Role of lymphadenectomy and vincristine, actinomycin-D, and cyclophosphamide chemotherapy in malignant ovarian germ cell tumors

Purpose of investigation: The objective of this study was to review all malignant ovarian germ cell tumors (MOGCT) managed at the present center, focusing on the role of lymphadenectomy, and vincristine, actinomycin-D, cyclophosphamide (VAC) chemotherapy on treatment, and survival outcome. Materials and Methods: The authors performed a retrospective chart review of 77 patients managed for MOGCT between January 1986 and December 2012. Results: Median age at diagnosis was 26 years. The histologic subtypes included 47 (61.0%) immature teratoma, 16 (20.8%) yolk sac tumor, 9 (11.7%) dysgerminoma, and five (6.5%) mixed germ cell tumor. Of 65 patients with clinically early-stage tumors, 17 (26.1%) had lymphadenectomy performed, of which all had no lymph node metastasis on histology. The overall survival was 100% for both lymphadenectomy and no lymphadenectomy groups. Postoperative adjuvant chemotherapy was administered to 51 (66.2%) patients, 38 (74.5%) of whom received VAC chemotherapy. Complete response and overall cure rate of VAC regimen was 100% and 89.5%, respectively when used as first-line postoperative adjuvant treatment. Median follow-up period was 138 months and overall survival was 97.4%. Conclusions: Lymphadenectomy did not provide survival benefits in patients with clinically early-stage MOGCT. The VAC chemotherapy regimen can be considered as an option for primary postoperative treatment, especially in patients with early-stage disease.