The types and treatment outcomes of germ cell tumours of the ovary seen at Groote Schuur Hospital, Cape Town, between 1994 and 2008: a retrospective survey
Keywords: Malignant Ovarian Germ Cell tumours, fertility-sparing surgery, chemotherapy, HIV infection.
AbstractObjective: This retrospective observational study aims to review patients with malignant ovarian germ cell tumours (MOGCTs) treated at Groote Schuur Hospital over a 15-year period. Method: A medical chart review of adult patients with MOGCTs treated between 1994 and 2008 was conducted. Gathered data were transferred to an electronic spreadsheet. The Kaplan-Meier method was used to obtain fiveyear survival data. Results: Forty patients were treated for MOGCTs. Median age at the time of diagnosis was 30.2 years (a range of 13-63 years). Ten patients (25%) had dysgerminoma and 30 (75%) had non-dysgerminomatous types. The latter group comprised immature teratoma (10 patients), yolk sac tumour (8), mixed germ cell tumour (3), and mature teratoma with malignant transformation (MTMT) (9). Standard staging surgery was performed with fertilitysparing procedures wherever possible. Chemotherapy entailed a three-day modified bleomycin/etoposide/cisplatinum (BEP) regimen during the study period. Excluding the group of nine with monodermal malignant transformation in mature teratoma, complete response to primary treatment was achieved in 24 of 31 patients (77.4%). After a median follow-up of 42.5 months (a range of 2-60), the overall five-year survival rate was 69.1%. The overall five-year survival rate was only 40% in five human immunodeficiency virus (HIV)-positive patients. Four of the nine patients with MTMT were alive after five years. Conclusion: The prognosis of MOGCTs is excellent if managed with standard treatment initially. Treatment of MTMT is less well defined. Patients with advanced HIV infection did poorly and should be considered for initiation of antiretroviral therapy prior to chemotherapy.
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