Ovarian
germ cell tumors are rare but very curable at all stages of disease. There is good evidence that surveillance for stage I
dysgerminomas is a safe option although many centers worldwide still advocate
adjuvant chemotherapy for stage IA nondysgerminomatous
tumors, despite the significant risk of developing long-term treatment side effects. Here, we review the safety of our ongoing surveillance program of all stage IA female
germ cell tumors. Thirty-seven patients (median age 26, range 14-48 years) with stage I disease were referred to Mount Vernon and Charing Cross Hospitals between 1981 and 2003. Patients underwent surgery and staging followed by intense surveillance, which included regular
tumor markers and imaging. The median period of follow-up was 6 years. Relapse rates for stage IA nondysgerminomatous
tumors and
dysgerminomas were 8 of 22 (36%) and 2 of 9 (22%), respectively, plus one patient with mature
teratoma and glial implants also relapsed; 10 of these 11 patients (91%) were successfully cured with
platinum-based
chemotherapy. Only one patient died from chemoresistant disease. All relapses occurred within 13 months of initial surgery. The overall disease-specific survival of malignant ovarian
germ cell tumors was 94%. Over 50% of patients who underwent fertility-sparing surgery went on to have successful pregnancies. We have confirmed again that surveillance of all stage IA ovarian
germ cell tumors is very safe and that the outcome is comparable with
testicular tumors. We question the need for potentially toxic
adjuvant chemotherapy in nondysgerminoma patients who have greater than 90% chance of being salvaged with
chemotherapy if they relapse later.