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621 Neoadjuvant chemotherapy and fertility sparing surgery in advanced malignant germ cell tumor ovary
  1. A JS1,
  2. S Sambasivan1,
  3. PN Rema1,
  4. S Ranjith J2,
  5. FV James3 and
  6. J Krishna4
  1. 1Regional Cancer Centre, Thiruvananthapuram, Gynecological oncology, Thiruvananthapuram, India
  2. 2Regional Cancer Centre, Thiruvananthapuram, Surgical oncology, Thiruvananthapuram, India
  3. 3Regional Cancer Centre, Thiruvananthapuram, Radiation Oncology, Thiruvananthapuram, India
  4. 4Regional Cancer Centre, Thiruvananthapuram, Cancer Epidemiology and Biostatistics, Thiruvananthapuram, India


Introduction/Background*Malignant Germ cell tumours (MGCTs) are rare tumours that account for 2% - 3% of all ovarian cancers. Being highly chemosensitive, fertility sparing surgery whenever feasible with or without adjuvant chemotherapy, is the standard treatment approach in these patients. Upfront fertility sparing surgery may not be feasible in all patients with advanced stage disease due to poor performance status, bilateral ovarian disease or large tumours infiltrating the uterus. Neoadjuvant chemotherapy (NACT) followed by conservative surgery might be considered for such patients. This study aimed to analyse the outcome of patients with advanced malignant germ cell tumour ovary who underwent NACT followed by surgery and to assess the menstrual and reproductive function in those patients who underwent conservative surgery.

Methodology A retrospective study of 28 patients who underwent debulking surgery following neoadjuvant chemotherapy for advanced malignant germ cell tumour ovary from January 2008 to March 2019. Clinical information and follow up data till December 2020 were collected from medical records.

Result(s)*The median follow up period was 76 months (range 7 to 133 months). The median age was 16.5 years (range 7 to 31years). Twenty four (85.8%) patients underwent fertility sparing surgery. Complete pathological response was seen in 25 (89.3%) patients. Two patients were lost to follow up, one of whom was pregnant at the time of the last follow up. One patient, who initially presented with stage IV Dysgerminoma and underwent bilateral salpingo- oophorectomy following chemotherapy, died 6 months after surgery due to disease recurrence. Of the remaining patients, 17 reported menstruation following treatment. Two patients were diagnosed with primary amenorrhoea and 2 were still premenarchal. Three patients tried for pregnancy and had a total of 4 pregnancies.

Conclusion*NACT followed by interval debulking surgery might be considered in patients with advanced malignant germ cell tumour. In patients with poor performance status and high tumor load, neoadjuvant chemotherapy makes fertility sparing surgery feasible with a good reproductive outcome.

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