Diapositiva 1

1
Beta hCG, AFP Rayos X de tórax TAC de abdomen y
pelvis
Dolor abdominal y masa pélvica palpable
(85) Abdomen agudo (10)
MOGCT
Salpingo-ooforectomía unilateral con preservación
de la fertilidad (si apropiado), citología de
líquido peritoneal, biopsias del peritoneo, del
fondo de saco posterior, de la reflexión vesical,
de las paredes pélvicas, de los espacios
paracólicos bilaterales y de las superficies
diafragmáticas, omentectomía, linfadenectomía
pélvica, incluyendo ganglios linfáticos pélvicos
y para-aórticos bilaterales
Salpingo-ooforectomía unilateral con preservación
de la fertilidad (si apropiado) y la trompa de
falopio si no está comprometida, citología de
líquido peritoneal, inspección del peritoneo y
omento, inspección de los ganglios linfáticos
pélvicos y paraaórticos. Resección de ganglios
indurados, adheridos, prominentes. Resección de
lesiones induradas en peritoneo u omento
Billmire D, Vinocur C, Rescorla F, et al Outcome
and staging evaluation in malignant germ cell
tumors of the ovary in children and adolescents
An intergroup study. J Pediatr Surg 39424-429,
2004 discussion 429
Gershenson, David M. Management of Ovarian Germ
Cell Tumors J Clin Oncol 2007 25 2938-2943
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2
MOGCT Cirugía
Estadío I
Estadío gt I
Observación
BEP/Carboplatino Etopósido
Recaidas 33 Rescate 90
Menstruación post quimioterapia 80-99
Gershenson DM, Morris M, Cangir A, et al
Treatment of malignant germ cell tumors of the
ovary with bleomycin, etoposide, and cisplatin. J
Clin Oncol 8715-720, 1990. Williams S, Blessing
JA, Liao SY, et al Adjuvant therapy of ovarian
germ cell tumors with cisplatin, etoposide, and
bleomycin A trial of the Gynecologic Oncology
Group. J Clin Oncol 12701-706, 1994. Gershenson
DM, Wharton JT, Kline RC, et al Chemotherapeutic
complete remission in patients with metastatic
ovarian dysgerminoma. Potential for cure and
preservation of reproductive capacity. Cancer
582594-2599, 1986. Williams SD, Blessing JA,
Hatch KD, et al Chemotherapy of advanced
dysgerminoma Trials of the Gynecologic Oncology
Group. J Clin Oncol 91950-1955, 1991. Brewer M,
Gershenson DM, Herzog CE, et al Outcome and
reproductive function after chemotherapy for
ovarian dysgerminoma. J Clin Oncol 172670-2675,
1999. Williams SD, Kauderer J, Burnett AF, et al
Adjuvant therapy of completely resected
dysgerminoma with carboplatin and etoposide A
trial of the Gynecologic Oncology Group. Gynecol
Oncol 95496-499, 200
Bonazzi C, Peccatori F, Colombo N, et al Pure
ovarian immature teratoma, a unique and curable
disease 10 years experience of 32 prospectively
treated patients. Obstet Gynecol 84598-604,
1994 Dark GG, Bower M, Newlands ES, et al
Surveillance policy for stage I ovarian germ cell
tumors. J Clin Oncol 15620-624, 1997 Mitchell
PL, Al-Nasiri N, A'Hern R, et al Treatment of
nondysgerminomatous ovarian germ cell tumors An
analysis of 69 cases. Cancer 852232-2244, 1999
Cushing B, Giller R, Ablin A, et al 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. Am J
Obstet Gynecol 181353-358, 1999. Marina NM,
Cushing B, Giller R, et al Complete surgical
excision is effective treatment for children with
immature teratomas with or without malignant
elements A Pediatric Oncology Group/Children's
Cancer Group Intergroup Study. J Clin Oncol
172137-2143, 1999 Gobel U, Schneider DT,
Calaminus G, et al Germ-cell tumors in childhood
and adolescence GPOH MAKEI and the MAHO study
groups. Ann Oncol 11263-271, 2000, Baranzelli M,
Bouffet E, Quintana E, et al Non-seminomatous
ovarian germ cell tumours in children. Eur J
Cancer 36376-383, 2000Gershenson DM Menstrual
and reproductive function after treatment with
combination chemotherapy for malignant ovarian
germ cell tumors. J Clin Oncol 6270-275, 1988
Gershenson, David M. Management of Ovarian Germ
Cell Tumors J Clin Oncol 2007 25 2938-2943
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MOGCT Cirugía Quimioterapia inicial
Recaida
lt 6 meses
gt 6 meses
Quimioterapia de altas dosis con trasplante de
células madres hematopoyéticas autólogo
Quimioterapia de salvamento Vinblastina
Ifosfamida Cisplatino Etopósido Ifosfamida
Cisplatino Paclitaxel Ifosfamida Cisplatino
Bhatia S, Abonour R, Porcu P, et al High-dose
chemotherapy as initial salvage chemotherapy in
patients with relapsed testicular cancer. J Clin
Oncol 183346-3351, 2000 Motzer RJ, Mazumdar M,
Sheinfeld J, et al Sequential dose-intensive
paclitaxel, ifosfamide, carboplatin, and
etoposide salvage therapy for germ cell tumor
patients. J Clin Oncol 181173-1180, 2000 Motzer
RJ, Nichols CJ, Margolin KA, et al Phase III
randomized trial of conventional-dose
chemotherapy with or without high-dose
chemotherapy and autologous hematopoietic
stem-cell rescue as first-line treatment for
patients with poor-prognosis metastatic germ cell
tumors. J Clin Oncol 25247-256, 2007
Loehrer PJ Sr, Lauer R, Roth BJ, et al Salvage
therapy in recurrent germ cell cancer Ifosfamide
and cisplatin plus either vinblastine or
etoposide. Ann Intern Med 109540-546, 1988
Loehrer PJ Sr, Gonin R, Nichols CR, et al
Vinblastine plus ifosfamide plus cisplatin as
initial salvage therapy in recurrent germ cell
tumor. J Clin Oncol 162500-2504, 1998 McCaffrey
JA, Mazumdar M, Bajorin DF, et al Ifosfamide and
cisplatin-containing chemotherapy as first-line
salvage therapy in germ cell tumors response and
survival. J Clin Oncol 152559-2563, 1997
Kondagunta GV, Bacik J, Donadio A, et al
Combination of paclitaxel, ifosfamide, and
cisplatin is an effective second-line therapy for
patients with relapsed testicular germ cell
tumors. J Clin Oncol 236549-6555, 2005 Broun
ER, Nichols CR, Gize G, et al Tandem high dose
chemotherapy with autologous bone marrow
transplantation for initial relapse of testicular
germ cell cancer. Cancer 79605-610, 1997
Gershenson, David M. Management of Ovarian Germ
Cell Tumors J Clin Oncol 2007 25 2938-2943
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Curación de aproximadamente 97-100 en pacientes
con estadíos tempranos Curación de 75 en
pacientes con estadíos avanzados Preservación
de la fertilidad en 80 Quimioterapia de
salvamento puede curar aproximadamente 50 de las
que recidivan
Gershenson, David M. Management of Ovarian Germ
Cell Tumors J Clin Oncol 2007 25 2938-2943
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LemaTeachFiles - 2007