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Ведение больных с герминогенными опухолями яичника I стадии
Нечушкина И.В., Нечушкина В.М., Бойченко Е.И., Сусулева Н.А. Ведение больных с герминогенными опухолями яичника I стадии. Современная Онкология. 2019; 21 (1): 37–39. DOI: 10.26442/18151434.2019.2.190226
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Nechushkina I.V., Nechushkina V.M., Boychenko E.I., Susuleva N.A. Management of the patients with stage I germ cell ovarian tumors. Journal of Modern Oncology. 2019; 21 (1): 37–39. DOI: 10.26442/18151434.2019.2.190226
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Аннотация
Лечение детей и подростков с герминогенными опухолями яичников направлено на сохранение не только жизни, но и качества жизни пациентов. Сохранение фертильности у детей – один из факторов качества жизни. Удаление придатков на стороне поражения позволяет сохранить яичник на противоположной стороне. Единственный яичник способен сохранить дальнейшее правильное развитие вторичных половых признаков у девочки, что имеет огромное психологическое значение. Кроме того, сохраняется и репродуктивная функция. Химиотерапия может отрицательно влиять на функции единственного яичника. Заранее выяснить, как проведение химиотерапии отразится на функции яичника невозможно, поэтому необходимо у больных с I стадией герминогенной опухоли яичника решить вопрос о возможности исключения химиотерапии. Удаление придатков на стороне поражения у больных c I стадией процесса может быть при определенных условиях вполне достаточным объемом лечения. В обзоре отражены возможные факторы риска, которые необходимо учитывать при отказе от химиотерапии.
Ключевые слова: герминогенные опухоли, опухоли яичников, органосохраняющее лечение, детская онкология.
Ключевые слова: герминогенные опухоли, опухоли яичников, органосохраняющее лечение, детская онкология.
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The goal of the treatment of children and adolescents with germ cell ovarian tumors is to save both life and its quality. One of the quality of life issue in pediatric patients is fertility preservation. The removal of the ovary on the affected side allows saving the ovary on the opposite side. The single ovary is able to save further full development of female secondary sexual characteristics and will play important role as psychological value. In addition, the reproductive function will be stored. Chemotherapy may badly impact the function of a single ovary. To find out in advance how chemotherapy will affect ovarian function is impossible, so it is necessary for patients with Stage
I ovarian germ cell tumors to decide the possibility of dismissing chemotherapy from the treatment. Under certain conditions unilateral salpingo-oophorectomy may be sufficient for stage I disease. Risk factors which should be considered when refusing chemotherapy are discussed.
Key words: germ cell tumors, ovarian tumors, conservative surgery, pediatric oncology.
Полный текст
Список литературы
1. Lee CW, Song MJ, Park ST et al. Residual tumor after the salvage surgery is the major factors for primary treatment failure in malignant ovarian germ cell tumors: a retrospective study of single institute. W J Surg Oncol 2011; 9: 123–30.
2. Lee KH, Lee IH, Kim BG et al. Clinicopathologic characteristics of malignant germ cell tumors in the ovaries of Korean women; A Korean Gynecologic Oncology Group Study. Int J Gynecol Cancer 2009; 19 (1): 84–7.
3. O’Connor DM, Norris HJ. The influence of grade on outcome of stage I ovarian immature (malignant) teratomas and the reproducibility of grading. Int J Gynecol Pathol 1994; 13: 283–9.
4. 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/Childrenˈs Cancer Group Intergroup Study. J Clin Oncol 1999; 17 (7): 2137–43.
5. Cushing B, Giller R, Albin 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 1999; 181 (2): 353–8.
6. Calaminus G, Gobel U, Teske C et al. Prognosis and outcome of ovarian germ cell tumors – Final results of the German MAKEI 96 trial. Presented at the 42nd Congress of the International Society of Pediatric Oncology. Boston, MA, October 21–24, 2010.
7. Mann JR, Raafat F, Robinson K et al. The United Kingdom Children’s Cancer Group’ second germ cell tumor study: carboplatin, etoposide and bleomycin are effective treatment for children with malignant extracranial germ cell tumors with acceptable toxicity. J Clin Oncol 2000; 18: 3809–18.
8. Patterson DM, Rustin GJ. Controversies in management of germ cell tumors of the ovary. Curr Opin Oncol 2006; 18 (5): 500–6.
9. Li H, Hong W, Zhang R et al. Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma. Chin Med J (Engl) 2002; 115 (10): 1496–500.
10. Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Ther Adv Urol 2012; 4: 187–205.
11. Нечушкина И.В. Опухоли женских половых органов у детей (клиника, диагностика, лечение). Дис. … д-ра мед. наук. М., 2010.
[Nechushkina I.V. Opukholi zhenskikh polovykh organov u detei (klinika, diagnostika, lechenie). Dis. … d-ra med. nauk. Moscow, 2010 (in Russian).]
12. Panteli C, Curry J, Kiely E et al. Ovarian germ cell tumors: a 17-year study in a single unit. Eur J Pediatr Surg 2009; 19: 96–100.
13. Jorge S, Jones NL, Chen L et al. Characteristics, treatment and outcomes of women with immature ovarian teratoma, 1998–2012. Gynecol Oncol 2016; 142 (2): 261–6.
14. Mangili G, Scarfone G, Gadducci A et al. Is adjuvant chemotherapy indicated in stage I pure immature ovarian teratoma (IT)? A multicenter Italian trial in ovarian cancer (MITO-9). Gynecol Oncol 2010; 119 (1): 48–52.
15. Mangili G, Sigismondi C, Gadducci A et al. Outcome and risk factors for recurrence in malignant ovarian germ cell tumors: a MITO-9 retrospective study. Int J Gynecol Cancer 2011; 21 (8): 1414–21.
16. Heinzelbecrer J, Gross-Weege M, Weiss C et al. Microvascular invasion of testicular nonseminomatous germ cell tumors: implications of separate evaluation of lymphatic and blood vessels. J Urol 2014; 192 (2): 593–9.
17. Isharwal S, Risk MC. Management of clinical stage I nonseminomatous germ cell tumors. Expert Rev Anticancer 2014; 14 (9): 1021–32.
18. Nastaly P, Ruf C, Becker P et al. Circulating tumor cells in patients with testicular germ cell tumors. Clin Cancer Res 2014; 20 (14): 3830–41.
19. Nasioudis D, Frey MK, Chapman-Davis E et al. Fertility-preserving surgery for advanced stage ovarian germ cell tumors. Gynecol Oncol 2017; S0090-8258 (17): 31370–7.
20. Billmire DF, Cullen JW, Frederick JR et al. Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Chidren’s Oncology Group. J Clin Oncol 2014; 32 (5): 465–70.
21. Kumar S, Shah JP, Bryant CS et al. The prevalence and prognostic impact of lymph node metastasis in malignant germ cell tumors of ovary. Gynecol Oncol 2008; 110: 125–32.
2. Lee KH, Lee IH, Kim BG et al. Clinicopathologic characteristics of malignant germ cell tumors in the ovaries of Korean women; A Korean Gynecologic Oncology Group Study. Int J Gynecol Cancer 2009; 19 (1): 84–7.
3. O’Connor DM, Norris HJ. The influence of grade on outcome of stage I ovarian immature (malignant) teratomas and the reproducibility of grading. Int J Gynecol Pathol 1994; 13: 283–9.
4. 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/Childrenˈs Cancer Group Intergroup Study. J Clin Oncol 1999; 17 (7): 2137–43.
5. Cushing B, Giller R, Albin 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 1999; 181 (2): 353–8.
6. Calaminus G, Gobel U, Teske C et al. Prognosis and outcome of ovarian germ cell tumors – Final results of the German MAKEI 96 trial. Presented at the 42nd Congress of the International Society of Pediatric Oncology. Boston, MA, October 21–24, 2010.
7. Mann JR, Raafat F, Robinson K et al. The United Kingdom Children’s Cancer Group’ second germ cell tumor study: carboplatin, etoposide and bleomycin are effective treatment for children with malignant extracranial germ cell tumors with acceptable toxicity. J Clin Oncol 2000; 18: 3809–18.
8. Patterson DM, Rustin GJ. Controversies in management of germ cell tumors of the ovary. Curr Opin Oncol 2006; 18 (5): 500–6.
9. Li H, Hong W, Zhang R et al. Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma. Chin Med J (Engl) 2002; 115 (10): 1496–500.
10. Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Ther Adv Urol 2012; 4: 187–205.
11. Нечушкина И.В. Опухоли женских половых органов у детей (клиника, диагностика, лечение). Дис. … д-ра мед. наук. М., 2010.
[Nechushkina I.V. Opukholi zhenskikh polovykh organov u detei (klinika, diagnostika, lechenie). Dis. … d-ra med. nauk. Moscow, 2010 (in Russian).]
12. Panteli C, Curry J, Kiely E et al. Ovarian germ cell tumors: a 17-year study in a single unit. Eur J Pediatr Surg 2009; 19: 96–100.
13. Jorge S, Jones NL, Chen L et al. Characteristics, treatment and outcomes of women with immature ovarian teratoma, 1998–2012. Gynecol Oncol 2016; 142 (2): 261–6.
14. Mangili G, Scarfone G, Gadducci A et al. Is adjuvant chemotherapy indicated in stage I pure immature ovarian teratoma (IT)? A multicenter Italian trial in ovarian cancer (MITO-9). Gynecol Oncol 2010; 119 (1): 48–52.
15. Mangili G, Sigismondi C, Gadducci A et al. Outcome and risk factors for recurrence in malignant ovarian germ cell tumors: a MITO-9 retrospective study. Int J Gynecol Cancer 2011; 21 (8): 1414–21.
16. Heinzelbecrer J, Gross-Weege M, Weiss C et al. Microvascular invasion of testicular nonseminomatous germ cell tumors: implications of separate evaluation of lymphatic and blood vessels. J Urol 2014; 192 (2): 593–9.
17. Isharwal S, Risk MC. Management of clinical stage I nonseminomatous germ cell tumors. Expert Rev Anticancer 2014; 14 (9): 1021–32.
18. Nastaly P, Ruf C, Becker P et al. Circulating tumor cells in patients with testicular germ cell tumors. Clin Cancer Res 2014; 20 (14): 3830–41.
19. Nasioudis D, Frey MK, Chapman-Davis E et al. Fertility-preserving surgery for advanced stage ovarian germ cell tumors. Gynecol Oncol 2017; S0090-8258 (17): 31370–7.
20. Billmire DF, Cullen JW, Frederick JR et al. Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Chidren’s Oncology Group. J Clin Oncol 2014; 32 (5): 465–70.
21. Kumar S, Shah JP, Bryant CS et al. The prevalence and prognostic impact of lymph node metastasis in malignant germ cell tumors of ovary. Gynecol Oncol 2008; 110: 125–32.
________________________________________________
1. Lee CW, Song MJ, Park ST et al. Residual tumor after the salvage surgery is the major factors for primary treatment failure in malignant ovarian germ cell tumors: a retrospective study of single institute. W J Surg Oncol 2011; 9: 123–30.
2. Lee KH, Lee IH, Kim BG et al. Clinicopathologic characteristics of malignant germ cell tumors in the ovaries of Korean women; A Korean Gynecologic Oncology Group Study. Int J Gynecol Cancer 2009; 19 (1): 84–7.
3. O’Connor DM, Norris HJ. The influence of grade on outcome of stage I ovarian immature (malignant) teratomas and the reproducibility of grading. Int J Gynecol Pathol 1994; 13: 283–9.
4. 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/Childrenˈs Cancer Group Intergroup Study. J Clin Oncol 1999; 17 (7): 2137–43.
5. Cushing B, Giller R, Albin 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 1999; 181 (2): 353–8.
6. Calaminus G, Gobel U, Teske C et al. Prognosis and outcome of ovarian germ cell tumors – Final results of the German MAKEI 96 trial. Presented at the 42nd Congress of the International Society of Pediatric Oncology. Boston, MA, October 21–24, 2010.
7. Mann JR, Raafat F, Robinson K et al. The United Kingdom Children’s Cancer Group’ second germ cell tumor study: carboplatin, etoposide and bleomycin are effective treatment for children with malignant extracranial germ cell tumors with acceptable toxicity. J Clin Oncol 2000; 18: 3809–18.
8. Patterson DM, Rustin GJ. Controversies in management of germ cell tumors of the ovary. Curr Opin Oncol 2006; 18 (5): 500–6.
9. Li H, Hong W, Zhang R et al. Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma. Chin Med J (Engl) 2002; 115 (10): 1496–500.
10. Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Ther Adv Urol 2012; 4: 187–205.
11. Нечушкина И.В. Опухоли женских половых органов у детей (клиника, диагностика, лечение). Дис. … д-ра мед. наук. М., 2010.
[Nechushkina I.V. Opukholi zhenskikh polovykh organov u detei (klinika, diagnostika, lechenie). Dis. … d-ra med. nauk. Moscow, 2010 (in Russian).]
12. Panteli C, Curry J, Kiely E et al. Ovarian germ cell tumors: a 17-year study in a single unit. Eur J Pediatr Surg 2009; 19: 96–100.
13. Jorge S, Jones NL, Chen L et al. Characteristics, treatment and outcomes of women with immature ovarian teratoma, 1998–2012. Gynecol Oncol 2016; 142 (2): 261–6.
14. Mangili G, Scarfone G, Gadducci A et al. Is adjuvant chemotherapy indicated in stage I pure immature ovarian teratoma (IT)? A multicenter Italian trial in ovarian cancer (MITO-9). Gynecol Oncol 2010; 119 (1): 48–52.
15. Mangili G, Sigismondi C, Gadducci A et al. Outcome and risk factors for recurrence in malignant ovarian germ cell tumors: a MITO-9 retrospective study. Int J Gynecol Cancer 2011; 21 (8): 1414–21.
16. Heinzelbecrer J, Gross-Weege M, Weiss C et al. Microvascular invasion of testicular nonseminomatous germ cell tumors: implications of separate evaluation of lymphatic and blood vessels. J Urol 2014; 192 (2): 593–9.
17. Isharwal S, Risk MC. Management of clinical stage I nonseminomatous germ cell tumors. Expert Rev Anticancer 2014; 14 (9): 1021–32.
18. Nastaly P, Ruf C, Becker P et al. Circulating tumor cells in patients with testicular germ cell tumors. Clin Cancer Res 2014; 20 (14): 3830–41.
19. Nasioudis D, Frey MK, Chapman-Davis E et al. Fertility-preserving surgery for advanced stage ovarian germ cell tumors. Gynecol Oncol 2017; S0090-8258 (17): 31370–7.
20. Billmire DF, Cullen JW, Frederick JR et al. Surveillance after initial surgery for pediatric and adolescent girls with stage I ovarian germ cell tumors: report from the Chidren’s Oncology Group. J Clin Oncol 2014; 32 (5): 465–70.
21. Kumar S, Shah JP, Bryant CS et al. The prevalence and prognostic impact of lymph node metastasis in malignant germ cell tumors of ovary. Gynecol Oncol 2008; 110: 125–32.
Авторы
И.В. Нечушкина*1,2, В.М. Нечушкина1,3, Е.И. Бойченко1,2, Н.А. Сусулева1,2
1 ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
3 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*ivnechushkina@mail.ru
1 ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
3 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*ivnechushkina@mail.ru
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Innesa V. Nechushkina*1,2, Valentina M. Nechushkina1,3, Elena I. Boychenko1,2, Natalia A. Susuleva1,2
1 N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation, Moscow, Russia;
2 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia;
3 Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
*ivnechushkina@mail.ru
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