Chemotherapy regimen for malignant teratoma

Clinically, teratomas are divided into benign teratomas and malignant teratomas. However, malignant teratomas are different from other ovarian malignant tumors. Teratomas are formed by another embryo during fetal development and do not belong to the patient's own tissue. Neither benign nor malignant represents the nature of the patient's own ovarian tissue. As long as the operation is delicate and the technique is skilled, the teratoma can be completely separated and the patient's own ovarian tissue can be retained. Let's take a look at the chemotherapy plan for malignant teratoma.

Laparotomy is limited by the incision, with a small field of view and difficult operation. It is often not easy to peel off the teratoma tissue cleanly. Laparoscopic surgery has a wide field of view and a magnifying effect. The ovary where the teratoma is located is placed in a plastic bag, and the teratoma tissue can be completely peeled off without contaminating the abdominal cavity. At the same time, it is convenient to explore the contralateral ovary (more than 50% of teratomas are bilateral and occur successively). Therefore, teratoma surgery does not require laparotomy. On the consent form for surgery, if there is a possibility of conversion to laparotomy or the words "ovarian removal is required for malignant teratoma", do not sign it. This means that the hospital is not proficient in laparoscopic technology and does not have a sufficient understanding of malignant teratoma. Once the ovaries are removed, the patient will quickly enter menopause, and there is no way to save the situation. It should be classified as overtreatment.

Teratomas originate from potentially multifunctional primitive embryonic cells and are mostly benign, but the tendency to be malignant increases with age. The site of occurrence is related to the midline anterior axis or midline paracentral area of ​​the embryological body cavity, and is often seen in the sacral and coccygeal region, mediastinum, retroperitoneum, and gonadal region. They are more common in newborns and infants, and are more common in women.

How to treat

Once a teratoma is diagnosed, early surgical resection is necessary to prevent benign teratoma from becoming malignant due to delayed surgery, and to prevent infection, rupture, bleeding and complications. The key point of teratoma surgery is to completely remove the tumor. For ovarian and testicular tumors, one ovary or testicle should be removed. For sacrococcygeal teratoma, the coccyx must be removed at the same time to avoid residual pluripotent cells that may cause tumor recurrence.

The treatment principle of malignant teratoma is combined adjuvant therapy. Conventional chemotherapy is used for 1.5 to 2 years after surgical resection. Cisplatin, vinblastine or vincristine, and bleomycin are commonly used. In recent years, combined chemotherapy with cisplatin, doxorubicin, ifosfamide and other chemotherapy drugs is recommended. Radiotherapy is only used for cases of malignant teratoma with clear microscopic or macroscopic residuals. The radiotherapy dose is preferably 25Gy for microscopic residuals, and 35Gy can be used for macroscopic residuals. For those with complete surgical resection, chemotherapy is advocated in recent years, and radiotherapy is used with caution to avoid delayed damage to reproductive organs and bone development during radiotherapy.

For patients with large or extensively infiltrated malignant teratomas that are clinically judged to be unresectable, preoperative chemotherapy or radiotherapy can be used to shrink the tumor before delayed radical surgery, which is of positive significance in improving the surgical resection rate and preserving important organs. For advanced cases, preoperative chemotherapy or radiotherapy can also achieve the therapeutic purpose of relieving tumor compression, controlling metastatic lesions, and gaining the opportunity for another surgery.