Recurrent granulosa cell tumors of the ovary (GCTs): A MITO-9 retrospective study

Abstract

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Optimal debulking surgery is the cornerstone of treatment in the recurrence setting and residual tumor affect the overall survival. Adjuvant chemotherapy seems to improve disease free survival but not overall survival

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Background and aim

Optimal treatment of recurrent GCTs is unknown. The aim of this study was to evaluate the characteristics of recurrent GCTs.

Methods

Data on 35 recurrent GCTs were reviewed.

Results

Initial FIGO stage was: 11 IA, 11 IC, 6 Ix, 1 IIB, 5 IIIC and 1 IV. All patients had undergone primary surgical treatment, and in 8 cases adjuvant chemotherapy was given. The median RFS was 53.2 months with differences between patients receiving adjuvant chemotherapy (72.5 months) and not(48 months)and between patients optimally staged(64.5 months) or not(47 months). Recurrence sites were: pelvic,13; abdominal,6; lymph-nodal,2; pelvic + abdominal,7; abdominal + lymph-nodal,4; pelvic + lymph-nodal,3. Twenty-five patients underwent debulking surgery + chemotherapy, 6 patients surgery, 2 surgery + radiotherapy, 1 chemotherapy and 1 palliation. 69% completed chemotherapy. No difference was found in OS among patients receiving or not chemotherapy after secondary surgery at recurrence and among the different relapse sites. Eleven patients developed a second relapse after a median time of 38 months. 81.8% had received adjuvant therapy at first recurrence. Four patients underwent surgery, 4 surgery + chemotherapy, 1 surgery + radiotherapy and 2 palliation. Four patients developed a third recurrence after a median time of 41 months. Two patients received chemotherapy and 2 hepatic resection. Nine patients (25.7%) died of disease. 5y-OS from the first recurrence was 55.6% and 87.4% for patients with or without residual tumor at subsequent debulking surgery, respectively.

Conclusions

In GCTs surgery remains the cornerstone treatment at relapse. RFS was higher in patients who received adjuvant therapy after initial diagnosis, with no difference in OS.