Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents: A report of the Pediatric Oncology Group and the Children's Cancer Group

被引:100
作者
Cushing, B
Giller, R
Ablin, A
Cohen, L
Cullen, J
Hawkins, E
Heifetz, SA
Krailo, M
Lauer, SJ
Marina, N
Rao, PV
Rescorla, F
Vinocur, CD
Weetman, RM
Castleberry, RP
机构
[1] Childrens Hosp Michigan, Detroit, MI 48201 USA
[2] Childrens Hosp, Denver, CO 80218 USA
[3] Rush Presbyterian St Lukes Med Ctr, Denver, CO USA
[4] Univ Calif San Francisco, San Francisco, CA 94143 USA
[5] Maine Childrens Canc Program, Portland, ME USA
[6] Baylor Coll Med, Houston, TX 77030 USA
[7] Indiana Univ, Sch Med, Indianapolis, IN 46204 USA
[8] Childrens Canc Grp Operat Off, Arcadia, CA USA
[9] Emory Univ, Sch Med, Atlanta, GA 30322 USA
[10] St Jude Childrens Res Hosp, Memphis, TN 38105 USA
[11] Univ Florida, Pediat Oncol Stat Off, Gainesville, FL USA
[12] St Christophers Hosp Children, Philadelphia, PA 19133 USA
[13] Univ Alabama, Birmingham, AL USA
关键词
immature teratoma; ovary; yolk sac tumor foci; gliomatosis peritonei;
D O I
10.1016/S0002-9378(99)70561-2
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: In both adult women and children the potential for malignant recurrence from ovarian immature teratoma has prompted the standard use of chemotherapy after complete resection of the primary tumor. The efficacy of postoperative chemotherapy in children and adolescents with ovarian immature teratoma, however, has not been established. A pediatric intergroup trial (INT 0106) was designed to determine the need for postoperative chemotherapy in patients with ovarian immature teratoma after management with surgical resection only. STUDY DESIGN: Between 1990 and 1995, 44 patients with completely resected ovarian immature tumor and without postoperative chemotherapy, who were able to undergo assessment, were accrued. Tumor tissue was evaluated by central pathology review to confirm diagnosis and determine tumor grading of immature neural elements. Patients were followed carefully for recurrence of disease with appropriate diagnostic imaging and serum marker studies. RESULTS: Thirty-one patients had pure ovarian immature teratoma with a tumor grade df 1 (n = 17), 2 (n = 12), or 3 (n = 2). Age at diagnosis ranged between 1.5 and 15 years (median, 10). Of the 29 patients studied, the serum alpha-fetoprotein level was elevated in 10 (34%); the median level was 25 ng/ml. Thirteen patients had ovarian immature teratoma plus microscopic foci of yolk sac tumor. Tumor grade was 1, 2, or 3 in 1, 6, and 6 patients, respectively. Age ranged between 6 and 20 years (median, 12). In the 12 patients evaluated for serum a-fetoprotein, 10 (83%) had elevated levels; the median level was 262 ng/ml. The 4-year event-free and overall survival for the ovarian immature teratoma group and for the ovarian immature teratoma plus yolk sac tumor group was 97.7% (95% confidence interval, 84.9%-99.7%) and 100%, respectively. The only yolk sac tumor relapse occurred in a child with ovarian immature teratoma and yolk sac tumor who was then treated with chemotherapy and is alive and free of disease 57 months after recurrence. CONCLUSION: The results of this study suggest that surgery alone is curative for most children and adolescents with resected ovarian immature teratoma of any grade, even when elevated levels of serum alpha-fetoprotein or microscopic foci of yolk sac tumor are present. This experience strongly supports avoiding the long-term effects of chemotherapy in most children with ovarian immature teratoma by reserving postoperative therapy for cases with relapse.
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页码:353 / 358
页数:6
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