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Therapy of advanced ovarian juvenile granulosa cell tumors.
Klin Padiatr. 2002 Jul-Aug; 214(4):173-8.KP

Abstract

BACKGROUND

Gonadal sex cord-stromal tumors are rare tumors that develop from the gonadal non-germ cell component such as granulosa, Sertoli or Leydig cells. Among these, juvenile granulosa cell tumors (JGCT) constitute the largest subgroup of ovarian sex cord-stromal tumors during childhood and adolescence. In local disease (FIGO stage I), the beneficial role of tumor-ovarectomy is well established. In contrast, life expectancy in patients with advanced JGCT (FIGO stage >/= II) is short even after complete tumor resection. The current literature provides only limited and inconclusive data regarding the value of adjuvant chemotherapy in such patients with advanced disease.

PATIENTS AND METHODS

Therefore, we analyzed the patients with FIGO stage >/= II JGCT who were prospectively documented as follow-up patients of the German MAKEI trials for non-testicular germ cell tumors and received the recommended cisplatin-based chemotherapy in an adjuvant setting. From 1988 until 2000, 7 patients (age, 4;2 - 18;11 years, median 14;8 years) were registered. Three patients were stage IIc, one stage IIIa, and three stage IIIc. 5 patients underwent laparatomy with adnectomy, which was complete in only two patients. Two patients received laparoscopic tumor resection, which was incomplete in both. All patients received 4 or 6 cycles of adjuvant cisplatin-based three-agent chemotherapy in analogy to the current therapeutic concept applied in malignant germ cell tumors. One patient with a large tumor and multiple peritoneal metastases additionally received 40 Gy abdominal irradiation.

RESULTS

All patients achieved complete clinical remission after initial surgery and adjuvant chemotherapy. 4 out of 7 patients are currently remaining in first continuous complete remission after 15 to 111 months follow-up. One patient developed a metachronous tumor of the contralateral ovary after 126 months follow-up and is still alive but currently in therapy of another recurrence. Another patient suffered a tumor recurrence after 12 months but achieved a second complete remission with cisplatin chemotherapy after a follow-up of currently 4 months. One patient achieved complete clinical remission but suffered a diffuse peritoneal tumor recurrence with massive ascites and finally died as a result of tumor progression. In summary, at the time of this report 6 of 7 patients are alive after a median of 47 (15 - 138) months.

CONCLUSION

This analysis clearly demonstrates that advanced JGCT can be successfully treated with surgery followed by adjuvant cisplatin-based chemotherapy. Therefore, this study reveals encouraging therapeutic perspectives in these otherwise fatal tumors that merit further investigation in a prospective cooperative trial.

Authors+Show Affiliations

Department of Pediatric Hematology and Oncology, Children's Hospital, Heinrich-Heine-University, Medical Center, Düsseldorf, Germany. dominik.schneider@uni-duesseldorf.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12165898

Citation

Schneider, D T., et al. "Therapy of Advanced Ovarian Juvenile Granulosa Cell Tumors." Klinische Padiatrie, vol. 214, no. 4, 2002, pp. 173-8.
Schneider DT, Calaminus G, Wessalowski R, et al. Therapy of advanced ovarian juvenile granulosa cell tumors. Klin Padiatr. 2002;214(4):173-8.
Schneider, D. T., Calaminus, G., Wessalowski, R., Pathmanathan, R., Harms, D., & Göbel, U. (2002). Therapy of advanced ovarian juvenile granulosa cell tumors. Klinische Padiatrie, 214(4), 173-8.
Schneider DT, et al. Therapy of Advanced Ovarian Juvenile Granulosa Cell Tumors. Klin Padiatr. 2002;214(4):173-8. PubMed PMID: 12165898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapy of advanced ovarian juvenile granulosa cell tumors. AU - Schneider,D T, AU - Calaminus,G, AU - Wessalowski,R, AU - Pathmanathan,R, AU - Harms,D, AU - Göbel,U, PY - 2002/8/8/pubmed PY - 2002/12/5/medline PY - 2002/8/8/entrez SP - 173 EP - 8 JF - Klinische Padiatrie JO - Klin Padiatr VL - 214 IS - 4 N2 - BACKGROUND: Gonadal sex cord-stromal tumors are rare tumors that develop from the gonadal non-germ cell component such as granulosa, Sertoli or Leydig cells. Among these, juvenile granulosa cell tumors (JGCT) constitute the largest subgroup of ovarian sex cord-stromal tumors during childhood and adolescence. In local disease (FIGO stage I), the beneficial role of tumor-ovarectomy is well established. In contrast, life expectancy in patients with advanced JGCT (FIGO stage >/= II) is short even after complete tumor resection. The current literature provides only limited and inconclusive data regarding the value of adjuvant chemotherapy in such patients with advanced disease. PATIENTS AND METHODS: Therefore, we analyzed the patients with FIGO stage >/= II JGCT who were prospectively documented as follow-up patients of the German MAKEI trials for non-testicular germ cell tumors and received the recommended cisplatin-based chemotherapy in an adjuvant setting. From 1988 until 2000, 7 patients (age, 4;2 - 18;11 years, median 14;8 years) were registered. Three patients were stage IIc, one stage IIIa, and three stage IIIc. 5 patients underwent laparatomy with adnectomy, which was complete in only two patients. Two patients received laparoscopic tumor resection, which was incomplete in both. All patients received 4 or 6 cycles of adjuvant cisplatin-based three-agent chemotherapy in analogy to the current therapeutic concept applied in malignant germ cell tumors. One patient with a large tumor and multiple peritoneal metastases additionally received 40 Gy abdominal irradiation. RESULTS: All patients achieved complete clinical remission after initial surgery and adjuvant chemotherapy. 4 out of 7 patients are currently remaining in first continuous complete remission after 15 to 111 months follow-up. One patient developed a metachronous tumor of the contralateral ovary after 126 months follow-up and is still alive but currently in therapy of another recurrence. Another patient suffered a tumor recurrence after 12 months but achieved a second complete remission with cisplatin chemotherapy after a follow-up of currently 4 months. One patient achieved complete clinical remission but suffered a diffuse peritoneal tumor recurrence with massive ascites and finally died as a result of tumor progression. In summary, at the time of this report 6 of 7 patients are alive after a median of 47 (15 - 138) months. CONCLUSION: This analysis clearly demonstrates that advanced JGCT can be successfully treated with surgery followed by adjuvant cisplatin-based chemotherapy. Therefore, this study reveals encouraging therapeutic perspectives in these otherwise fatal tumors that merit further investigation in a prospective cooperative trial. SN - 0300-8630 UR - https://www.unboundmedicine.com/medline/citation/12165898/Therapy_of_advanced_ovarian_juvenile_granulosa_cell_tumors_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2002-33183 DB - PRIME DP - Unbound Medicine ER -