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Management of Ovarian Stromal Cell Tumors

Nicoletta Colombo, Gabriella Parma, Vanna Zanagnolo, Alessandra Insinga

From the University of Milan Bicocca; Gynecologic Oncology Division, European Institute of Oncology; and the Department of Experimental Oncology, European Institute of Oncology, Milan, Italy

Address reprint requests to Nicoletta Colombo, MD, Gynecologic Oncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy; e-mail: nicoletta.colombo{at}ieo.it

Purpose To describe the clinical management of ovarian stromal cell tumors, which are a heterogeneous group of neoplasms that develop from the sex cords and the ovarian stroma.

Design We reviewed the current evidence on the clinical management of these relatively rare ovarian malignancies, which are typically detected at an early stage and may recur as late as 30 years following the initial treatment. The overall prognosis is favorable with a long-term survival ranging from 75% to 90% for all stages. Adult granulosa cell tumor (GCT) is the most common malignancy among these tumors.

Results Surgery is the cornerstone of initial treatment. In women of childbearing age and with disease limited to one ovary, a fertility-sparing surgery can be a reasonable approach. Tumor stage represents the most important clinical parameter of prognostic relevance. The value of postoperative adjuvant therapy for high-risk patients has not been proven by prospective randomized studies. Platinum-based chemotherapy is used currently for patients with advanced stages or recurrent disease, with an overall response rate of 63% to 80%. Taxane and platinum combination chemotherapy seems to be a reasonable candidate for future trials. Little evidence exists for the use of radiation or hormonal therapy, and these modalities should be restricted to selected cases. Given the propensity of GCT for late relapse, prolonged follow-up is required.

Conclusion Surgery remains the most effective treatment for ovarian stromal tumors and, whenever feasible, for relapsing disease. Platinum-based chemotherapy is currently used in metastatic or recurrent tumors.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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