abstract
Optimal management of women
with
early stage GCT presents a management conundrum - they have
excellent prognosis but a
third will relapse. Advances uncovering the
molecular characteristics of GCTs have not been matched by improvements
in our understanding and treatment.
METHODS:
Stage
I GCT patients referred to Auckland City Hospital (1955-2012) and
Princess Margaret Cancer Centre (1992-2012) were identified. Baseline
characteristics, histopathology and outcomes were recorded
retrospectively.
RESULTS:
One
hundred and sixty stage I GCT patients were identified with
median age
of 49 years. Median follow-up was 7.0 years (range 0.1-44.2 years).
Fifty-one patients (32%) relapsed with a
median time to relapse (TTR) of
12.0 years (1.3-17.7 years) - 20 initial relapses occurred 10 years
post-diagnosis. Higher relapse rates (43% vs. 24% p=0.02) and shorter
TTR (10.2 vs. 16.2 years p=0.007) were seen with stage Ic versus stage
Ia disease.
Cyst rupture was associated with increased relapse (p=0.03).
Surgery was the main therapeutic modality at relapse. Eighty six
percent of patients received non-surgical management at least once
post-relapse.
Clinical benefit rate was 43% with chemotherapy, 61% with
hormonal therapy and 86% with radiation. Five- and 10-year overall
survival (OS) were 98.5 and 91.6%, respectively. Median OS was similar
in patients with (24.3 years) and without relapse (22.3 years).
CONCLUSION:
Surgery
remains fundamental at diagnosis and relapse.
Caution should be
exercised in recommending adjuvant chemotherapy at initial diagnosis
given OS was greater than 20 years even with relapse. Hormonal therapy
at relapse appears encouraging but needs further assessment. Novel
treatment strategies need exploration with international collaboration
essential for this.
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