Feasibility of Fertility-Sparing Surgery After Neoadjuvant Chemotherapy for Advanced Malignant Germ Cell Tumor of the Ovary

Purpose To analyze the feasibility of fertility-sparing surgery in patients who received neoadjuvant therapy for advanced malignant germ cell tumor of the ovary and to assess the menstrual and reproductive function in such patients. Methods A retrospective study of 28 patients who underwent cytoreductive surgery following neoadjuvant chemotherapy for advanced germ cell tumor of the ovary from January 2008 to March 2019. Results The median age of the patients was 16.5 years. All patients responded well to neoadjuvant chemotherapy. Twenty-four patients underwent fertility-sparing surgery. Two patients opted for hysterectomy and bilateral salpingo-oophorectomy as they had completed their family and two patients underwent bilateral salpingo-oophorectomy for residual disease. One patient underwent completion surgery at a later date for a large benign cyst of the remaining ovary. Two patients were lost to follow-up, one of whom was pregnant at the time of the last follow-up. One patient, who initially presented with stage IV Dysgerminoma died due to disease recurrence. Of the remaining patients, 16 reported regular menstrual cycles and one patient has irregular cycles. Two patients were diagnosed with primary amenorrhea and two are still premenarchal. Three patients tried for pregnancy and had a total of four pregnancies. Conclusion When fertility preservation is not feasible, neoadjuvant chemotherapy followed by surgery might be considered in patients with advanced malignant germ cell tumor. Neoadjuvant chemotherapy followed by surgery can result in complete cytoreduction, with high chance of fertility preservation and good menstrual and reproductive outcome.