The choice of adjuvant therapy depends on the stage, grade and histological type of the tumor. For example, stage IA of dysgerminoma and stage I of IA of immature teratoma do not require further treatment after surgery. At present, adjuvant chemotherapy is recommended for other staged and graded tumors.
For dysgerminoma, adjuvant therapy includes radiotherapy or chemotherapy. Before platinum chemotherapy, asexual cell tumors were treated with in vitro radiotherapy, and the main side effect was unilateral ovarian failure. Due to the good efficacy of platinum chemotherapy, and the vast majority of patients after treatment of ovaries. The function is normal, and chemotherapy has gradually replaced radiotherapy in the treatment of dysgerminoma.Modern chemotherapy regimens for malignant ovarian germ cell tumors include BEP regimens. In the 1970s, GOG first proposed the initial chemotherapy regimen for ovarian germ cell tumors, namely VAC chemotherapy (vincristine / actinomycin D / cyclophosphamide), and then the proposed PVB regimen (cisplatin 1 vincristine / bleomycin) was proved to be more effective. Because BEP chemotherapy regimen has a good effect on testicular tumors, GOG tried to use BEP regimen to treat ovarian germ cell tumors. It was found that BEP chemotherapy regimen was more effective than PVB regimen. Studies by the Eastern Cancer Cooperation Group (ECOG) confirmed the importance of bleomycin in the BEP regimen. Patients treated with BEP chemotherapy (including bleomycin) had a survival rate of 95%, while patients treated with etoposide and cisplatin alone had a survival rate of only 86%.According to the data of Cuiwan Cancer study, the optimal number of cycles of BEP chemotherapy is not fixed and can be changed according to the patient's clinical manifestations. Some studies compared the therapeutic effects of 3 cycles of BEP regimen and 4 cycles of chemotherapy in patients with low-risk testicular cancer and found that there was no significant difference in prognosis between the two groups. The advantage of reducing one chemotherapy cycle is that it reduces the early and late side effects of chemotherapy, rather than reducing bleomycin-related pulmonary toxicity and the treatment of advanced leukemia. Studies have also shown that BEP regimen 3 cycles of chemotherapy is effective in the treatment of ovarian germ cell tumors. However, 4 cycles of chemotherapy should be performed for obvious residual tumors, because there is no more effective treatment.Surgery has gradually been regarded as the first choice for the treatment of germ cell tumors. In a prospective single-study study, Bonazzi and colleagues followed up 32 cases of simple immature ovarian teratoma, including all stage I and grade 1-2. Among them, 22 cases were treated with operation and 2 cases with recurrence were treated with chemotherapy. Marina et al reviewed 50 cases of simple immature teratoma, 23 cases with malignant lesions (grade 1-3) were treated by surgical resection, of which 4 cases relapsed and all were treated with chemotherapy.Dark and colleagues recently summarized their surgical experience, conducted close follow-up, and received chemotherapy for recurrent cases. To put it simply, the initial study investigated 24 cases of malignant ovarian germ cell tumors in stage IA, including 9 cases of asexual germ cells, 9 cases of immature teratoma and 6 cases of endodermal sinus tumor. Of the 8 recurrent cases, 7 cases were treated with chemotherapy. The only death was due to pulmonary embolism during treatment. The latest data show that the recurrence rate of asexual germ cells is 22%, and that of non-asexual cell tumors is 36%. Of the 11 recurrent cases, 10 cases were treated successfully and 1 case died of side effects of chemotherapy. All relapses occurred within 13 months after operation, and the total survival rate was 94%. The results of these single-agency studies have prompted the Children's Cancer Institute to explore the efficacy of surgical resection for stage I tumors, and data from the study will be released soon.
