Fertility and gonadal function after adjuvant therapy in women diagnosed with a malignant ovarian germ cell tumor (MOGCT) during the "cisplatin era"

O Solheim; C G Tropé; E Rokkones; J Kærn; T Paulsen; H B Salvesen; B Hagen; A B Vereide; S D Fosså

doi:10.1016/j.ygyno.2014.12.010

Fertility and gonadal function after adjuvant therapy in women diagnosed with a malignant ovarian germ cell tumor (MOGCT) during the "cisplatin era"

Gynecol Oncol. 2015 Feb;136(2):224-9. doi: 10.1016/j.ygyno.2014.12.010. Epub 2014 Dec 12.

Authors

O Solheim¹, C G Tropé², E Rokkones³, J Kærn³, T Paulsen³, H B Salvesen⁴, B Hagen⁵, A B Vereide⁶, S D Fosså⁷

Affiliations

¹ Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway. Electronic address: OLSOLH@ous-hf.no.
² Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Gynaecologic Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
⁴ Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
⁵ Department of Gynaecology and Obstetrics, St. Olavs Hospital Trondheim, University Hospital, Trondheim, Norway.
⁶ Department of Clinical medicine, University Hospital of North Norway, Tromsø, Norway.
⁷ National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

PMID: 25511159
DOI: 10.1016/j.ygyno.2014.12.010

Abstract

Purpose: By self-report and serum levels of anti-Mullerian hormone (AMH) this study aims to assess post-treatment fertility after modern treatment of women with malignant ovarian germ cell tumors (MOGCT).

Patients and methods: In 2013 a questionnaire-based survey was performed in 61 MOGCT patients diagnosed at age <40years from 1980-2009. Forty-nine of them also attended the out-patient clinic. The event of first post-treatment pregnancy ("fertility") was documented as cumulative estimates for all 61 patients and within each of 4 treatment groups: Group 1: Surgery only (n=10); Group 2: ≤3cycles of cisplatin-based chemotherapy (CBCT) (n=20); Group 3: >3cycles of CBCT (n=15) and Group 4: other adjuvant treatment (n=16). AMH was determined in 22 women <40years at survey. Statistics were based on Kaplan Meier procedure, log-rank test and a significance level p<0.05.

Results: At least one post-treatment pregnancy was reported by 34 of 39 MOGCT survivors who attempted motherhood after treatment. The 15-year cumulative post-treatment fertility estimate was 28% (95% CI: 26-30) for all 61 survivors and was significantly higher in patients treated with 3 or fewer cycles of CBCT (53% [95% CI: 50-55]) than those treated with more than 3cycles (20% [95% CI: 17-22]) (P=0.03). Of 22 AMH levels, two were <3pmol/l, with one women being pregnant at survey.

Conclusion: After fertility-sparing surgery and modern cisplatin-based chemotherapy, fertility is preserved in most MOGCT survivors though dependent on the number of cycles. AMH's role as a biomarker of gonadal function seems promising but requires further research.

Keywords: Cisplatin-based chemotherapy; Fertility; Ovarian germ cell cancer.

MeSH terms

Antineoplastic Agents / administration & dosage
Antineoplastic Agents / therapeutic use*
Cisplatin / administration & dosage
Cisplatin / therapeutic use*
Female
Fertility / drug effects*
Gonads / drug effects*
Humans
Neoplasms, Germ Cell and Embryonal / drug therapy*
Neoplasms, Germ Cell and Embryonal / mortality
Ovarian Neoplasms / drug therapy*
Ovarian Neoplasms / mortality
Surveys and Questionnaires

Substances

Antineoplastic Agents
Cisplatin

Supplementary concepts

Ovarian Germ Cell Cancer