Resident, Department of Obstetrics and Gynecology, General University Hospital "Attikon", University of Athens, Athens, Greece
| | - Marco-Johannes Battista
- Professor, Department of Gynecology and Obstetrics, University Hospital Mainz, Mainz, Germany
| | - Charalampos Chrelias
- Professor, Department of Obstetrics and Gynecology, General University Hospital "Attikon", University of Athens, Athens, Greece
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Nasioudis D, Chapman-Davis E, Frey MK, Caputo TA, Holcomb K. Management and prognosis of ovarian yolk sac tumors; an analysis of the National Cancer Data Base. Gynecol Oncol 2017; 147:296-301. [PMID: 28803748 DOI: 10.1016/j.ygyno.2017.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the clinico-pathological characteristics, management and prognosis of women diagnosed with ovarian yolk sac tumors (OYSTs). METHODS The U.S National Cancer Data Base was queried for women diagnosed with OYST between 2004 and 2014. Overall survival (OS) was calculated following generation of Kaplan-Meir curves. Univariate analysis was performed with the log-rank test. A Cox model was constructed to determine independent predictors of mortality. RESULTS A total of 561 women were identified with a median age of 23years. The majority (58.5%) had early stage (I-II), while 29.6% and 11.9% had stage III and IV disease respectively. Five-year OS for women with stage I, II, III and IV disease were 94.8%, 97.1%, 70.9% and 51.6% respectively, p<0.001. Better 5-yr OS was observed for adolescents (94.4%) and young adults (89.3%) compared to older premenopausal (67.6%) and postmenopausal women (30.6%), p<0.001. Omentectomy, hysterectomy and lymph node sampling/dissection (LND) were not associated with better OS. Women who received adjuvant chemotherapy had superior OS compared to those who did not, p=0.016. Early disease stage, younger age and receipt of adjuvant chemotherapy, but not LND were independently associated with better mortality. CONCLUSIONS Women with OYST commonly present with early stage disease. Administration of adjuvant chemotherapy, early stage and younger age are associated with superior outcomes.
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Affiliation(s)
- Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Eloise Chapman-Davis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Melissa K Frey
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Thomas A Caputo
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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Chan JL, Wang ET. Oncofertility for women with gynecologic malignancies. Gynecol Oncol 2016; 144:631-636. [PMID: 28012689 DOI: 10.1016/j.ygyno.2016.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 11/30/2022]
Abstract
The emerging field of oncofertility addresses fertility and the reproductive health needs for cancer patients, a key topic in cancer survivorship. Given that the standard treatment for gynecologic malignancies involves removal of reproductive organs, pelvic radiation, or chemotherapy, the effect of such treatment on fertility and options for fertility preservation are even more relevant than for other malignancies. In young women with new diagnoses of cervical, endometrial, or ovarian cancers, viable strategies for fertility preservation without compromising oncological outcome exist and should be considered. We present here a comprehensive review of the literature as it pertains to gynecologic malignancies on 1) the effects of radiation and chemotherapy on fertility, 2) fertility-sparing surgeries and the role of assisted reproductive technology, and 3) fertility preservation in adolescent girls and women with BRCA germline mutations.
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Affiliation(s)
- Jessica L Chan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Erica T Wang
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
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36
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Feichtinger M, Rodriguez-Wallberg KA. Fertility preservation in women with cervical, endometrial or ovarian cancers. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:8. [PMID: 27468354 PMCID: PMC4962474 DOI: 10.1186/s40661-016-0029-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/06/2016] [Indexed: 12/19/2022]
Abstract
Background Although cancer in general affects an aged population, a significant number of women develop cancer at childbearing age. Long-term survival rates after gynecological cancer, especially in young patients are increasing and all quality-of-life aspects, including preservation of fertility have become of major relevance. Outcomes Surgical techniques aimed at sparing reproductive organs and preserving fertility have been developed for women presenting with gynecological cancer found at early stages. Indications for fertility-sparing surgery are in general restricted to women presenting with a well-differentiated low-grade tumor in its early stages or with low malignant potential. Up to now, use of fertility-sparing techniques in well-selected patients has not been shown to affect overall survival negatively and fertility outcomes reported have been favorable. Still larger amounts of data and longer follow-up periods are needed. Several current fertility-sparing cancer treatments may result in sub-fertility and in those cases assisted reproductive techniques are indicated. Overall quality of life has been satisfactory in cancer patients after fertility-sparing surgery. Conclusions Fertility-sparing surgery is a viable tool to enable gynecological cancer patients of young age to fulfill their family building without impairment of oncological outcome. Cancer patients of reproductive age should undergo fertility counseling to analyze this sensitive subject. Further studies are needed to investigate the role of fertility-sparing treatment and combined adjuvant therapy in higher-grade cancers.
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Affiliation(s)
- Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria ; Wunschbaby Institut Feichtinger, Vienna, Austria ; Department of Obstetrics and Gynecology, Section of Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology - Pathology, Karolinska Institutet, Stockholm, Sweden ; Department of Obstetrics and Gynecology, Section of Reproductive Medicine, Karolinska University Hospital, Novumhuset Plan 4, SE-141 86 Stockholm, Sweden
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de la Motte Rouge T, Pautier P, Genestie C, Rey A, Gouy S, Leary A, Haie-Meder C, Kerbrat P, Culine S, Fizazi K, Lhommé C. Prognostic significance of an early decline in serum alpha-fetoprotein during chemotherapy for ovarian yolk sac tumors. Gynecol Oncol 2016; 142:452-7. [PMID: 27401840 DOI: 10.1016/j.ygyno.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The ovarian yolk sac tumor (OYST) is a very rare malignancy arising in young women. Our objective was to determine whether an early decline in serum alpha-fetoprotein (AFP) during chemotherapy has a prognostic impact. METHODS This retrospective study is based on prospectively recorded OYST cases at Gustave Roussy (Cancer Treatment Center). Survival curves were estimated using the Kaplan-Meier method. The serum AFP decline was calculated with the formula previously developed and validated in male patients with poor prognosis non-seminomatous germ cell tumors. Univariate and multivariate analyses were performed using the log-rank test and logistic regression, respectively. RESULTS Data on AFP were available to calculate an early AFP decline in 57 patients. All patients had undergone surgery followed by chemotherapy. The 5-year overall survival (OS) and event-free survival (EFS) rates were 86% (95% CI: 74%-93%) and 84% (95% CI: 73%-91%), respectively. The disease stage, presence of ascites at presentation, use of the BEP regimen, serum AFP half-life and an early AFP decline were significantly predictive factors for OS and EFS in the univariate analysis. The OS rate was 100% and 49% (95% CI: 26%-72%) in patients with a favorable AFP decline and in those with an unfavorable decline, respectively (p<0.001). In the multivariate analysis, only the presence of ascites at diagnosis (RR=7.3, p=0.03) and an unfavorable early AFP decline (RR=16.9, p<0.01) were significant negative predictive factors for OS. CONCLUSIONS An early AFP decline during chemotherapy is an independent prognostic factor in patients with OYSTs. CONFLICT OF INTEREST STATEMENT No conflict of interest.
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Affiliation(s)
- Thibault de la Motte Rouge
- Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France
| | - Patricia Pautier
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Catherine Genestie
- Department of Biopathology, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Annie Rey
- Department of Biostatistics, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Sébastien Gouy
- Department of Surgery, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Alexandra Leary
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Christine Haie-Meder
- Department of Radiotherapy, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Pierre Kerbrat
- Department of Medical Oncology, Centre Eugène Marquis, Av de la bataille Flandres-Dunkerque, CS 44229, F-35042 Rennes, France
| | - Stéphane Culine
- Department of Medical Oncology, CHU Hôpital Saint Louis, 1 avenue Claude-Vellefaux, F-75010 Paris, France
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France
| | - Catherine Lhommé
- Department of Cancer Medicine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, F-94805 Villejuif, France.
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Abstract
ObjectiveThe aim of this study was to evaluate the clinicopathologic characteristics of patients with ovarian yolk sac tumor and the benefit of omentectomy in patients with clinical early-stage disease.MethodsThe medical records of 66 patients with ovarian yolk sac tumor were reviewed retrospectively.ResultsThere were 37, 8, 14, and 7 patients with stages I, II, III, and IV disease, respectively. Sixty-five patients received surgery and adjuvant chemotherapy, and 1 had chemotherapy only. The median follow-up was 78 months. The overall 5-year survival rate was 86.0%. Univariate analysis revealed that stage (P = 0 .022), age (P = 0.001), residual tumor (P = 0.036), and satisfactory α-fetoprotein (AFP) decline (defined as normalization of AFP after the first or second cycles of postsurgery chemotherapy, P = 0.006) were significant prognostic factors. Multivariate analysis revealed that satisfactory AFP decline was an independent significant prognostic factor for overall survival (P = 0.028). The postoperative pathology showed that only 1 (2.7%) of 37 patients who received omentectomy without gross spread had omentum metastasis microscopically. The 5-year survival rates were 89.2% and 100.0% for stage I-II patients with (36 cases) or without (9 cases) omentectomy, respectively (P > 0.05). Three of the 7 patients with recurrence were successfully salvaged and lived 38.0, 102.6, and 45.2 months after initial diagnosis.ConclusionsPostsurgery satisfactory AFP decline was an independent significant prognostic factor for patient survival. Omentectomy might not be of therapeutic significance for clinical stage I-II patients.
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Rudaitis V, Mickys U, Katinaitė J, Dulko J. Successful treatment of advanced stage yolk sac tumour of extragonadal origin: a case report and review of literature. Acta Med Litu 2016; 23:110-116. [PMID: 28356797 PMCID: PMC5088743 DOI: 10.6001/actamedica.v23i2.3327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background. Yolk sac tumour diagnosis should be considered for young age patients admitted to the hospital with non-specific complaints of widespread disease. Correct diagnosis and carefully planned treatment is the key to a successful outcome. Methods and materials. We present a rare case of a widespread yolk sack tumour of a uterine broad ligament. Our team directed a special attention towards the patient’s young age, advanced disease, and fertility sparing strategy of treatment. Results and conclusions. Stage IV yolk sac tumours of extragonadal origin are rarely reported in the literature. Hence, diagnosis and treatment often pose a challenge for emergency care unit doctors, gynaecologists, and oncologists. However, it can be a potentially curable disease. Moreover, patients’ fertility can also be preserved. We believe that further analysis of similar cases is necessary to study outcomes and evaluate patients’ responses to a sequence of medical decisions taken for this specific case.
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Affiliation(s)
- Vilius Rudaitis
- Clinic of Obstetrics and Gynaecology, Faculty of Medicine, Vilnius University.,Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Ugnius Mickys
- National Centre of Pathology, Santariskiu Clinics Affiliate, Vilnius.,Medical Faculty, Vilnius University, Vilnius, Lithuania
| | | | - Justyna Dulko
- Medical Faculty, Vilnius University, Vilnius, Lithuania
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Chen CA, Lin H, Weng CS, Wen KC, Lu CH, Chou HH, Huang YF, Kang CY, Ho CM, Yu MH, Chou CY. Outcome of 3-day bleomycin, etoposide and cisplatin chemotherapeutic regimen for patients with malignant ovarian germ cell tumours: a Taiwanese Gynecologic Oncology Group study. Eur J Cancer 2015; 50:3161-7. [PMID: 25459394 DOI: 10.1016/j.ejca.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/03/2014] [Accepted: 10/05/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The combination of bleomycin, etoposide and cisplatin (BEP) is currently the most widely used treatment for malignant ovarian germ cell tumours (MOGCTs). The aim of this study was to evaluate the efficacy and adverse effects of the 3-day BEP regimen in Taiwan. The prognostic factors of the MOGCT patients were also analysed. PATIENTS AND METHODS Two hundred and thirty-nine cases of MOGCTs were identified from the Taiwanese Gynecologic Oncology Group database, and 204 of those who received postoperative BEP chemotherapy were then analysed. RESULTS The estimated rate of no evidence of disease was 94.0% for 204 patients with adjuvant BEP regimen. Seven grade 3/4 haematological adverse effects including four subjects with neutropenia, one with pancytopenia and two with neutropenic fever were recorded in the 853 total courses of chemotherapeutic cycles. The rates of haematological and non-haematological adverse effects were 0.82% and 2.3%, respectively. No treatment-related mortality was noted. In the analysis of prognostic factors, only tumour stage had a significant impact on disease recurrence (95% confidence interval (CI), 4.2–94.4, p < 0.001) and disease-related mortality (95% CI, 2.2–163.9, p = 0.007). CONCLUSIONS The current 3-day adjuvant BEP regimen was effective and safe for patients with MOGCTs.
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Satoh T, Aoki Y, Kasamatsu T, Ochiai K, Takano M, Watanabe Y, Kikkawa F, Takeshima N, Hatae M, Yokota H, Saito T, Yaegashi N, Kobayashi H, Baba T, Kodama S, Saito T, Sakuragi N, Sumi T, Kamura T, Yoshikawa H. Administration of standard-dose BEP regimen (bleomycin+etoposide+cisplatin) is essential for treatment of ovarian yolk sac tumour. Eur J Cancer 2015; 51:340-51. [PMID: 25559616 DOI: 10.1016/j.ejca.2014.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/18/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to investigate prognostic factors, including postoperative chemotherapy regimen, for the treatment of ovarian yolk sac tumour (YST), and resulting fertility outcome. METHODS A multi-institutional retrospective investigation was undertaken to identify patients with ovarian pure or mixed YST who were treated between 1980 and 2007. Postoperative chemotherapy regimen and other variables were assessed in univariate and multivariate analyses. Additionally, the reproductive safety of the BEP (bleomycin, etoposide and cisplatin) regimen was evaluated. RESULTS There were 211 patients enrolled from 43 institutions. The BEP regimen and a non-BEP regimen were administered to 112 and 99 patients as postoperative chemotherapy, respectively. In univariate and multivariate analyses, age⩾22, alpha-fetoprotein⩾33,000 ng/ml, residual tumours after surgery and non-BEP regimen were independently and significantly associated with poor overall survival (OS). BEP was significantly superior to non-BEP in 5-year OS (93.6% versus 74.6%, P=0.0004). Reduced-dose BEP (<75% standard-dose bleomycin and<50% etoposide dose) was significantly associated with poorer 5-year OS compared with standard-dose BEP (89.4% versus 100%, P=0.02 and 62.5% versus 96.9%, P=0.0002). All patients who underwent fertility-sparing surgery recovered their menstrual cycles. Sixteen of 23 patients receiving BEP (70.0%) and 13 of 17 patients receiving non-BEP (76.5%) who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 21 and 19 healthy children, respectively. CONCLUSIONS The results of the present study suggest that standard-dose BEP should be administered for ovarian YST. BEP is as safe as non-BEP for preserving reproductive function.
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Affiliation(s)
- Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Yoichi Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Naha, Japan
| | - Takahiro Kasamatsu
- Department of Gynecologic, National Cancer Center Hospital, Tokyo, Japan
| | - Kazunori Ochiai
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Saitama, Japan
| | - Yoh Watanabe
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Masayuki Hatae
- Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima, Japan
| | | | - Toshiaki Saito
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University, Sendai, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences Kyushu University, Fukuoka, Japan
| | - Tsukasa Baba
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shoji Kodama
- Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Noriaki Sakuragi
- Department of Gynecology and Obstetrics, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Sumi
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshiharu Kamura
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyuki Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Zovko G, Madžarac V, Kukura V, Gašparov S, Kovačić-Vicić V, Bursać D. Successful Pregnancy After Conservative Treatment of Advanced Yolk-Sac Tumor of the Ovary. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2014.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gojko Zovko
- Department of Obstetrics and Gynecology, Merkur University Hospital, Zagreb, Croatia
| | - Vedran Madžarac
- Department of Obstetrics and Gynecology, Merkur University Hospital, Zagreb, Croatia
| | - Vlastimir Kukura
- Department of Obstetrics and Gynecology, Merkur University Hospital, Zagreb, Croatia
| | - Slavko Gašparov
- Department of Pathology, Merkur University Hospital, Zagreb, Croatia
| | - Vesna Kovačić-Vicić
- Department of Anaesthesia and Intensive Care, Merkur University Hospital, Zagreb, Croatia
| | - Danijel Bursać
- Department of Obstetrics and Gynecology, Merkur University Hospital, Zagreb, Croatia
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Lhommé C, Leary A, Uzan C, Pautier P, Gouy S, Morice P. Adjuvant Chemotherapy in Stage I Ovarian Germ Cell Tumors: Should Indications and Treatment Modalities Be Different in Young Girls and Adults? J Clin Oncol 2014; 32:2815-6. [DOI: 10.1200/jco.2014.56.1431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Catherine Uzan
- Institut National de la Santé et de la Recherche Médicale Unit U10-30, Villejuif; University Paris Sud, Le Kremlin-Bicêtre, France
| | | | | | - Philippe Morice
- Gustave Roussy; Institut National de la Santé et de la Recherche Médicale Unit U10-30, Villejuif; University Paris Sud, Le Kremlin-Bicêtre, France
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Billmire DF, Krailo M, Rodriguez-Galindo C, Frazier AL. Reply to G. Mangili et al and C. Lhommé et al. J Clin Oncol 2014; 32:2816-7. [PMID: 25071123 DOI: 10.1200/jco.2014.56.3890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Mark Krailo
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - A Lindsay Frazier
- Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA
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Gadducci A, Lanfredini N, Tana R. Menstrual function and childbearing potential after fertility-sparing surgery and platinum-based chemotherapy for malignant ovarian germ cell tumours. Gynecol Endocrinol 2014; 30:467-71. [PMID: 24702194 DOI: 10.3109/09513590.2014.907262] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malignant ovarian germ cell tumours (MOGCT) account for 5% of all ovarian malignancies. Their elevated chemosensitivity, the frequent unilaterality and the young age of patients have strongly supported the conservative surgery as the standard approach, often followed by adjuvant platinum-based chemotherapy. The risk for recurrence is not affected by the performance of conservative versus radical surgery. During chemotherapy 50% of patients become amenorrhoeic but more than 95% of them resume normal menses after treatment completion. Literature has reported several healthy babies born after fertility-sparing surgery with or without chemotherapy for MOGCT. The incidence of miscarriages is in the normal range, whereas malformation rate is slightly higher compared to general population, without any difference between chemotherapy-treated and -untreated patients. Therefore, young women with MOGCT must be reassured of their excellent chances of survival and fertility preservation following conservative surgery and adjuvant platinum-based chemotherapy.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
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46
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Sacco JJ, Cliff J, Green JA. Chemotherapy for gynaecological malignancies and fertility preservation. World J Obstet Gynecol 2014; 3:54-60. [DOI: 10.5317/wjog.v3.i2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/31/2013] [Accepted: 08/06/2013] [Indexed: 02/05/2023] Open
Abstract
Infertility is an increasingly important issue for patients surviving cancer. Significant improvements in cancer management have led to greater numbers of patients living healthy and fulfilling lives for many years after a diagnosis of cancer, and the ability to bear children is a major component of well-being. Infertility is particularly challenging in gynaecological cancer, where multiple treatment modalities are often employed. Surgery may involve the removal of reproductive organs and subsequent chemotherapy may also lead to infertility. Mitigation of this through the use of cryopreservation of embryos, oocytes or ovarian tissue before chemotherapy may enable subsequent pregnancy in the patient or a surrogate mother. Suppression of ovarian function during chemotherapy is less well established, but promises a reduction in infertility without the risks associated with surgery. Similarly, evolving chemotherapy regimens with replacement of alkylating agents will reduce the incidence of infertility. With a combination of these techniques, an increasing proportion of patients may be able to conceive after completion of treatment, and there is no evidence of an increase in congenital abnormalities. This review discusses chemotherapy-induced infertility, interventions and success rates, and demonstrates that individualisation of management is required for optimum outcome.
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Lu Y, Yang J, Cao D, Huang H, Wu M, You Y, Chen J, Lang J, Shen K. Role of neoadjuvant chemotherapy in the management of advanced ovarian yolk sac tumor. Gynecol Oncol 2014; 134:78-83. [PMID: 24582864 DOI: 10.1016/j.ygyno.2014.02.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the study was to identify the role of neoadjuvant chemotherapy (NACT) in the treatment of the patients with advanced stage ovarian yolk sac tumor (OYST). METHODS The comparative study was based on 53 cases with advanced stage OYST registered at Peking Union Medical College Hospital from 1995 to 2010. Twenty one cases were treated with NACT followed by interval debulking surgery (IDS). Thirty two cases were treated with primary debulking surgery (PDS). Data on patient characteristics, treatment and survival were analyzed and compared between two groups to assess the outcome of NACT. RESULTS After NACT, the overall status of the patients was improved significantly. Patients in NACT had better optimal cytoreduction rate and less peri-operative morbidities. Seven patients (13.2%) suffered from relapse. There was a significantly better PFS for patients with ovarian tumor size >20cm in the NACT than those underwent PDS. Residual disease >2cm was the independent risk factor of relapse. CONCLUSIONS NACT is the better treatment option for some patients with advanced stage OYST, especially for those with unresectable tumors and poor general condition.
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Affiliation(s)
- Yan Lu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China
| | - Huifang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China
| | - Yan You
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China
| | - Jie Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China
| | - Jinhe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, People's Republic of China and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, People's Republic of China.
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Mui WH, Lee KC, Chiu SC, Pang CY, Chu SK, Man CW, Wong CS, Sze WK, Tung Y. Primary yolk sac tumour of the urinary bladder: A case report and review of the literature. Oncol Lett 2013; 7:199-202. [PMID: 24348848 PMCID: PMC3861607 DOI: 10.3892/ol.2013.1670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/22/2013] [Indexed: 01/02/2023] Open
Abstract
We present a case of rare primary yolk sac tumour of the urinary bladder in adulthood. A 31-year-old female patient presented with a history of chronic ketamine abuse, which has not previously been shown to be associated with malignancy development. The final diagnosis was established only after radical cystectomy. A computed tomography (CT) scan showed paraaortic lymph node metastasis. The patient was treated with systemic chemotherapy. A review of the literature revealed that surgical excision and cisplatin-based chemotherapy remain to be the standard of care for extragonadal yolk sac tumours.
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Affiliation(s)
- Wing Ho Mui
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Ka Chai Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Sin Chuen Chiu
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Chun Yin Pang
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Sau Kwan Chu
- Department of Surgery, Division of Urology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Chi Wai Man
- Department of Surgery, Division of Urology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Chi Sing Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Wing Kin Sze
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
| | - Yuk Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, P.R. China
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Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer 2011; 21:951-63. [PMID: 21697684 DOI: 10.1097/igc.0b013e31821bec6b] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In young patients with borderline ovarian tumor a conservative treatment approach does not seem to have a significant impact on survival, and the outcome regarding fertility is good in general. It can be considered even if noninvasive peritoneal implants are discovered at the time of the initial surgery. In contrast, in patients with epithelial ovarian cancer, conservative surgery should be considered only in adequately staged patients, with a stage IA grade 1 (and probably 2) serous, mucinous or an endometrioid tumor, including a careful follow-up. Such an approach could also probably be discussed in stage IC grade 1 disease.In patients with nonepithelial malignant ovarian tumors, conservative surgery is also feasible, particularly in patients with malignant germ cell tumors because of their high chemosensitivity leading to an excellent prognosis in general.
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Doi M, Okamoto Y, Yamauchi M, Naitou H, Shinozaki K. Bleomycin-induced pulmonary fibrosis after tumor lysis syndrome in a case of advanced yolk sac tumor treated with bleomycin, etoposide and cisplatin (BEP) chemotherapy. Int J Clin Oncol 2011; 17:528-31. [PMID: 22127348 DOI: 10.1007/s10147-011-0356-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 11/15/2011] [Indexed: 11/29/2022]
Abstract
Ovarian yolk sac tumor (YST) is a highly aggressive malignancy arising in young women. Chemotherapy has dramatically improved the prognosis, and bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy appears to be the most effective combination regimen. A 23-year-old woman was admitted to our hospital with worsening abdominal distention and a lower abdominal mass. She was diagnosed with a stage IIIc pure YST of the right ovary, and right salpingo-oophorectomy was performed; there were numerous disseminated peritoneal tumors within the abdominal cavity. A few days postoperatively, massive ascites developed, and right hydronephrosis occurred. Chemotherapy with BEP was started, and after 24 h of administration, oliguria and tumor lysis syndrome (TLS) developed. Continuous hemodiafiltration was started, and hemodialysis was initiated following full-dose standard cisplatin and etoposide on days 2-5 of the 1st cycle. After the electrolyte abnormalities and the elevation of creatinine became normal, the patient received an additional three cycles of BEP and achieved complete remission. However, she also suffered from severe non-hematological toxicities, including grade 3 left ventricular dysfunction and grade 4 pulmonary fibrosis. In the case of rapidly progressing and high-volume YST treated with BEP chemotherapy, special attention should be paid to bleomycin-induced pulmonary toxicity following TLS. Further study is required to optimize drug exposure to ensure efficacy and reduce the risk of side effects in this population.
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Affiliation(s)
- Mihoko Doi
- Department of Clinical Oncology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima 734-8530, Japan.
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