Thirty-five patients with ovarian germ cell
malignancies presenting from 1982 to 1992 were studied. The pathologic diagnoses were
immature teratoma in 11 patients,
endodermal sinus tumor in eight,
dysgerminoma in 12, and mixed
germ cell tumor in four. The median age at presentation was 20 years. Postoperative multiple-agent
chemotherapy was given to 28 patients. Five out of 35 (14%) patients died of
malignancy, three with
endodermal sinus tumors with stage Ia, Ic, and IIIc, respectively, one with stage IIIc
dysgerminoma, and one with stage IIIc mixed
germ cell tumor. The other 30 patients were alive without evidence of disease from 14 to 124 months, with a median follow-up of 52 months. All eleven patients with
immature teratoma were alive with no evidence of disease at 20 to 104 months of follow-up. Four patients with stage I, grade 1
immature teratoma were successfully treated with surgery alone. The other seven patients were treated with
adjuvant chemotherapy and were disease-free. One patient with stage IIIc
dysgerminoma was treated with surgery and
radiotherapy but died of disease. The other eleven patients were safely treated with surgery and
adjuvant chemotherapy with
vincristine,
actinomycin-D and
cyclophosphamide (VAC) or
platinum-based
chemotherapy. For the more virulent
tumors such as
endodermal sinus tumor and mixed
germ cell tumor,
platinum-based
chemotherapy should be used exclusively in view of the high failure rate of the
VAC regimen. Preservation of fertility for young patients with malignant ovarian
germ cell tumors is possible in the early stages of disease and in selected cases of advanced disease.