title: Neo-adjuvant chemotherapy in the treatment of advanced malignant germ cell tumors of ovary.
abstract: OBJECTIVE
  In order to preserve fertility, we attempted neo-adjuvant chemotherapy (NACT) in patients of malignant ovarian germ cell tumor (MOGCT) with advance and bulky disease.
  
  
  METHODS
  Between January 1988 and December 2009, 23 patients received NACT. Patient's median age was 19 years, ranging from 14 to 28 years. FIGO stages III - 20 and IV - 3. Histology subtypes were: dysgerminoma, n = 14, mixed GCT, n=6 and 3 had endodermal sinus tumor. Patients were planned for four cycles of BEP (bleomycin, etoposide and cisplatin) chemotherapy followed by fertility sparing surgery (unilateral salpingo-oophorectomy+omentectomy ± lymphadenectomy).
  
  
  RESULTS
  Following NACT - 21 patients responded; complete (CR) - 16 and partial response (PR) - 5. One patient progressed and another was lost to follow-up after 2 cycles. 18 of 21 responders underwent surgery; 13/18 had pathological CR, 5/18 had residual disease and achieved CR following 2 more cycles of BEP. 3 patients refused for surgery; 2 relapsed at 9 and 12 months, and achieved second CR following salvage chemotherapy and surgery, third patient continues to be disease-free. Currently, 21 of 23 patients are alive and disease-free at a median follow-up of 74 months. 18/21 patients have resumed menstruation and 10 eligible patients have delivered 13 full term healthy babies. These results are comparable to patients with advanced disease (n = 43) treated with standard approach (initial surgery and adjuvant chemotherapy) during the same period.
  
  
  CONCLUSIONS
  NACT followed by fertility sparing surgery could be a reasonable option for patients of advanced MOGCT, not suitable for optimal cyto-reduction.
authors.affiliation: Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Shobhana
authors.initials: S
authors.lastname: Talukdar
authors.affiliation: Department of Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Sunesh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Neerja
authors.initials: N
authors.lastname: Bhatla
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: S
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: S
authors.initials: S
authors.lastname: Thulkar
authors.affiliation: Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: lalitaiims@yahoo.com.
authors.forename: Lalit
authors.initials: L
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D005298:Fertility; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery
keywords: Bleomycin, etoposide, cisplatin; Complete response; Fertility; Malignant ovarian germ cell tumors; Neoadjuvant chemotherapy