Is adjuvant chemotherapy indicated in ovarian immature teratomas? A combined data analysis from the Malignant Germ Cell Tumor International Collaborative

Farzana Pashankar, Juliet P. Hale, Ha Dang, Mark Krailo, William E. Brady, Carlos Rodriguez-Galindo, James C. Nicholson, Matthew J. Murray, Deborah F. Bilmire, Sara Stoneham, G. Suren Arul, Thomas A. Olson, Daniel Stark, Furqan Shaikh, James F. Amatruda, Allan Covens, David M. Gershenson, A. Lindsay Frazier

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Abstract

BACKGROUND There is a debate regarding the management of ovarian immature teratomas (ITs). In adult women, postoperative chemotherapy is standard except for stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, a pooled analysis of pediatric and adult clinical trials was conducted. METHODS Data from 7 pediatric trials and 2 adult trials were merged in the Malignant Germ Cell International Collaborative data set. Four trials included patients with newly diagnosed pure ovarian ITs and were selected (Pediatric Oncology Group/Children's Cancer Group Intergroup Study (INT 0106), Second UKCCSG Germ Cell Tumor Study (GC2), Gynecologic Oncology Group (GOG 0078 and GOG 0090). Adult and pediatric trials were analyzed separately. The primary outcome measures were event-free survival (EFS) and overall survival (OS). RESULTS One hundred seventy-nine patients were included (98 pediatric patients and 81 adult patients). Ninety pediatric patients were treated with surgery alone, whereas all adult patients received chemotherapy. The 5-year EFS and OS were 91% and 99%, respectively, for the pediatric cohort and 87% and 93%, respectively, for the adults. There were no relapses in grade 1 patients, regardless of the stage or age. Only 1 adult patient with a grade 2 IT relapsed. Among grade 3 patients, the 5-year EFS was 0.92 (0.72-0.98) for stage I/II and 0.52 (0.22-0.75) for stage III in the pediatric cohort (P =.005) and 0.91 (0.69-0.98) for stage I/II and 0.65 (0.39-0.83) for stage III/IV in the adult cohort (P =.01). Postoperative chemotherapy did not decrease relapses in the pediatric cohort. CONCLUSIONS The grade was the most important risk factor for relapse in ovarian ITs. Among grade 3 patients, the stage was significantly associated with relapse. Adjuvant chemotherapy did not decrease relapses in the pediatric cohort; its role in adults remains unresolved.

Original languageEnglish (US)
Pages (from-to)230-237
Number of pages8
JournalCancer
Volume122
Issue number2
DOIs
StatePublished - Jan 15 2016

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Germ Cell and Embryonal Neoplasms
Teratoma
Adjuvant Chemotherapy
Pediatrics
Recurrence
Disease-Free Survival
Drug Therapy
Ovarian Teratoma
Survival
Germ Cells
Outcome Assessment (Health Care)
Clinical Trials

Keywords

  • adult
  • chemotherapy
  • ovarian immature teratoma
  • pediatric

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Pashankar, F., Hale, J. P., Dang, H., Krailo, M., Brady, W. E., Rodriguez-Galindo, C., ... Frazier, A. L. (2016). Is adjuvant chemotherapy indicated in ovarian immature teratomas? A combined data analysis from the Malignant Germ Cell Tumor International Collaborative. Cancer, 122(2), 230-237. https://doi.org/10.1002/cncr.29732

Is adjuvant chemotherapy indicated in ovarian immature teratomas? A combined data analysis from the Malignant Germ Cell Tumor International Collaborative. / Pashankar, Farzana; Hale, Juliet P.; Dang, Ha; Krailo, Mark; Brady, William E.; Rodriguez-Galindo, Carlos; Nicholson, James C.; Murray, Matthew J.; Bilmire, Deborah F.; Stoneham, Sara; Arul, G. Suren; Olson, Thomas A.; Stark, Daniel; Shaikh, Furqan; Amatruda, James F.; Covens, Allan; Gershenson, David M.; Frazier, A. Lindsay.

In: Cancer, Vol. 122, No. 2, 15.01.2016, p. 230-237.

Research output: Contribution to journalArticle

Pashankar, F, Hale, JP, Dang, H, Krailo, M, Brady, WE, Rodriguez-Galindo, C, Nicholson, JC, Murray, MJ, Bilmire, DF, Stoneham, S, Arul, GS, Olson, TA, Stark, D, Shaikh, F, Amatruda, JF, Covens, A, Gershenson, DM & Frazier, AL 2016, 'Is adjuvant chemotherapy indicated in ovarian immature teratomas? A combined data analysis from the Malignant Germ Cell Tumor International Collaborative', Cancer, vol. 122, no. 2, pp. 230-237. https://doi.org/10.1002/cncr.29732
Pashankar, Farzana ; Hale, Juliet P. ; Dang, Ha ; Krailo, Mark ; Brady, William E. ; Rodriguez-Galindo, Carlos ; Nicholson, James C. ; Murray, Matthew J. ; Bilmire, Deborah F. ; Stoneham, Sara ; Arul, G. Suren ; Olson, Thomas A. ; Stark, Daniel ; Shaikh, Furqan ; Amatruda, James F. ; Covens, Allan ; Gershenson, David M. ; Frazier, A. Lindsay. / Is adjuvant chemotherapy indicated in ovarian immature teratomas? A combined data analysis from the Malignant Germ Cell Tumor International Collaborative. In: Cancer. 2016 ; Vol. 122, No. 2. pp. 230-237.
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abstract = "BACKGROUND There is a debate regarding the management of ovarian immature teratomas (ITs). In adult women, postoperative chemotherapy is standard except for stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, a pooled analysis of pediatric and adult clinical trials was conducted. METHODS Data from 7 pediatric trials and 2 adult trials were merged in the Malignant Germ Cell International Collaborative data set. Four trials included patients with newly diagnosed pure ovarian ITs and were selected (Pediatric Oncology Group/Children's Cancer Group Intergroup Study (INT 0106), Second UKCCSG Germ Cell Tumor Study (GC2), Gynecologic Oncology Group (GOG 0078 and GOG 0090). Adult and pediatric trials were analyzed separately. The primary outcome measures were event-free survival (EFS) and overall survival (OS). RESULTS One hundred seventy-nine patients were included (98 pediatric patients and 81 adult patients). Ninety pediatric patients were treated with surgery alone, whereas all adult patients received chemotherapy. The 5-year EFS and OS were 91{\%} and 99{\%}, respectively, for the pediatric cohort and 87{\%} and 93{\%}, respectively, for the adults. There were no relapses in grade 1 patients, regardless of the stage or age. Only 1 adult patient with a grade 2 IT relapsed. Among grade 3 patients, the 5-year EFS was 0.92 (0.72-0.98) for stage I/II and 0.52 (0.22-0.75) for stage III in the pediatric cohort (P =.005) and 0.91 (0.69-0.98) for stage I/II and 0.65 (0.39-0.83) for stage III/IV in the adult cohort (P =.01). Postoperative chemotherapy did not decrease relapses in the pediatric cohort. CONCLUSIONS The grade was the most important risk factor for relapse in ovarian ITs. Among grade 3 patients, the stage was significantly associated with relapse. Adjuvant chemotherapy did not decrease relapses in the pediatric cohort; its role in adults remains unresolved.",
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AU - Pashankar, Farzana

AU - Hale, Juliet P.

AU - Dang, Ha

AU - Krailo, Mark

AU - Brady, William E.

AU - Rodriguez-Galindo, Carlos

AU - Nicholson, James C.

AU - Murray, Matthew J.

AU - Bilmire, Deborah F.

AU - Stoneham, Sara

AU - Arul, G. Suren

AU - Olson, Thomas A.

AU - Stark, Daniel

AU - Shaikh, Furqan

AU - Amatruda, James F.

AU - Covens, Allan

AU - Gershenson, David M.

AU - Frazier, A. Lindsay

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N2 - BACKGROUND There is a debate regarding the management of ovarian immature teratomas (ITs). In adult women, postoperative chemotherapy is standard except for stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, a pooled analysis of pediatric and adult clinical trials was conducted. METHODS Data from 7 pediatric trials and 2 adult trials were merged in the Malignant Germ Cell International Collaborative data set. Four trials included patients with newly diagnosed pure ovarian ITs and were selected (Pediatric Oncology Group/Children's Cancer Group Intergroup Study (INT 0106), Second UKCCSG Germ Cell Tumor Study (GC2), Gynecologic Oncology Group (GOG 0078 and GOG 0090). Adult and pediatric trials were analyzed separately. The primary outcome measures were event-free survival (EFS) and overall survival (OS). RESULTS One hundred seventy-nine patients were included (98 pediatric patients and 81 adult patients). Ninety pediatric patients were treated with surgery alone, whereas all adult patients received chemotherapy. The 5-year EFS and OS were 91% and 99%, respectively, for the pediatric cohort and 87% and 93%, respectively, for the adults. There were no relapses in grade 1 patients, regardless of the stage or age. Only 1 adult patient with a grade 2 IT relapsed. Among grade 3 patients, the 5-year EFS was 0.92 (0.72-0.98) for stage I/II and 0.52 (0.22-0.75) for stage III in the pediatric cohort (P =.005) and 0.91 (0.69-0.98) for stage I/II and 0.65 (0.39-0.83) for stage III/IV in the adult cohort (P =.01). Postoperative chemotherapy did not decrease relapses in the pediatric cohort. CONCLUSIONS The grade was the most important risk factor for relapse in ovarian ITs. Among grade 3 patients, the stage was significantly associated with relapse. Adjuvant chemotherapy did not decrease relapses in the pediatric cohort; its role in adults remains unresolved.

AB - BACKGROUND There is a debate regarding the management of ovarian immature teratomas (ITs). In adult women, postoperative chemotherapy is standard except for stage I, grade 1 disease, whereas surgery alone is standard in pediatric patients. To determine the role of chemotherapy, a pooled analysis of pediatric and adult clinical trials was conducted. METHODS Data from 7 pediatric trials and 2 adult trials were merged in the Malignant Germ Cell International Collaborative data set. Four trials included patients with newly diagnosed pure ovarian ITs and were selected (Pediatric Oncology Group/Children's Cancer Group Intergroup Study (INT 0106), Second UKCCSG Germ Cell Tumor Study (GC2), Gynecologic Oncology Group (GOG 0078 and GOG 0090). Adult and pediatric trials were analyzed separately. The primary outcome measures were event-free survival (EFS) and overall survival (OS). RESULTS One hundred seventy-nine patients were included (98 pediatric patients and 81 adult patients). Ninety pediatric patients were treated with surgery alone, whereas all adult patients received chemotherapy. The 5-year EFS and OS were 91% and 99%, respectively, for the pediatric cohort and 87% and 93%, respectively, for the adults. There were no relapses in grade 1 patients, regardless of the stage or age. Only 1 adult patient with a grade 2 IT relapsed. Among grade 3 patients, the 5-year EFS was 0.92 (0.72-0.98) for stage I/II and 0.52 (0.22-0.75) for stage III in the pediatric cohort (P =.005) and 0.91 (0.69-0.98) for stage I/II and 0.65 (0.39-0.83) for stage III/IV in the adult cohort (P =.01). Postoperative chemotherapy did not decrease relapses in the pediatric cohort. CONCLUSIONS The grade was the most important risk factor for relapse in ovarian ITs. Among grade 3 patients, the stage was significantly associated with relapse. Adjuvant chemotherapy did not decrease relapses in the pediatric cohort; its role in adults remains unresolved.

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