Successful Management of Ultra-high-risk Mixed Ovarian Germ Cell Tumor Using a Pediatric-inspired Intensive Chemotherapy Regimen: A Case Report

Abstract

Background/Aim: Non-gestational ovarian choriocarcinoma is an extremely aggressive malignancy with limited standardized treatment protocols. We present a successful multidisciplinary approach for a high-risk mixed malignant ovarian germ cell tumor (MOGCT) containing a predominant choriocarcinomatous component. Case Report: A 33-year-old woman presented with acute hemoperitoneum. Pathology confirmed a mixed MOGCT (60% dysgerminoma, 40% choriocarcinoma, focal yolk sac tumor), International Federation of Obstetrics and Gynecology stage IVB. Following optimal cytoreductive surgery, a multidisciplinary tumor board, incorporating pediatric oncology paradigms, initiated a dose-dense, modified regimen of cyclophosphamide, bleomycin, etoposide, cisplatin, and methotrexate (Cy-BEP-MTX), administered every 2 weeks. This intensified strategy aimed to suppress rapid tumor repopulation. The patient tolerated seven cycles of this therapy and achieved complete remission, currently maintaining progression-free survival for 3 years. Conclusion: For ultra-high-risk non-gestational ovarian choriocarcinoma, optimal surgery followed by a pediatric-inspired, dose-dense chemotherapy regimen may provide a superior curative chance compared to standard protocols for adults, highlighting the value of interdisciplinary collaboration.