Management of Early stage Management of Early stage Malignant Ovarian Germ Cell Tumours Malignant Ovarian Germ Cell Tumours Michael J Seckl Charing Cross Hospital Campus of Imperial College NHS Healthcare Trust Imperial College London, UK 9-12 9-12 th th June 2010 Caravaggio Meeting on Rare Gynae June 2010 Caravaggio Meeting on Rare Gynae Cancers Cancers
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Management of Early stage Malignant Ovarian Germ Cell Tumours · Malignant Ovarian Germ Cell Tumours Michael J Seckl ... 3 BEP x 3-4 • 1 patient died 8 ... 11 DXT 4 BEP/EP Relapses:
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Management of Early stage Management of Early stage Malignant Ovarian Germ Cell TumoursMalignant Ovarian Germ Cell Tumours
Michael J Seckl
Charing Cross Hospital Campus of Imperial College NHS Healthcare TrustImperial College London, UK
9-129-12thth June 2010 Caravaggio Meeting on Rare Gynae June 2010 Caravaggio Meeting on Rare Gynae CancersCancers
What are OGCTs? - PathologyWhat are OGCTs? - Pathology
• Latest relapse 13 mnths from surgeryLatest relapse 13 mnths from surgery
Patterson et al Int J Gynaecol Cancer 2008Patterson et al Int J Gynaecol Cancer 2008
Salvage treatmentsSalvage treatments
• 9/10 salvaged with chemo (90%)9/10 salvaged with chemo (90%)7 POMB/ACE (1 died despite surgery)7 POMB/ACE (1 died despite surgery)3 BEP x 3-43 BEP x 3-4
• 1 patient died 8 yrs later - melanoma1 patient died 8 yrs later - melanoma
Patterson et al Int J Gynaecol Cancer 2008Patterson et al Int J Gynaecol Cancer 2008
• 29/31 alive and in remission after median 6 yrs29/31 alive and in remission after median 6 yrs
• 5 yr disease free survival 68% (95% CI: 46-84%) 5 yr disease free survival 68% (95% CI: 46-84%)
• 5 yr overall survival 5 yr overall survival 93% (95% CI: 78-99%) 93% (95% CI: 78-99%)
• 5 yr DSS5 yr DSS 97% 97%
Stage Ia Surveillance: Results 1981-2003Stage Ia Surveillance: Results 1981-2003
Patterson et al Int J Gynaecol Cancer 2008Patterson et al Int J Gynaecol Cancer 2008
• CarboplatinCarboplatin
• EPEP
• DXTDXT
• BEPBEP
• Surgery??Surgery??
Stage Ia Adjuvant treatment?Stage Ia Adjuvant treatment?
Dysgerminoma vs NDGCT?Dysgerminoma vs NDGCT?
Carboplatin / EP/ BEP / DXT??Carboplatin / EP/ BEP / DXT?? AdvantagesAdvantages Disadvantages Disadvantages
Less relapsesLess relapses Still relapseStill relapse
Less surveillanceLess surveillance Surveillance still requiredSurveillance still required
Improved OS?Improved OS? Second cancers?Second cancers?
Cardiovascular?Cardiovascular?
Drug resistance?Drug resistance?
Reduced fertility?Reduced fertility?
Stage Ia Adjuvant Rx for OGCTs?Stage Ia Adjuvant Rx for OGCTs?
Stage Ia Adjuvant for Dysgerminomas?Stage Ia Adjuvant for Dysgerminomas?
Vicus et al Gynecol Oncol 2010Vicus et al Gynecol Oncol 2010
• Don’t currently do this at CXDon’t currently do this at CX
• Fertility conserving surgeryFertility conserving surgery
• Surveillance is reasonableSurveillance is reasonable- 22-36% relapse but nearly all cured- 22-36% relapse but nearly all cured
• Adjuvant therapy an alternativeAdjuvant therapy an alternative- for non-compliant pts- for non-compliant pts
- over-treats 75%- over-treats 75%
-22ndnd cancer risk cancer risk
• Relapses within 1-2 yrs in Relapses within 1-2 yrs in
pelvis/abdopelvis/abdo
• Fertility is high but not with DXTFertility is high but not with DXT
Summary for Stage IaSummary for Stage Ia
AcknowledgementsAcknowledgementsProf Edward S NewlandsProf Edward S NewlandsProf Fernando J ParadinasProf Fernando J ParadinasProf Gordon JS RustinProf Gordon JS RustinDr Philip SavageDr Philip SavageDr Iain LindsayDr Iain LindsayDr Iain McNeishDr Iain McNeishDr Nirupa MurugaesuDr Nirupa MurugaesuDr Daniel PattersonDr Daniel PattersonDr Roshan AgarwalDr Roshan AgarwalDr Adrian LimDr Adrian LimMs Linda DyallMs Linda DyallMs Sarah StricklandMs Sarah Strickland
Dr Edward KanferDr Edward KanferMr Richard SmithMr Richard SmithMr Angus McIndoeMr Angus McIndoeMrs Delia ShortMrs Delia ShortMrs Sandra FullerMrs Sandra FullerDr Lydia HoldenDr Lydia HoldenMr Hugh MitchellMr Hugh MitchellDr Richard HarveyDr Richard HarveyDr Adam MitchellDr Adam MitchellDr Joe BoultbeeDr Joe Boultbee