title: Fertility-Sparing Surgery Should Be the Standard Treatment in Patients with Malignant Ovarian Germ Cell Tumors.
abstract: OBJECTIVE
  To validate the oncological safety of fertility preservation in malignant ovarian germ cell tumors (MOGCTs) and to define the significance of maximal cytoreduction in early stage MOGCTs.
  
  
  METHODS
  Sixty-nine patients with stage I and II MOGCTs who underwent surgical treatment were included in the study. Fertility-sparing surgery is defined as conservative surgery and hysterectomy and contralateral salpingo-oophorectomy were defined as definitive surgery. Both surgical approaches involved lymphadenectomy and omentectomy. Most patients received platinum-based combinations for adjuvant therapy. Survival outcomes of the conservative surgery group were compared with the definitive surgery group.
  
  
  RESULTS
  Median age of the study group was 21 years (range: 12-40 years). Median tumor size measured 150 mm (range, 20-300 mm). Surgery type (conservative surgery vs. definitive surgery) and lymphadenectomy (performed vs. not performed) were insignificant for the recurrence (p = 0.758, p = 0.271). However, surgical outcome (maximal vs. optimal and suboptimal) and type of tumor (dysgerminoma vs. nondysgerminoma) determined the recurrence (p = 0.001, p = 0.021).
  
  
  CONCLUSIONS
  Fertility-conserving approach is safe in early stage MOGCTs. However, maximal cytoreduction should be achieved in this group of patients, without conceding fertility-conserving approach. On the other hand, development of chemotherapy options with less gonadotoxic effects, but equal or stronger efficiency in comparison with platinum-based chemotherapy, will certainly facilitate management of this patient group.
authors.affiliation: Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey .
authors.forename: Osman
authors.initials: O
authors.lastname: Turkmen
authors.affiliation: Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey .
authors.forename: Alper
authors.initials: A
authors.lastname: Karalok
authors.affiliation: Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey .
authors.forename: Derman
authors.initials: D
authors.lastname: Basaran
authors.affiliation: Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey .
authors.forename: Gunsu Comert
authors.initials: GC
authors.lastname: Kimyon
authors.affiliation: Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey .
authors.forename: Tolga
authors.initials: T
authors.lastname: Tasci
authors.affiliation: Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey .
authors.forename: Isin
authors.initials: I
authors.lastname: Ureyen
authors.affiliation: Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey .
authors.forename: Gokhan
authors.initials: G
authors.lastname: Tulunay
authors.affiliation: Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital , Ankara, Turkey .
authors.forename: Taner
authors.initials: T
authors.lastname: Turan
mesh_terms: D000293:Adolescent; D000328:Adult; D018236:Carcinoma, Embryonal / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D002822:Choriocarcinoma / Q000473:pathology / Q000601:surgery; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D004407:Dysgerminoma / Q000473:pathology / Q000601:surgery; D018240:Endodermal Sinus Tumor / Q000473:pathology / Q000601:surgery; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D005500:Follow-Up Studies; D018238:Gonadoblastoma / Q000473:pathology / Q000601:surgery; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery*; D009852:Omentum / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods; D058994:Salpingectomy / Q000379:methods; D013330:Struma Ovarii / Q000473:pathology / Q000601:surgery; D013724:Teratoma / Q000473:pathology / Q000601:surgery; D055815:Young Adult
keywords: chemotherapy; cytoreduction; fertility sparing; ovarian germ cell tumor