From the Guidelines
Patients with stage IA grade 1 immature teratoma do not require further adjuvant chemotherapy after adequate surgical staging. This approach is based on the excellent survival outcomes and low recurrence rates associated with fertility-sparing surgery, as highlighted in the 2018 ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of non-epithelial ovarian cancer 1. The guidelines emphasize the importance of preserving fertility in young patients, and fertility-sparing surgery appears to be safe with excellent long-term outcomes.
Key considerations in the management of teratomas include:
- The classification of teratomas as either mature (benign) or immature (potentially malignant)
- The location of the tumor, with the ovaries, testicles, sacrococcygeal region, and mediastinum being common sites
- The use of surgical removal as the primary treatment, with additional chemotherapy for immature or malignant teratomas
- The prognosis, which is generally excellent for mature teratomas after complete surgical excision, but depends on the grade and stage for immature teratomas
In terms of specific treatment approaches, the 2018 ESMO guidelines recommend:
- Surgery only for stage IA pure dysgerminoma 1
- Close surveillance after fertility-sparing surgery for stage IA grade 1 immature teratoma, reserving chemotherapy for cases with documented recurrence 1
- Adjuvant chemotherapy for all patients with stage I yolk sac tumors (YSTs) after surgery, although recent data suggest close surveillance may be an option for pediatric patients with complete surgical staging and negative postoperative alpha-fetoprotein (a-FP) 1
The most commonly used chemotherapy regimen is the 5-day bleomycin/etoposide/cisplatin (BEP) regimen, which is recommended for patients with immature teratoma or other germ cell tumors 1. Overall, the management of teratomas requires a multidisciplinary approach, taking into account the patient's age, fertility status, and tumor characteristics to optimize outcomes and minimize treatment-related morbidity.
From the Research
Definition and Treatment of Teratoma
- Teratoma is a type of tumor that can occur in various parts of the body, including the testicles, thyroid, and brain 2, 3, 4, 5, 6.
- The treatment of teratoma depends on the location, size, and type of tumor, as well as the patient's overall health 2, 3, 4, 5, 6.
Testicular Teratoma
- Testicular teratoma is a type of non-seminomatous germ cell tumor (NSGCT) that can be treated with chemotherapy, surgery, or a combination of both 2, 3, 4.
- A study published in 1991 found that a combination of bleomycin, etoposide, and cisplatin (BEP) was effective in treating metastatic testicular teratoma, with a 77% survival rate after a median follow-up of 31 months 2.
- Another study published in 2020 found that primary retroperitoneal lymph node dissection (RPLND) was a safe and effective treatment for patients with pure metastatic teratoma in the retroperitoneum, with a 92.9% disease-free survival rate after a median follow-up of 6.9 years 4.
Thyroid Teratoma
- Thyroid teratoma is a rare type of tumor that can be malignant, with a poor prognosis 5.
- A study published in 2019 found that neoadjuvant chemotherapy combined with surgical excision was a promising approach for patients with primary malignant thyroid teratoma, with all four patients in the study remaining alive and disease-free after a median follow-up of 172 months 5.
Intracranial Teratoma
- Intracranial teratoma is a rare type of tumor that can be difficult to treat due to its heterogeneity and totipotent origins 6.
- A study published in 2009 found that accurate histological diagnosis of teratoma subtypes was the most important factor for adequate treatment, and that proper therapeutic protocols were needed to cure teratomas, with a 5-year survival rate of 74% in the study population 6.