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Fertility Preserved Through Conservative Treatment of Rare Ovarian Cancer
HOUSTON - For a growing number of persons with cancer, there is life after their disease.
For many girls and young women with a rare form of ovarian cancer, there is a better chance to give life after their disease.
Researchers at The University of Texas M. D. Anderson Cancer Center have found that fertility-sparing surgery combined with chemotherapy -- rather than the traditional radiation therapy -- offers an equally effective treatment for ovarian dysgerminoma and preserves their fertility.
"The successful treatment of germ cell tumors -- such as ovarian dysgerminoma -- is one of the great triumphs in cancer treatment," said Dr. David Gershenson, senior author of the study and chairman ad interim of the Department of Gynecologic Oncology at M. D. Anderson." Few other cancers have the success rates we have with this type of tumor.
"Now we have succeeded in finding a way to ensure a better quality of life and opportunity for reproduction for these girls and young women," he continued.
Ovarian dysgerminoma is the most common malignant germ cell tumor of the ovary, accounting for approximately two percent of all ovarian malignancies. An aggressive but treatable disease, it occurs most often in girls and young women, ranging in age from mid-teens to the mid-30s.
Findings of the M. D. Anderson study are reported in the September issue of the Journal of Clinical Oncology. In the same journal, a corresponding editorial by Dr. Marc Laufer, chief of gynecology at Children's Hospital - Boston, reported that the study "is most helpful as we aim to counsel our newly-diagnosed patients with cancer and provide options for reproductive function for long-term survivors."
For the last four decades, girls and young women with ovarian dysgerminoma have received aggressive surgery followed by radiation, according to Dr. Gershenson. Historically, surgery for this rare form of tumor usually included the removal of both ovaries and fallopian tubes and often removal of the uterus, he said. Though an effective treatment for the disease. Dr. Gershenson said that if the surgery did not render the young patients sterile, radiation to the pelvic and abdominal areas often did.
In the M. D. Anderson retrospective study, researchers reviewed the cases of 26 females with ovarian dysgerminoma who underwent surgery and received a chemotherapy regimen of bleomycin, etoposide and cisplatin beginning in 1984. According to the study, 25 of those who received the chemotherapy, rather than radiation therapy, remained continuously disease free after a median follow-up of more than seven years.
Sixteen of the 26 patients underwent fertility-sparing surgery known as salpingo-oophorectomy, and chemotherapy. In this conservative procedure, the surgeon removes only the affected ovary and fallopian tube, leaving the rest of the reproductive system intact.
Five pregnancies have occurred among the 16 patients who had fertility-sparing surgery and chemotherapy. One patient had two full-term pregnancies while another patient had one full-term pregnancy and is expecting her second child. According to researchers, neither patient had difficulty conceiving, and there is no evidence of birth defects or other disabilities in any of the babies. Another patient pregnant at the time of the study has not continued with follow-up.
"By using conservative surgery and chemotherapy, instead of radiation, we have found a way to successfully treat these patients of child-bearing years, and still give them the opportunity to have their fertility," said Dr. Gershenson, who directs M. D. Anderson's Blanton - Davis Ovarian Cancer Research Program.
"We've succeeded with effective treatment, but we must now further extend our efforts to focus on qualify of life issues, including lifestyle, sexuality and reproductive potential. It is also very important that patients with a gynecologic cancer see a physician who fully understands the biology, pathology and proper treatment of these cancers so fertility can be spared," he said.
Members of the M. D. Anderson research team included Drs. Molly Brewer, Cynthia E. Herzog, Michele Follen Mitchell, Elivio G. Silva and J. Taylor Wharton.
- 30 - 08/30/99
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