The management of malignant nondysgerminomatous ovarian germ cell tumors.

Nondysgerminomatous ovarian germ cell tumors are always unilateral and predominantly occur in children, adolescents and young women. Conservative surgery should be the standard approach for most patients regardless of tumor stage. The role of adjuvant chemotherapy in stage I disease is questionable. Platinum-based chemotherapy is the standard postoperative treatment for all patients with advanced nondysgerminomatous ovarian germ cell malignancies. In immature teratoma patients with peritoneal spreading, chemotherapy is not required for grade 0 or 1 implants, is of uncertain significance for grade 2 lesions, but is warranted for grade 3 implants. In recent series, in which most patients received conservative surgery often followed by platinum-based chemotherapy, 5-year survival rates range from 82% to 100%. There have been several cases reported of normal babies delivered following treatment of ovarian germ cell tumors. In women previously treated conservatively for these malignancies, miscarriages are in the expected range whereas the malformation rate seems to be slightly higher than in the general population. In conclusion, the current therapeutic strategies are able to save the large majority of patients with nondysgerminomatous ovarian germ cell tumors and to preserve their reproductive potential.