From the Guidelines
The treatment for dysgerminomas typically involves surgery followed by chemotherapy, depending on the stage of the disease, with the BEP regimen being the most widely used chemotherapy combination 1.
Overview of Dysgerminomas
Dysgerminomas are a type of germ cell tumor that accounts for approximately 40% of ovarian germ cell malignancies. They are highly sensitive to chemotherapy and have an excellent prognosis, especially when diagnosed at an early stage.
Treatment Approach
The initial management of dysgerminomas usually begins with surgical removal of the tumor through unilateral salpingo-oophorectomy (removal of the affected ovary and fallopian tube), which may be sufficient for stage IA disease 1. For patients concerned about fertility preservation, conservative surgery that spares the unaffected ovary and uterus is often possible since dysgerminomas are highly sensitive to chemotherapy.
Chemotherapy
For more advanced stages, adjuvant chemotherapy with the BEP regimen (bleomycin, etoposide, and cisplatin) is recommended, typically administered in 3-4 cycles every 21 days 1. The BEP regimen consists of bleomycin 30 units IV on days 1,8, and 15, etoposide 100 mg/m² IV on days 1-5, and cisplatin 20 mg/m² IV on days 1-5.
Fertility Preservation and Follow-Up
Fertility preservation should not jeopardize the oncological management, and options such as oocyte cryopreservation can be considered for patients scheduled to receive chemotherapy 1. Regular follow-up with tumor markers (particularly LDH, hCG, and AFP) and imaging is essential after treatment completion.
Prognosis
Dysgerminomas are generally very responsive to treatment, with overall survival rates exceeding 90% even in advanced stages 1. The prognosis is excellent, especially when diagnosed at an early stage, with long-term disease-free status of about 90% for stage I patients.
From the Research
Treatment for Dysgerminomas
- The treatment for dysgerminomas typically involves a combination of surgery and chemotherapy 2, 3, 4, 5, 6.
- Surgery may involve a unilateral salpingo-oophorectomy (USO) for early-stage disease, with or without chemotherapy 2, 6.
- For more advanced disease, a cytoreductive operation may be performed to remove as much of the tumor as possible, followed by chemotherapy 3, 4, 6.
- Chemotherapy regimens such as BEP (bleomycin, etoposide, and cisplatin) have been shown to be effective in treating dysgerminomas 2, 3.
- Radiation therapy may also be used in some cases, as dysgerminomas are highly radiosensitive 4.
- Fertility-sparing treatment is often possible for women with dysgerminomas, especially those of reproductive age 5, 6.
Chemotherapy Regimens
- The BEP regimen has been shown to have excellent activity and acceptable toxicity in patients with malignant ovarian germ cell tumors, including dysgerminomas 2.
- A modified 3-day BEP regimen has also been shown to be safe and effective in patients with ovarian germ cell tumors, including dysgerminomas 3.
- Chemotherapy is often used as adjuvant therapy after surgery, and may also be used as primary therapy in some cases 4, 5, 6.
Surgical Approaches
- Conservative surgery, such as USO, may be performed for early-stage disease, with or without chemotherapy 2, 6.
- Non-conservative surgery, such as total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), may be performed for more advanced disease or in cases where fertility is not a concern 6.
- Cytoreductive surgery may be performed to remove as much of the tumor as possible, followed by chemotherapy 3, 4, 6.