Malignant nongerminomatous ovarian GCTs

A multidisciplinary approach is essential for treatment of ovarian GCTs. Various surgical subspecialists and the pediatric oncologist must be involved in clinical decisions. The surgical approach for pediatric ovarian GCTs is often guided by the expectation that reproductive function can be preserved.

The treatment of ovarian malignant GCTs that are not dysgerminomas or immature teratomas generally involves surgical resection and adjuvant chemotherapy.[31,32]

The role for surgery at diagnosis depends on patient age and tumor site, and treatment must be individualized. The use of laparoscopy in children with ovarian GCTs has not been well studied.

The use of intraoperative frozen biopsy in pediatric and adolescent patients to determine the presence of malignancy to allow an ovarian-sparing procedure has been questioned. In a retrospective analysis from the COG AGCT0132 (NCT00053352) study, 60 of 131 eligible patients with ovarian tumors had both intraoperative frozen section and final paraffin section diagnoses available.[33] Intraoperative frozen section biopsy was incorrect 38% of the time (23 patients), and it confirmed the final diagnosis 76% of the time. In addition, central pathological review detected additional germ cell components in 23.7% of patients.

Pediatric surgical guidelines to determine stage I disease have been published.[34] Adult surgical guidelines to determine stage are more extensive. For more information about staging of ovarian GCTs in postpubertal females, see the Stage Information for Ovarian Germ Cell Tumors section in Ovarian Germ Cell Tumors Treatment.

Strict surgical staging guidelines need to be followed to determine true stage I disease. Historically, in both pediatric and adult studies, comprehensive staging guidelines have not been followed. If strict surgical staging guidelines are not followed, surgery followed by chemotherapy, rather than surgery followed by observation, is the standard treatment.[9,13,35]

A goal of surgical therapy for pediatric GCTs is to preserve reproductive function. If conservative surgery is the choice, a high rate of cure can be obtained with adjuvant chemotherapy, and adherence to strict surgical guidelines is not necessary.[36]