Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents: A report of the Pediatric Oncology Group and the Children's Cancer Group

Barbara Cushing, Roger Giller, Arthur Ablin, Lewis Cohen, John Cullen, Edith Hawkins, Stephen A. Heifetz, Mark Krailo, Stephen J. Lauer, Neyssa Marina, P. V. Rao, Frederick Rescorla, Charles D. Vinocur, Robert M. Weetman, Robert P. Castleberry

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

OBJECTIVE: In both adult women and children the potential for malignant recurrence from ovarian immature teratoma has prompted the standard use of chemotherapy after complete resection of the primary tumor. The efficacy of postoperative chemotherapy in children and adolescents with ovarian immature teratoma, however, has not been established. A pediatric intergroup trial (INT 0106) was designed to determine the need for postoperative chemotherapy in patients with ovarian immature teratoma after management with surgical resection only. STUDY DESIGN: Between 1990 and 1995, 44 patients with completely resected ovarian immature tumor and without postoperative chemotherapy, who were able to undergo assessment, were accrued. Tumor tissue was evaluated by central pathology review to confirm diagnosis and determine tumor grading of immature neural elements. Patients were followed carefully for recurrence of disease with appropriate diagnostic imaging and serum marker studies. RESULTS: Thirty-one patients had pure ovarian immature teratoma with a tumor grade of 1 (n = 17), 2 (n = 12), or 3 (n = 2). Age at diagnosis ranged between 1.5 and 15 years (median, 10). Of the 29 patients studied, the serum α-fetoprotein level was elevated in 10 (34%); the median level was 25 ng/ml. Thirteen patients had ovarian immature teratoma plus microscopic loci of yolk sac tumor. Tumor grade was 1, 2, or 3 in 1 6, and 6 patients, respectively. Age ranged between 6 and 20 years (median, 12). In the 12 patients evaluated for serum α-fetoprotein, 10 (83%) had elevated levels; the median level was 262 ng/ml. The 4-year event-free and overall survival for the ovarian immature teratoma group and for the ovarian immature teratoma plus yolk sac tumor group was 97.7% (95% confidence interval, 84.9%- 99.7%) and 100%, respectively. The only yolk sac tumor relapse occurred in a child with ovarian immature teratoma and yolk sac tumor who was then treated with chemotherapy and is alive and free of disease 57 months after recurrence. CONCLUSION: The results of this study suggest that surgery alone is curative for most children and adolescents with resected ovarian immature teratoma of any grade, even when elevated levels of serum α-fetoprotein or microscopic foci of yolk sac tumor are present. This experience strongly supports avoiding the long-term effects of chemotherapy in most children with ovarian immature teratoma by reserving postoperative therapy for cases with relapse.

Original languageEnglish
Pages (from-to)353-358
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume181
Issue number2
DOIs
StatePublished - 1999

Fingerprint

Teratoma
Pediatrics
Endodermal Sinus Tumor
Neoplasms
Fetal Proteins
Drug Therapy
Recurrence
Therapeutics
Serum
Ovarian Teratoma
Neoplasm Grading
Diagnostic Imaging
Disease-Free Survival
Biomarkers
Confidence Intervals
Pathology

Keywords

  • Gliomatosis peritonei
  • Immature teratoma
  • Ovary
  • Yolk sac tumor foci

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents : A report of the Pediatric Oncology Group and the Children's Cancer Group. / Cushing, Barbara; Giller, Roger; Ablin, Arthur; Cohen, Lewis; Cullen, John; Hawkins, Edith; Heifetz, Stephen A.; Krailo, Mark; Lauer, Stephen J.; Marina, Neyssa; Rao, P. V.; Rescorla, Frederick; Vinocur, Charles D.; Weetman, Robert M.; Castleberry, Robert P.

In: American Journal of Obstetrics and Gynecology, Vol. 181, No. 2, 1999, p. 353-358.

Research output: Contribution to journalArticle

Cushing, B, Giller, R, Ablin, A, Cohen, L, Cullen, J, Hawkins, E, Heifetz, SA, Krailo, M, Lauer, SJ, Marina, N, Rao, PV, Rescorla, F, Vinocur, CD, Weetman, RM & Castleberry, RP 1999, 'Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents: A report of the Pediatric Oncology Group and the Children's Cancer Group', American Journal of Obstetrics and Gynecology, vol. 181, no. 2, pp. 353-358. https://doi.org/10.1016/S0002-9378(99)70561-2
Cushing, Barbara ; Giller, Roger ; Ablin, Arthur ; Cohen, Lewis ; Cullen, John ; Hawkins, Edith ; Heifetz, Stephen A. ; Krailo, Mark ; Lauer, Stephen J. ; Marina, Neyssa ; Rao, P. V. ; Rescorla, Frederick ; Vinocur, Charles D. ; Weetman, Robert M. ; Castleberry, Robert P. / Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents : A report of the Pediatric Oncology Group and the Children's Cancer Group. In: American Journal of Obstetrics and Gynecology. 1999 ; Vol. 181, No. 2. pp. 353-358.
@article{3a6b6ccc55914c9cbaa254314b21ccbd,
title = "Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents: A report of the Pediatric Oncology Group and the Children's Cancer Group",
abstract = "OBJECTIVE: In both adult women and children the potential for malignant recurrence from ovarian immature teratoma has prompted the standard use of chemotherapy after complete resection of the primary tumor. The efficacy of postoperative chemotherapy in children and adolescents with ovarian immature teratoma, however, has not been established. A pediatric intergroup trial (INT 0106) was designed to determine the need for postoperative chemotherapy in patients with ovarian immature teratoma after management with surgical resection only. STUDY DESIGN: Between 1990 and 1995, 44 patients with completely resected ovarian immature tumor and without postoperative chemotherapy, who were able to undergo assessment, were accrued. Tumor tissue was evaluated by central pathology review to confirm diagnosis and determine tumor grading of immature neural elements. Patients were followed carefully for recurrence of disease with appropriate diagnostic imaging and serum marker studies. RESULTS: Thirty-one patients had pure ovarian immature teratoma with a tumor grade of 1 (n = 17), 2 (n = 12), or 3 (n = 2). Age at diagnosis ranged between 1.5 and 15 years (median, 10). Of the 29 patients studied, the serum α-fetoprotein level was elevated in 10 (34{\%}); the median level was 25 ng/ml. Thirteen patients had ovarian immature teratoma plus microscopic loci of yolk sac tumor. Tumor grade was 1, 2, or 3 in 1 6, and 6 patients, respectively. Age ranged between 6 and 20 years (median, 12). In the 12 patients evaluated for serum α-fetoprotein, 10 (83{\%}) had elevated levels; the median level was 262 ng/ml. The 4-year event-free and overall survival for the ovarian immature teratoma group and for the ovarian immature teratoma plus yolk sac tumor group was 97.7{\%} (95{\%} confidence interval, 84.9{\%}- 99.7{\%}) and 100{\%}, respectively. The only yolk sac tumor relapse occurred in a child with ovarian immature teratoma and yolk sac tumor who was then treated with chemotherapy and is alive and free of disease 57 months after recurrence. CONCLUSION: The results of this study suggest that surgery alone is curative for most children and adolescents with resected ovarian immature teratoma of any grade, even when elevated levels of serum α-fetoprotein or microscopic foci of yolk sac tumor are present. This experience strongly supports avoiding the long-term effects of chemotherapy in most children with ovarian immature teratoma by reserving postoperative therapy for cases with relapse.",
keywords = "Gliomatosis peritonei, Immature teratoma, Ovary, Yolk sac tumor foci",
author = "Barbara Cushing and Roger Giller and Arthur Ablin and Lewis Cohen and John Cullen and Edith Hawkins and Heifetz, {Stephen A.} and Mark Krailo and Lauer, {Stephen J.} and Neyssa Marina and Rao, {P. V.} and Frederick Rescorla and Vinocur, {Charles D.} and Weetman, {Robert M.} and Castleberry, {Robert P.}",
year = "1999",
doi = "10.1016/S0002-9378(99)70561-2",
language = "English",
volume = "181",
pages = "353--358",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Surgical resection alone is effective treatment for ovarian immature teratoma in children and adolescents

T2 - A report of the Pediatric Oncology Group and the Children's Cancer Group

AU - Cushing, Barbara

AU - Giller, Roger

AU - Ablin, Arthur

AU - Cohen, Lewis

AU - Cullen, John

AU - Hawkins, Edith

AU - Heifetz, Stephen A.

AU - Krailo, Mark

AU - Lauer, Stephen J.

AU - Marina, Neyssa

AU - Rao, P. V.

AU - Rescorla, Frederick

AU - Vinocur, Charles D.

AU - Weetman, Robert M.

AU - Castleberry, Robert P.

PY - 1999

Y1 - 1999

N2 - OBJECTIVE: In both adult women and children the potential for malignant recurrence from ovarian immature teratoma has prompted the standard use of chemotherapy after complete resection of the primary tumor. The efficacy of postoperative chemotherapy in children and adolescents with ovarian immature teratoma, however, has not been established. A pediatric intergroup trial (INT 0106) was designed to determine the need for postoperative chemotherapy in patients with ovarian immature teratoma after management with surgical resection only. STUDY DESIGN: Between 1990 and 1995, 44 patients with completely resected ovarian immature tumor and without postoperative chemotherapy, who were able to undergo assessment, were accrued. Tumor tissue was evaluated by central pathology review to confirm diagnosis and determine tumor grading of immature neural elements. Patients were followed carefully for recurrence of disease with appropriate diagnostic imaging and serum marker studies. RESULTS: Thirty-one patients had pure ovarian immature teratoma with a tumor grade of 1 (n = 17), 2 (n = 12), or 3 (n = 2). Age at diagnosis ranged between 1.5 and 15 years (median, 10). Of the 29 patients studied, the serum α-fetoprotein level was elevated in 10 (34%); the median level was 25 ng/ml. Thirteen patients had ovarian immature teratoma plus microscopic loci of yolk sac tumor. Tumor grade was 1, 2, or 3 in 1 6, and 6 patients, respectively. Age ranged between 6 and 20 years (median, 12). In the 12 patients evaluated for serum α-fetoprotein, 10 (83%) had elevated levels; the median level was 262 ng/ml. The 4-year event-free and overall survival for the ovarian immature teratoma group and for the ovarian immature teratoma plus yolk sac tumor group was 97.7% (95% confidence interval, 84.9%- 99.7%) and 100%, respectively. The only yolk sac tumor relapse occurred in a child with ovarian immature teratoma and yolk sac tumor who was then treated with chemotherapy and is alive and free of disease 57 months after recurrence. CONCLUSION: The results of this study suggest that surgery alone is curative for most children and adolescents with resected ovarian immature teratoma of any grade, even when elevated levels of serum α-fetoprotein or microscopic foci of yolk sac tumor are present. This experience strongly supports avoiding the long-term effects of chemotherapy in most children with ovarian immature teratoma by reserving postoperative therapy for cases with relapse.

AB - OBJECTIVE: In both adult women and children the potential for malignant recurrence from ovarian immature teratoma has prompted the standard use of chemotherapy after complete resection of the primary tumor. The efficacy of postoperative chemotherapy in children and adolescents with ovarian immature teratoma, however, has not been established. A pediatric intergroup trial (INT 0106) was designed to determine the need for postoperative chemotherapy in patients with ovarian immature teratoma after management with surgical resection only. STUDY DESIGN: Between 1990 and 1995, 44 patients with completely resected ovarian immature tumor and without postoperative chemotherapy, who were able to undergo assessment, were accrued. Tumor tissue was evaluated by central pathology review to confirm diagnosis and determine tumor grading of immature neural elements. Patients were followed carefully for recurrence of disease with appropriate diagnostic imaging and serum marker studies. RESULTS: Thirty-one patients had pure ovarian immature teratoma with a tumor grade of 1 (n = 17), 2 (n = 12), or 3 (n = 2). Age at diagnosis ranged between 1.5 and 15 years (median, 10). Of the 29 patients studied, the serum α-fetoprotein level was elevated in 10 (34%); the median level was 25 ng/ml. Thirteen patients had ovarian immature teratoma plus microscopic loci of yolk sac tumor. Tumor grade was 1, 2, or 3 in 1 6, and 6 patients, respectively. Age ranged between 6 and 20 years (median, 12). In the 12 patients evaluated for serum α-fetoprotein, 10 (83%) had elevated levels; the median level was 262 ng/ml. The 4-year event-free and overall survival for the ovarian immature teratoma group and for the ovarian immature teratoma plus yolk sac tumor group was 97.7% (95% confidence interval, 84.9%- 99.7%) and 100%, respectively. The only yolk sac tumor relapse occurred in a child with ovarian immature teratoma and yolk sac tumor who was then treated with chemotherapy and is alive and free of disease 57 months after recurrence. CONCLUSION: The results of this study suggest that surgery alone is curative for most children and adolescents with resected ovarian immature teratoma of any grade, even when elevated levels of serum α-fetoprotein or microscopic foci of yolk sac tumor are present. This experience strongly supports avoiding the long-term effects of chemotherapy in most children with ovarian immature teratoma by reserving postoperative therapy for cases with relapse.

KW - Gliomatosis peritonei

KW - Immature teratoma

KW - Ovary

KW - Yolk sac tumor foci

UR - http://www.scopus.com/inward/record.url?scp=0032870767&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032870767&partnerID=8YFLogxK

U2 - 10.1016/S0002-9378(99)70561-2

DO - 10.1016/S0002-9378(99)70561-2

M3 - Article

C2 - 10454682

AN - SCOPUS:0032870767

VL - 181

SP - 353

EP - 358

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 2

ER -