Ovarian germ cell tumor medical therapy: Difference between revisions

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{{CMG}}{{AE}} {{Sahar}} {{MD}}
{{CMG}}{{AE}} {{Sahar}} {{MD}}
==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
* Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas. The platinum-based regimen is currently the most effective management.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
* Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas.<ref> "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer. National comprehensive cancer network, 2011; http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf."</ref>
* Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas.<ref> "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer. National comprehensive cancer network, 2011; http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf."</ref><ref name="GershensonMorris1990">{{cite journal|last1=Gershenson|first1=D M|last2=Morris|first2=M|last3=Cangir|first3=A|last4=Kavanagh|first4=J J|last5=Stringer|first5=C A|last6=Edwards|first6=C L|last7=Silva|first7=E G|last8=Wharton|first8=J T|title=Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin.|journal=Journal of Clinical Oncology|volume=8|issue=4|year=1990|pages=715–720|issn=0732-183X|doi=10.1200/JCO.1990.8.4.715}}</ref>
* In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.   
* In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.   
* In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.
* In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.

Revision as of 18:44, 12 March 2019

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

Overview

  • Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas. The platinum-based regimen is currently the most effective management.

Medical Therapy

  • Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas.[1][2]
  • In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.
  • In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.
  • Platinum-based regimen is currently the most effective management.
    • This regimen is as following:
      • Bleomycin 30 Unit IV per dose be given on day 1, 8, and 15 of the cycle
        • It must be diluted in 50 ml of normal saline (NS) and over 10 minutes.
      • Etoposide 100 mg/m2 IV per day be given on days 1-5.
        • It must be diluted in 500 ml NS (concentration less than 0.4 mg/mL) and administered over one hour.
      • Cisplatin 20 mg/m2 IV per day be given on Days 1 through 5.
        • It must be diluted in 250 mL NS and administer over two hours.
        • No aluminum needles or intravenous sets be used for the administration.
    • This regimen is given every 21 days for three cycles (or four cycles in the presence of bulky residual disease after surgery.
    • Factors that should be monitored during the treatment:
      • Complete blood count (CBC) weekly during treatment
      • Liver function test (LFT) before each treatment cycle
      • Creatinin and electrolytes before each treatment cycle
      • Pulmonary function test before starting bleomycin and at repeated intervals

Medical Therapy

  • The mainstay of therapy for ovarian germ cell tumor is chemotherapy.[3][4][5][6]
  • There is no pharmacologic therapy for the mature teratoma.

Stage I ovarian germ cell tumors

  • Dysgerminomas
  • Other germ cell tumors

Stage II ovarian germ cell tumors

  • Dysgerminomas
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy
  • Other germ cell tumors
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy

Stage III ovarian germ cell tumors

  • Dysgerminomas
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy
  • Other germ cell tumors
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy

Stage IV ovarian germ cell tumors

  • Dysgerminomas
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy
  • Other germ cell tumors
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
  • Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy

References

  1. ↑ "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer. National comprehensive cancer network, 2011; http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf."
  2. ↑ Gershenson, D M; Morris, M; Cangir, A; Kavanagh, J J; Stringer, C A; Edwards, C L; Silva, E G; Wharton, J T (1990). "Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin". Journal of Clinical Oncology. 8 (4): 715–720. doi:10.1200/JCO.1990.8.4.715. ISSN 0732-183X.
  3. ↑ Stage I Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015
  4. ↑ Stage II Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015
  5. ↑ Stage III Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015
  6. ↑ Stage IV Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015

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