Neo-adjuvant chemotherapy in the treatment of advanced malignant germ cell tumors of ovary

• We used four cycles of BEP (bleomycin, etoposide, cisplatin) prior to fertility sparing.
• Surgery for patients with advanced malignant ovarian germ cell tumor.
• Complete and partial response rate to NACT followed by fertility sparing surgery was 90%.
• All eligible patients had recovery of menstrual and reproductive functions.

ObjectiveIn order to preserve fertility, we attempted neo-adjuvant chemotherapy (NACT) in patients of malignant ovarian germ cell tumor (MOGCT) with advance and bulky disease.Patients and methodsBetween January 1988 and December 2009, 23 patients received NACT. Patient's median age was 19 years, ranging from 14 to 28 years. FIGO stages III — 20 and IV — 3. Histology subtypes were: dysgerminoma, n = 14, mixed GCT, n = 6 and 3 had endodermal sinus tumor. Patients were planned for four cycles of BEP (bleomycin, etoposide and cisplatin) chemotherapy followed by fertility sparing surgery (unilateral salpingo-oophorectomy + omentectomy ± lymphadenectomy).ResultsFollowing NACT — 21 patients responded; complete (CR) — 16 and partial response (PR) — 5. One patient progressed and another was lost to follow-up after 2 cycles. 18 of 21 responders underwent surgery; 13/18 had pathological CR, 5/18 had residual disease and achieved CR following 2 more cycles of BEP. 3 patients refused for surgery; 2 relapsed at 9 and 12 months, and achieved second CR following salvage chemotherapy and surgery, third patient continues to be disease-free. Currently, 21 of 23 patients are alive and disease-free at a median follow-up of 74 months. 18/21 patients have resumed menstruation and 10 eligible patients have delivered 13 full term healthy babies. These results are comparable to patients with advanced disease (n = 43) treated with standard approach (initial surgery and adjuvant chemotherapy) during the same period.ConclusionNACT followed by fertility sparing surgery could be a reasonable option for patients of advanced MOGCT, not suitable for optimal cyto-reduction.