A young woman undergoes surgery for a right ovarian germ cell tumor found to be dysgerminoma, Stage IA. Histopathology shows pure dysgerminoma with no lymphovascular invasion. The most appropriate adjuvant management is:

• A BEP chemotherapy (bleomycin, etoposide, cisplatin) × 3 cycles
• B Pelvic and para-aortic radiotherapy
• C Surveillance without adjuvant treatment ✓
• D Carboplatin monotherapy × 4 cycles

Explanation

Stage IA pure dysgerminoma is highly curable (>95% survival) with fertility-sparing surgery alone (unilateral salpingo-oophorectomy with surgical staging), and surveillance without adjuvant therapy is the standard of care. Adjuvant BEP chemotherapy is reserved for Stage IB–IV or recurrent disease; dysgerminoma is exquisitely sensitive to both radiation and BEP. Radiation is now rarely used due to infertility risk. Unlike other malignant germ cell tumors, isolated Stage IA dysgerminoma has such a favorable prognosis with surgery alone that the toxicity of adjuvant treatment is not justified. LDH and PLAP are the characteristic tumor markers.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.