Malignant ovarian germ cell tumors: identification of novel prognostic markers and long-term outcome after multimodality treatment.

PURPOSE: Malignant ovarian germ cell tumors are rare and knowledge about prognostic parameters currently is limited. This study was undertaken to evaluate long-term outcome of patients with malignant ovarian germ cell tumors (MOGCTs) after chemotherapy and to assess prognostic parameters. PATIENTS AND METHODS: A total of 113 patients with stage IC to IV MOGCTs were included into this retrospective study. Patients were treated at two large regional cancer centers between 1977 and 2003. RESULTS: Ten-year recurrence-free and overall survival rates were 82% and 81%, respectively. A total of 20 patients experienced relapse, all within the first 8 years. Outcome after relapse was poor, with only 10% of patients achieving long-term survival. Univariate and multivariate analyses demonstrated that initial stage of disease (relative risk [RR], 5.96; 95% CI, 3.47 to 10.22; P = .03) and elevation of serum markers beta-human chorionic gonadotropin and alpha-fetoprotein (RR, 3.90; 95% CI, 1.40 to 10.9; P = .009) were significant predictors of overall survival, whereas age at diagnosis was of no prognostic value. CONCLUSION: This is the first study to identify stage and tumor markers as prognostic parameters for patients with MOGCTs. This might help to select patients for risk-adapted treatment. There is need for improvement of therapeutic strategies after relapse.

Management of brain metastases in patients with high-risk gestational trophoblastic tumors.

OBJECTIVE: To analyze the results of current treatment of patients with brain metastases from high-risk gestational trophoblastic tumors. STUDY DESIGN: Consecutive patients treated between June 1981 and the end of 2000 with brain metastases from high-risk gestational trophoblastic tumors were selected from our computerized database. RESULTS: There were 39 patients with cerebral metastases from high-risk gestational trophoblastic tumors, and 30 (79.5%) of these patients are alive and in remission. Four patients died within 8 days of admission from disease extent. If these four patients are excluded, the survival of the remaining 35 patients is 86%. Eight patients had received prior chemotherapy, and 3 died of the disease. The antecedent pregnancy (AP) was term delivery in 23 (59%), and in 2 of those patients there was a prior history of a molar pregnancy in an AP. Six patients had a history of molar pregnancy as the AP, and in 10 the type of AP was uncertain. The presence of both liver and brain metastases was a particularly adverse prognostic combination, and only one of five patients is still alive in remission. No deaths or relapses occurred beyond 30+ months from the initiation of high-dose etoposide, methotrexate and actinomycin D with cyclophosphamide and vincristine chemotherapy. CONCLUSION: With appropriate management, the outlook for patients with brain metastases from high-risk gestational trophoblastic tumors is good, and the majority of patients achieved sustained remission and probably a cure with chemotherapy as the dominant form of treatment. When the tumor is sufficiently chemosensitive, the blood-brain barrier does not prevent disease elimination.