title: Recurrent granulosa cell tumors (GCTs) of the ovary: a MITO-9 retrospective study.
abstract: OBJECTIVE
  Optimal treatment of recurrent GCTs is unknown. The aim of this study was to evaluate the characteristics of recurrent GCTs.
  
  
  METHODS
  Data on 35 recurrent GCTs were reviewed.
  
  
  RESULTS
  Initial FIGO stages were: 11 IA, 11 IC, 6 Ix, 1 IIB, 5 IIIC and 1 IV. All patients had undergone primary surgical treatment, and in 8 cases adjuvant chemotherapy was given. The median RFS was 53.2 months with differences between patients receiving (72.5 months) and not receiving (48 months) adjuvant chemotherapy and between patients optimally staged (64.5 months) or not staged (47 months). Recurrence sites were: pelvic, 13; abdominal, 6; lymph-nodal, 2; pelvic+abdominal, 7; abdominal+lymph-nodal, 4; and pelvic+lymph-nodal, 3. Twenty-five patients underwent debulking surgery+chemotherapy, 6 surgery, 2 surgery+radiotherapy, 1 chemotherapy and 1 palliation. 69% completed the chemotherapy. No difference was found in OS among patients receiving or not receiving chemotherapy after secondary surgery at recurrence and among the different relapse sites. Eleven patients developed a second relapse after a median time of 38 months. 81.8% had received adjuvant therapy at first recurrence. Four patients underwent surgery, 4 surgery+chemotherapy, 1 surgery+radiotherapy and 2 palliation. Four patients developed a third recurrence after a median time of 41 months. Two patients received chemotherapy and 2 hepatic resection. Nine patients (25.7%) died of disease. 5y-OS from the first recurrence was 55.6% and 87.4% for patients with or without residual tumor at subsequent debulking surgery, respectively.
  
  
  CONCLUSIONS
  In GCTs surgery remains the cornerstone treatment at relapse. RFS was higher in patients who received adjuvant therapy after initial diagnosis, with no difference in OS.
authors.affiliation: Gynecology Department, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
authors.forename: Cristina
authors.initials: C
authors.lastname: Sigismondi
authors.forename: Luigi
authors.initials: L
authors.lastname: Frigerio
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
authors.forename: Antonella
authors.initials: A
authors.lastname: Savarese
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.forename: Rossella
authors.initials: R
authors.lastname: Lauria
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamberi
authors.forename: Stefano
authors.initials: S
authors.lastname: Greggi
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006106:Granulosa Cell Tumor / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate