Ovarian germ cell tumor patients treated with platinum-based chemotherapy and fertility-sparing surgery are likely to retain their menstrual function and reproductive ability, according to the largest and most comprehensive survey of survivors ever conducted.
The new prospective study, published in the July 1 issue of the Journal of Clinical Oncology and conducted by The University of Texas M. D. Anderson Cancer Center and the Gynecologic Oncology Group, also found that despite having reproductive and sexual concerns, survivors were more likely than their healthy counterparts to be involved in meaningful, positive relationships.
Ovarian cancer is rare; in 2007, 22,430 females will be diagnosed and 15,280 are expected to die from the disease, according to the American Cancer Society. Germ cell tumors, a disease in which malignant cells form in the germ (or egg) of the ovary, constitute just five percent of all ovarian cancers diagnosed, says David Gershenson, M.D., professor and chair of the Department of Gynecologic Oncology and the study's lead author.
There's been a tremendous amount of interest in fertility as it relates to germ cell tumor survivors, explains Gershenson. While an extremely rare cancer, ovarian germ cell tumors often occur in girls and young women, with the average age of diagnosis occurring in the teenage years. Although the tumors are aggressive malignancies, they tend to involve only one ovary.
"Before the 1970s, there was no effective treatment for ovarian germ cell tumor patients and the death rate was extremely high. However, with the introduction of platinum-based combination chemotherapy, there's been a dramatic increase in survival, with cure rates now reaching close to 100 percent. Simultaneously in the 1970s, gynecologic oncologists began to realize that fertility-sparing surgery could be performed safely and without compromising a woman's curability," says Gershenson.
The study surveyed 132 germ cell tumor survivors formally enrolled in M. D. Anderson or Gynecologic Oncology Group clinical trials all over the nation. Each patient received platinum-based combination chemotherapy following surgery. The women were compared to 137 healthy women - all acquaintances of the survivors. Both the survivors and the acquaintances filled out questionnaires and were matched for age, race and education.
Seventy-one of the 132 survivors had fertility-sparing surgery as part of their treatment Of the 71 patients who had fertility-sparing surgery, 62 women, or 87 percent, were still having menstrual periods and 24 survivors had given birth to 37 babies.
"At the time of the study, the median survivor's age was just 35.5 years - this is a very young cohort of survivors," says Gershenson. "One can only assume that the women will have, or likely already have had, more children since the study."
The study also found that compared to the healthy women, germ cell tumor survivors had significantly greater reproductive concerns and experienced less sexual pleasure and more sexual discomfort. However, the survivors were more likely to be in partnered, meaningful relationships.
"The finding should allow oncologists and therapists to better inform and counsel patients and their families about expectations in the perioperative period, during primary treatment and long term," says Gershenson. "Ultimately as a cancer community, we need to develop better interventions and pay much more attention to both the psycho-social and fertility issues of our patients."
To ovarian germ cell tumor patients, Gershenson stresses the importance of having their fertility-sparing surgery performed by a board-certified gynecological oncologist who understands the clinical behavior of these tumors and is who is trained to optimize patients' probability of undergoing appropriate surgery and chemotherapy.
"Still in 2007, despite medical advances, too many of these patients are operated on by general obstetricians and gynecologists or general surgeons who do not make a proper diagnosis during surgery, or may not truly understand the biology of this disease. As a result, both ovaries and the uterus are removed, leaving a patient unnecessarily sterile."
Other study authors include: Anna M. Miller, D.N.S. and Stephen D. Williams, both of the Indiana University Cancer Center; Victoria L. Champion, DNS, Indiana University School of Nursing; Patrick O. Monahan, Ph.D and Qianqian Zhao, both of the Indiana School of Medicine and David Cella, Ph.D., Evanston Northwestern Healthcare.
The study was funded by a National Cancer Institute R01 grants and NCI grants to the Gynecologic Oncology Group and the Gynecologic Oncology Group Statistical Office.
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