title: Is adjuvant chemotherapy indicated in stage I pure immature ovarian teratoma (IT)? A multicentre Italian trial in ovarian cancer (MITO-9).
abstract: OBJECTIVE
  Conservative surgery followed by platinum-based chemotherapy is considered the standard approach for stage I immature ovarian teratoma (IT), except for stage IA G1. Nevertheless the use of chemotherapy in stage IA G2-3 and IB-IC is controversial. The aim of this study was to evaluate the outcome of patients with IT in order to define the role of chemotherapy in stage I disease.
  
  
  METHODS
  Twenty-eight patients with stage I IT treated in MITO centers were retrospectively reviewed. Grade, stage, age, surgical and postoperative treatment were analyzed using χ(2) test and T test looking for association with recurrence.
  
  
  RESULTS
  Median age was 25.5. Twenty-four patients underwent fertility-sparing surgery. FIGO stages were 19 IA, 2 IB, and 7 IC. Nine patients had grade 1 tumor, 12 grade 2, and 7 grade 3. Nine patients received adjuvant chemotherapy. Overall recurrence rate was 21.4% (2 in chemotherapy group and 4 in the group without treatment). No patients with G1 had recurrence, whereas 25% of G2 and 42.9% of G3 relapsed. Recurrence rate was not significantly different according to stage, grade or adjuvant chemotherapy, whereas it was greater in the group not operated in a MITO center, not staged and of age lower than 20 years, with statistical significance. At recurrence 4 patients presenting with mature teratoma were treated with surgery alone, whereas 2 recurring with IT were treated with surgery plus chemotherapy. After a median follow-up of 59 months all patients are NED.
  
  
  CONCLUSIONS
  Our study suggests that chemotherapy may be withheld for primary therapy and utilized only for recurrence.
authors.affiliation: Gynecology Department, IRCCS San Raffaele Hospital, Milan, Italy. mangili.giorgia@hsr.it
authors.forename: G
authors.initials: G
authors.lastname: Mangili
authors.forename: G
authors.initials: G
authors.lastname: Scarfone
authors.forename: A
authors.initials: A
authors.lastname: Gadducci
authors.forename: C
authors.initials: C
authors.lastname: Sigismondi
authors.forename: G
authors.initials: G
authors.lastname: Ferrandina
authors.forename: G
authors.initials: G
authors.lastname: Scibilia
authors.forename: R
authors.initials: R
authors.lastname: Viganò
authors.forename: S
authors.initials: S
authors.lastname: Tateo
authors.forename: A
authors.initials: A
authors.lastname: Villa
authors.forename: D
authors.initials: D
authors.lastname: Lorusso
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013724:Teratoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin