Ovarian germ cell tumor medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*There is no pharmacologic therapy for the mature teratoma. | |||
* Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 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> | * 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. | ||
* Platinum-based regimen is currently the most effective management. | * Platinum-based regimen is currently the most effective management. | ||
** This regimen is as following: | ** This regimen is as following: | ||
| Line 24: | Line 24: | ||
***Creatinin and electrolytes before each treatment cycle | ***Creatinin and electrolytes before each treatment cycle | ||
***Pulmonary function test before starting bleomycin and at repeated intervals | ***Pulmonary function test before starting bleomycin and at repeated intervals | ||
===Treatment during pregnancy=== | |||
* In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.<ref name="HubalekSmekal-Schindelwig2007">{{cite journal|last1=Hubalek|first1=Michael|last2=Smekal-Schindelwig|first2=Caecilia|last3=Zeimet|first3=Alain G.|last4=Sergi|first4=Consolato|last5=Brezinka|first5=Christoph|last6=Mueller-Holzner|first6=Elisabeth|last7=Marth|first7=Christian|title=Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma|journal=Archives of Gynecology and Obstetrics|volume=276|issue=2|year=2007|pages=179–183|issn=0932-0067|doi=10.1007/s00404-007-0328-2}}</ref> | |||
*Etoposide use is associated with teratogenicity during the first trimester of the pregnancy and therefore should be avoided.<ref name="AmantHalaska2014">{{cite journal|last1=Amant|first1=Frédéric|last2=Halaska|first2=Michael J.|last3=Fumagalli|first3=Monica|last4=Dahl Steffensen|first4=Karina|last5=Lok|first5=Christianne|last6=Van Calsteren|first6=Kristel|last7=Han|first7=Sileny N.|last8=Mir|first8=Olivier|last9=Fruscio|first9=Robert|last10=Uzan|first10=Cathérine|last11=Maxwell|first11=Cynthia|last12=Dekrem|first12=Jana|last13=Strauven|first13=Goedele|last14=Mhallem Gziri|first14=Mina|last15=Kesic|first15=Vesna|last16=Berveiller|first16=Paul|last17=van den Heuvel|first17=Frank|last18=Ottevanger|first18=Petronella B.|last19=Vergote|first19=Ignace|last20=Lishner|first20=Michael|last21=Morice|first21=Philippe|last22=Nulman|first22=Irena|title=Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting|journal=International Journal of Gynecologic Cancer|volume=24|issue=3|year=2014|pages=394–403|issn=1048-891X|doi=10.1097/IGC.0000000000000062}}</ref> | *Etoposide use is associated with teratogenicity during the first trimester of the pregnancy and therefore should be avoided.<ref name="AmantHalaska2014">{{cite journal|last1=Amant|first1=Frédéric|last2=Halaska|first2=Michael J.|last3=Fumagalli|first3=Monica|last4=Dahl Steffensen|first4=Karina|last5=Lok|first5=Christianne|last6=Van Calsteren|first6=Kristel|last7=Han|first7=Sileny N.|last8=Mir|first8=Olivier|last9=Fruscio|first9=Robert|last10=Uzan|first10=Cathérine|last11=Maxwell|first11=Cynthia|last12=Dekrem|first12=Jana|last13=Strauven|first13=Goedele|last14=Mhallem Gziri|first14=Mina|last15=Kesic|first15=Vesna|last16=Berveiller|first16=Paul|last17=van den Heuvel|first17=Frank|last18=Ottevanger|first18=Petronella B.|last19=Vergote|first19=Ignace|last20=Lishner|first20=Michael|last21=Morice|first21=Philippe|last22=Nulman|first22=Irena|title=Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting|journal=International Journal of Gynecologic Cancer|volume=24|issue=3|year=2014|pages=394–403|issn=1048-891X|doi=10.1097/IGC.0000000000000062}}</ref> | ||
*Also its use is associated with | *Also its use is associated with neonatal delayed growth and bone marrow suppresssion.<ref name="CardonickIacobucci2004">{{cite journal|last1=Cardonick|first1=Elyce|last2=Iacobucci|first2=Audrey|title=Use of chemotherapy during human pregnancy|journal=The Lancet Oncology|volume=5|issue=5|year=2004|pages=283–291|issn=14702045|doi=10.1016/S1470-2045(04)01466-4}}</ref> | ||
* Paclitaxel-carboplatin or cisplatin-vinblastine-bleomycin may is recommended to be used during the preganacy.<ref name="AmantHalaska2014">{{cite journal|last1=Amant|first1=Frédéric|last2=Halaska|first2=Michael J.|last3=Fumagalli|first3=Monica|last4=Dahl Steffensen|first4=Karina|last5=Lok|first5=Christianne|last6=Van Calsteren|first6=Kristel|last7=Han|first7=Sileny N.|last8=Mir|first8=Olivier|last9=Fruscio|first9=Robert|last10=Uzan|first10=Cathérine|last11=Maxwell|first11=Cynthia|last12=Dekrem|first12=Jana|last13=Strauven|first13=Goedele|last14=Mhallem Gziri|first14=Mina|last15=Kesic|first15=Vesna|last16=Berveiller|first16=Paul|last17=van den Heuvel|first17=Frank|last18=Ottevanger|first18=Petronella B.|last19=Vergote|first19=Ignace|last20=Lishner|first20=Michael|last21=Morice|first21=Philippe|last22=Nulman|first22=Irena|title=Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting|journal=International Journal of Gynecologic Cancer|volume=24|issue=3|year=2014|pages=394–403|issn=1048-891X|doi=10.1097/IGC.0000000000000062}}</ref> | |||
* | ===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</ref><ref name= sss> Stage II Ovarian Germ Cell Tumors | ||
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name= sss> 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</ref><ref name= www> Stage III Ovarian Germ Cell Tumors | . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015</ref><ref name= www> 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</ref><ref name= rrr> Stage IV Ovarian Germ Cell Tumors | . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name= rrr> 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</ref> | . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref> | ||
* Dysgerminomas | * Dysgerminomas | ||
:* Unilateral [[salpingo-oophorectomy]] with adjuvant [[radiation]] therapy or chemotherapy | :* Unilateral [[salpingo-oophorectomy]] with adjuvant [[radiation]] therapy or chemotherapy | ||
Revision as of 14:18, 13 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
- There is no pharmacologic therapy for the mature teratoma.
- Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas.[1][2]
- In those with stage 1a dysgerminoma and immature teratoma, surgery will be curative.
- Platinum-based regimen is currently the most effective management.
- This regimen is as following:
- Bleomycin 30 Unit IV per dose be given on day 1, 8, and 15 of the cycle
- It must be diluted in 50 ml of normal saline (NS) and over 10 minutes.
- Etoposide 100 mg/m2 IV per day be given on days 1-5.
- It must be diluted in 500 ml NS (concentration less than 0.4 mg/mL) and administered over one hour.
- Cisplatin 20 mg/m2 IV per day be given on Days 1 through 5.
- It must be diluted in 250 mL NS and administer over two hours.
- No aluminum needles or intravenous sets be used for the administration.
- Bleomycin 30 Unit IV per dose be given on day 1, 8, and 15 of the cycle
- 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
- This regimen is as following:
Treatment during pregnancy
- In pregnant women, chemotherapy should be postponed at least until the end of the first trimester.[3]
- Etoposide use is associated with teratogenicity during the first trimester of the pregnancy and therefore should be avoided.[4]
- Also its use is associated with neonatal delayed growth and bone marrow suppresssion.[5]
- Paclitaxel-carboplatin or cisplatin-vinblastine-bleomycin may is recommended to be used during the preganacy.[4]
===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</ref>[6][7][8]
- Dysgerminomas
- Unilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
- Other germ cell tumors
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
Stage II ovarian germ cell tumors
- Dysgerminomas
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant radiation therapy or chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Other germ cell tumors
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
Stage III ovarian germ cell tumors
- Dysgerminomas
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Other germ cell tumors
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy, with or without neoadjuvant chemotherapy
Stage IV ovarian germ cell tumors
- Dysgerminomas
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy
- Other germ cell tumors
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
- Unilateral salpingo-oophorectomy with adjuvant chemotherapy with or without neoadjuvant chemotherapy
References
- ↑ "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer. National comprehensive cancer network, 2011; http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf."
- ↑ 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.
- ↑ Hubalek, Michael; Smekal-Schindelwig, Caecilia; Zeimet, Alain G.; Sergi, Consolato; Brezinka, Christoph; Mueller-Holzner, Elisabeth; Marth, Christian (2007). "Chemotherapeutic treatment of a pregnant patient with ovarian dysgerminoma". Archives of Gynecology and Obstetrics. 276 (2): 179–183. doi:10.1007/s00404-007-0328-2. ISSN 0932-0067.
- ↑ 4.0 4.1 Amant, Frédéric; Halaska, Michael J.; Fumagalli, Monica; Dahl Steffensen, Karina; Lok, Christianne; Van Calsteren, Kristel; Han, Sileny N.; Mir, Olivier; Fruscio, Robert; Uzan, Cathérine; Maxwell, Cynthia; Dekrem, Jana; Strauven, Goedele; Mhallem Gziri, Mina; Kesic, Vesna; Berveiller, Paul; van den Heuvel, Frank; Ottevanger, Petronella B.; Vergote, Ignace; Lishner, Michael; Morice, Philippe; Nulman, Irena (2014). "Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting". International Journal of Gynecologic Cancer. 24 (3): 394–403. doi:10.1097/IGC.0000000000000062. ISSN 1048-891X.
- ↑ Cardonick, Elyce; Iacobucci, Audrey (2004). "Use of chemotherapy during human pregnancy". The Lancet Oncology. 5 (5): 283–291. doi:10.1016/S1470-2045(04)01466-4. ISSN 1470-2045.
- ↑ 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
- ↑ 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
- ↑ 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