What is the primary treatment for a patient diagnosed with a teratoma?

From the Guidelines

The primary treatment for a patient diagnosed with a teratoma is surgical removal of the tumor, with fertility-sparing surgery considered in advanced stages and in younger patients to preserve fertility. This approach is supported by recent guidelines, including those from the European Society for Medical Oncology (ESMO) 1, which emphasize the importance of surgical excision in the management of teratomas. The goal of surgery is to remove as much of the tumor as possible while minimizing long-term morbidity and avoiding delays in postoperative chemotherapy (ChT) if needed.

Key Considerations in Teratoma Treatment

• Fertility-sparing surgery should be considered, especially in younger patients or those with advanced-stage disease, to preserve fertility while effectively managing the tumor 1.
• The surgical approach may vary depending on the tumor's location and size, with laparoscopic or robotic techniques often preferred for ovarian teratomas, and open surgery reserved for more complex cases.
• For patients with stage IA grade 1 immature teratoma, surgery alone may be sufficient, with no need for adjuvant chemotherapy after adequate surgical staging 1.
• In cases where malignant elements are identified, or the tumor is not completely resected, chemotherapy regimens such as the BEP (bleomycin, etoposide, cisplatin) regimen may be recommended, with the specific treatment plan tailored to the patient's disease stage and overall health status 1.

Chemotherapy and Follow-Up

• Platinum-based regimens, particularly the BEP regimen, are the treatment of choice for teratomas that require chemotherapy, with the number of cycles dependent on the extent of disease and response to treatment 1.
• Regular follow-up with imaging studies is crucial after treatment to monitor for recurrence, although the risk is relatively low with complete surgical excision and appropriate adjuvant therapy if needed.
• The management of teratomas, especially in younger patients, requires a multidisciplinary approach, considering not only the oncological outcomes but also the preservation of fertility and quality of life 1.

From the Research

Treatment Options for Teratoma

The primary treatment for a patient diagnosed with a teratoma depends on various factors, including the type and location of the tumor.

• Surgical resection is often the mainstay of therapy for localized transformed disease, as teratomas are thought to be resistant to standard treatment 2.
• Chemotherapy may have a role in selected patients with teratoma with malignant transformation, determined by cell type 2.
• In cases of ovarian growing teratoma syndrome, surgical removal is the main treatment, and chemotherapy and radiotherapy are not effective and can be harmful to patients 3.
• For patients with immature teratoma, complete surgical excision remains the most effective treatment, with continued close follow-up recommended for high-risk patients 4.

Factors Influencing Treatment Outcomes

Several factors can influence treatment outcomes for patients with teratoma, including:

• Tumor burden: a higher tumor burden is associated with a worse prognosis 4.
• Immature teratoma with nongerm cell elements: this type of teratoma is associated with a higher risk of relapse and worse survival 4.
• Primary tumor site: a mediastinal primary tumor site is associated with a worse prognosis 4, 5.
• Histology: nonprimitive neuroectodermal tumor histology is associated with better overall survival 5.
• Prior chemotherapy regimens: fewer prior chemotherapy regimens are associated with better overall survival 5.

Emerging Treatment Approaches

New treatment approaches are being explored for patients with teratoma, including:

• Neoadjuvant chemotherapy combined with surgical excision, which may be a promising approach for patients with gross extrathyroidal extension, cervical lymph node metastases, and/or distantly metastatic disease 6.
• Chemotherapy regimens based on the specific malignant cell type observed in the transformed histology, which may result in major responses and long-term survival in selected patients 2.