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| {{CMG}}{{AE}} {{Sahar}} | | {{CMG}}{{AE}} {{Sahar}} |
| ==Overview== | | ==Overview== |
| * [[Adjuvant]] [[Chemotherapy]] is recommended for all the patients with [[Diagnosis|diagnosed]] [[malignant]] [[ovarian]] [[germ cell]] [[tumor]], except those with stage 1a, stage 1a, 1b [[dysgerminoma]], and grade 1 immature [[Teratoma|teratomas]]. The [[platinum]]-based regimen is currently the most effective management.
| | Among [[ovarian]] [[germ cell]] [[tumors]], only [[dysgerminoma]] is [[radiosensitive]]. |
| | | Raditherapy is not anymore the first opttion of tratment for [[dysgerminoma]] considering its association with ovarian failure development. |
| ==Medical Therapy== | | ==Radiotherapy== |
| *There is no [[pharmacologic]] [[therapy]] for the [[Mature cystic teratoma|mature teratoma]]. | | * Not all the [[ovarian]] [[germ cell]] [[tumors]] are [[radiosensitive]]. <ref name="ChenRuiz2003">{{cite journal|last1=Chen|first1=Vivien W.|last2=Ruiz|first2=Bernardo|last3=Killeen|first3=Jeffrey L.|last4=Cot�|first4=Timothy R.|last5=Wu|first5=Xiao Cheng|last6=Correa|first6=Catherine N.|last7=Howe|first7=Holly L.|title=Pathology and classification of ovarian tumors|journal=Cancer|volume=97|issue=S10|year=2003|pages=2631–2642|issn=0008-543X|doi=10.1002/cncr.11345}}</ref> |
| * [[Adjuvant]] [[Chemotherapy]] is recommended for all the patients with [[Diagnose|diagnosed]] [[malignant]] [[ovarian]] [[germ cell]] [[tumor]], except those with stage 1a, stage 1a and 1b [[dysgerminoma]], and grade 1 immature [[Teratoma|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>
| | * [[Dysgerminoma]] is a [[radiosensitive]] [[tumor]]. |
| * In those with stage 1a [[dysgerminoma]] and immature [[teratoma]], [[surgery]] will be curative. | | * [[Radiotherapy]] is not the first option for treating [[dysgerminoma]] and it reserved for patients for whom [[chemotherapy]] is contraindicated for whatever reason. |
| * [[Platinum]]-based regimen is currently the most effective management. | | * Whole abdomina [[radiotherapy]] is used for the treatment of [[dysgerminoma]], however, it may be associated with [[ovarian failure]].<ref name="MitchellGershenson1991">{{cite journal|last1=Mitchell|first1=Michele Follen|last2=Gershenson|first2=David M.|last3=Soeters|first3=Robbert-Paul|last4=Eifel|first4=Patricia J.|last5=Delclos|first5=Luis|last6=Wharton|first6=J. Taylor|title=Long-term effects of radiation therapy on patients with ovarian dysgerminoma|journal=Cancer|volume=67|issue=4|year=1991|pages=1084–1090|issn=0008-543X|doi=10.1002/1097-0142(19910215)67:4<1084::AID-CNCR2820670436>3.0.CO;2-E}}</ref> |
| ** This regimen is as following:
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| *** [[Bleomycin]] 30 Unit [[Intravenous therapy|IV]] per [[dose]] be given on day 1, 8, and 15 of the cycle
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| **** It must be [[diluted]] in 50 ml of [[normal saline]] ([[Normal saline|NS]]) and over 10 minutes.
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| *** [[Etoposide]] 100 mg/m2 [[IV]] per day be given on days 1-5.
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| **** It must be [[diluted]] in 500 ml [[Normal saline|NS]] (concentration less than 0.4 mg/mL) and administered over one hour.
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| *** [[Cisplatin]] 20 mg/m2 [[Intravenous therapy|IV]] per day be given on Days 1 through 5.
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| **** It must be [[diluted]] in 250 ml [[Normal saline|NS]] and administer over two hours.
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| **** No aluminum needles or [[intravenous]] sets be used for the administration.
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| ** This regimen is given every 21 days for three cycles (or four cycles in the presence of bulky residual [[disease]] after [[surgery]].
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| ** Factors that should be monitored during the treatment: | |
| ***[[Complete blood count]] ([[CBC]]) weekly during treatment
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| ***[[Liver function test]] ([[LFT]]) before each treatment cycle
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| ***[[Creatinine|Creatinin]] and [[Electrolyte|electrolytes]] before each treatment cycle
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| ***[[Pulmonary function test]] before starting [[bleomycin]] and at repeated intervals
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| ** The overall [[survival rate]] for the patients treated with this regimen is 87% to 98%.<ref name="SegelovCampbell1994">{{cite journal|last1=Segelov|first1=E|last2=Campbell|first2=J|last3=Ng|first3=M|last4=Tattersall|first4=M|last5=Rome|first5=R|last6=Free|first6=K|last7=Hacker|first7=N|last8=Friedlander|first8=M L|title=Cisplatin-based chemotherapy for ovarian germ cell malignancies: the Australian experience.|journal=Journal of Clinical Oncology|volume=12|issue=2|year=1994|pages=378–384|issn=0732-183X|doi=10.1200/JCO.1994.12.2.378}}</ref><ref name="DimopoulosPapadimitriou2004">{{cite journal|last1=Dimopoulos|first1=Meletios A.|last2=Papadimitriou|first2=Christos|last3=Hamilos|first3=Georgios|last4=Efstathiou|first4=Eleni|last5=Vlahos|first5=Georgios|last6=Rodolakis|first6=Alexandros|last7=Aravantinos|first7=Gerassimos|last8=Kalofonos|first8=Haralambos|last9=Kouroussis|first9=Charalambos|last10=Gika|first10=Dimitra|last11=Skarlos|first11=Dimosthenis|last12=Bamias|first12=Aristotle|title=Treatment of ovarian germ cell tumors with a 3-day bleomycin, etoposide, and cisplatin regimen: a prospective multicenter study|journal=Gynecologic Oncology|volume=95|issue=3|year=2004|pages=695–700|issn=00908258|doi=10.1016/j.ygyno.2004.08.018}}</ref>
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| * Another regimen for the treatment of [[ovarian]] [[germ cell]] [[tumors]] is the combination of [[Vincristine]], [[dactinomycin]], and [[cyclophosphamide]] (VAC); however, [[Platinum]]-based regimen are now preferred because of a lower relapse rate and shorter treatment time.<ref name="WilliamsBlessing1994">{{cite journal|last1=Williams|first1=S|last2=Blessing|first2=J A|last3=Liao|first3=S Y|last4=Ball|first4=H|last5=Hanjani|first5=P|title=Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group.|journal=Journal of Clinical Oncology|volume=12|issue=4|year=1994|pages=701–706|issn=0732-183X|doi=10.1200/JCO.1994.12.4.701}}</ref>
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| ===Treatment during pregnancy===
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| * 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>
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| * [[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>
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| ** Also its use is associated with neonatal delayed growth and [[bone marrow suppression]].<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>
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| * [[Paclitaxel]]-[[carboplatin]] or [[cisplatin]]-[[vinblastine]]-[[bleomycin]] is recommended to be used during the [[pregnancy]].<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>
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| * [[Chemotherapy]] during the second and third [[trimester]] of [[pregnancy]] has not been observed to be associated with increased risk of [[fetal]] [[abnormalities]].<ref name="pmid12094965">{{cite journal |vauthors=Khi C, Low JJ, Tay EH, Chew SH, Ho TH |title=Malignant ovarian germ cell tumors: the KK Hospital experience |journal=Eur. J. Gynaecol. Oncol. |volume=23 |issue=3 |pages=251–6 |date=2002 |pmid=12094965 |doi= |url=}}</ref>
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| * [[Miscarriage]] rate following [[chemotherapeutic]] treatment has been reported to be the same as for general population.<ref name="ZanettaBonazzi2001">{{cite journal|last1=Zanetta|first1=Gerardo|last2=Bonazzi|first2=Cristina|last3=Cantù|first3=Maria Grazia|last4=Bini†|first4=Sergio|last5=Locatelli|first5=Anna|last6=Bratina|first6=Giorgio|last7=Mangioni|first7=Costantino|title=Survival and Reproductive Function After Treatment of Malignant Germ Cell Ovarian Tumors|journal=Journal of Clinical Oncology|volume=19|issue=4|year=2001|pages=1015–1020|issn=0732-183X|doi=10.1200/JCO.2001.19.4.1015}}</ref>
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| ===Chemotherapy for malignant ovarian germ cell tumors and ovarian function===
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| The long term effects of [[chemotherapy]] on ability of [[ovary]] for future [[pregnancies]] has been studied and the results are as following:
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| * In one study, 83% of cases treated for these [[tumors]], resumed regular [[period]] during follow ups.<ref name="Gershenson1988">{{cite journal|last1=Gershenson|first1=D M|title=Menstrual and reproductive function after treatment with combination chemotherapy for malignant ovarian germ cell tumors.|journal=Journal of Clinical Oncology|volume=6|issue=2|year=1988|pages=270–275|issn=0732-183X|doi=10.1200/JCO.1988.6.2.270}}</ref>
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| * In another study, regular [[menses]] resumed in 100% of patients within 1 year of [[chemotherapy]] completion.<ref name="WeinbergLurain2011">{{cite journal|last1=Weinberg|first1=Lori E.|last2=Lurain|first2=John R.|last3=Singh|first3=Diljeet K.|last4=Schink|first4=Julian C.|title=Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors|journal=Gynecologic Oncology|volume=121|issue=2|year=2011|pages=285–289|issn=00908258|doi=10.1016/j.ygyno.2011.01.003}}</ref>
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| * [[Infertility]] rate for women who has been treated [[Chemotherapeutic|chemo-therapeutically]] for these [[tumors]] has been reported between 5% and 10%.<ref name="Gershenson1988">{{cite journal|last1=Gershenson|first1=D M|title=Menstrual and reproductive function after treatment with combination chemotherapy for malignant ovarian germ cell tumors.|journal=Journal of Clinical Oncology|volume=6|issue=2|year=1988|pages=270–275|issn=0732-183X|doi=10.1200/JCO.1988.6.2.270}}</ref><ref name="pmid10918171">{{cite journal |vauthors=Low JJ, Perrin LC, Crandon AJ, Hacker NF |title=Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumors. A review of 74 cases |journal=Cancer |volume=89 |issue=2 |pages=391–8 |date=July 2000 |pmid=10918171 |doi= |url=}}</ref>
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| ==References== | | ==References== |