How are granulosa cell tumors (GCTs) of the ovaries treated?

Updated: Aug 30, 2018
  • Author: David C Starks, MD, MPH; Chief Editor: Warner K Huh, MD  more...
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Answer

Primary treatment for patients with GCTs is surgical. Chemotherapy and/or radiotherapy are reserved for patients with advanced disease by surgical staging, and for patients with recurrent tumor.

Surveillance for patients postoperatively consists of frequent pelvic examinations and assessment of tumor markers (if applicable) to detect recurrences as early as possible. Findings from physical examination or laboratory studies that are suggestive of recurrence should be further evaluated with abdominopelvic CT scan or other diagnostic imaging modalities.

Radiotherapy for patients with advanced or recurrent GCTs has been studied and appears to have limited efficacy.

In a 1999 study by Wolf et al at the MD Anderson Cancer Center, 6 of 14 patients with measurable disease had complete clinical responses to pelvic radiation and 3 patients were without evidence of disease 10-21 years after radiation. However, 3 patients experienced a recurrence 4-5 years after radiation. [12] Eight of 14 had no response to treatment and had a median survival of 12.3 months overall.

A more recent study by Hauspy et al reviewed 45 years of GCT treatment at Princess Margaret Hospital. Thirty-one of 103 women received abdominal and/or pelvic radiation as adjuvant therapy. Multivariate analysis showed that adjuvant radiation significantly improved survival and that stage III disease was independently predictive of a poor response. They concluded that patients receiving radiation had better disease-free survival (251 mo vs 114 mo for those not receiving radiation). However, 86% of those receiving radiation were stage I versus only 52% of those who did not receive radiation. Moreover, only 2 of the 103 patients received chemotherapy. [13]

Currently, radiation is considered an option for advanced-stage patients and, in patients with pelvic recurrence, radiotherapy should be considered because a clinical response occurs in almost half of patients treated with radiation therapy.

Adjuvant therapy for GCTs has typically been carried out using chemotherapy. There is also data available regarding hormonal manipulation of these tumors using GnRH analogues and aromatase inhibitors. See additional discussion under "Experimental medications" below.


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