There does not much information on the treatment of gynandroblastoma available in the literature. Findings from a recent study suggest that surgery may be the most optimal and effective method to treatment gynandroblastoma. However, if complete and well-defined histological tumor-cell excision is not possible due to extensive tumor, adjuvant radiotherapy seems to be a very useful tool to prevent recurrence of the tumor.
Gynandroblastoma is a rare tumour arising from the germ cells of the gonads. In its most common form, it presents as a palpable abdominal mass. The prognosis is excellent compared with other germ cell tumours.
The American Cancer Society estimates 825 new cases of gynandroblastoma will be diagnosed in 2010; 1 of every 100,000 men should be diagnosed with gynandroblastoma.
Gynandroblastoma seems to occur most often in girls ≤ 2 years of age, usually with an ovarian mass or an abdominal mass. Its behavior is quite similar to that of mature ovarian teratomas, for instance with local recurrences of the same type.
About half of patients with gynandroblastoma have non-adherent tumors that do not respond to chemotherapy. Therefore, biopsy is recommended before chemotherapy begins. The tumor must be surgically removed in cases of tumor that is highly adherent.
There are several risk factors for developing testicular germ cell tumours, and the rate of the tumours is increasing with age. Most cases of testicular germ cell tumour arise at puberty, and this could be due to the influence of gonadotropic hormones on germ cells. Although epidemiological studies have confirmed the causal relationship between gonadotropic hormones and testicular germ cell tumours, the molecular mechanism of cancer is still uncertain.
The most common side effects of single-agent paclitaxel treatment, which did not correlate with the dose of the drug, were leukopenia (54%), febrile neutropenia (27%), and fatigue (26). Other side effects that were observed in more than 1% of the patients included nausea (23%), diarrhea (16%), anemia (5%), nausea (5%), alopecia (5%), hypertension, asthenia, edema, pain, peripheral edema, hypotension and pneumonitis. The treatment was generally well tolerated, although neutropenia was seen in 10% of patients in the first 12 weeks after treatment.
The mechanisms of action of paclitaxel are as follows. It binds and depolymerizes microtubules of which the majority is composed of colchicine, a compound which occurs naturally in the gynandroblastoma. It is also able to enhance cisplatin cytotoxicity when given in the presence of vinblastine. And when paclitaxel is combined with epirubicin in a fixed sequence of cisplatin and epirubicin the synergistic effect is greatly enhanced by paclitaxel.
[A single study from 1993 analyzed 11 patients with a median age of 53 years and a median survival time of 44.5 months.] Surviving patients were classified as long-term survivors (LT) or patients with recurrent/dying tumours. [Statistical analysis was performed using the Kaplan-Meier method, not on the log-rank test used by most modern studies.]\n\nSurvival rate (SR), time to death (TTD), and relapse rates have been widely reported and standardized as the three most important elements of prognostic factor analysis.
Data from a recent study of this study show an interesting response rate when using taxol analogs in patients with metastatic gynandroblastoma. Taxol has been investigated in the treatment of breast cancer, prostate cancer, and non-small cell lung cancer. It appeared similar to vinorelbine, but showed less toxicity and can be administered in repeated treatments of up to six cycles of weekly intravenous infusions every third week.
There is a large discrepancy in paclitaxel use between institutions. Clinical trial results showed improvement in survival rates, and paclitaxel has been shown to improve survival time while in combination with other chemotherapy regimens. Further research is needed to identify the optimum chemotherapeutic dose and combination of chemotherapy in order to improve outcomes.
Paclitaxel increased progression-free survival (PFS) and overall survival (OS) in metastatic germ cell tumors in combination with standard-dose carboplatin. This trial should not be interpreted as a demonstration of the superiority of paclitaxel over comparator to treat germ cell tumors; rather, it indicates that the use of paclitaxel as a component of combination chemotherapy warrants further study.