Is my screen visible? Yes, perfect. Thank you. So, we have a case of neoadjuvant chemotherapy in malignant ovarian germ cell tumors and in civil service hospital. So, as we know that these malignant ovarian germ cell tumors, they account for 3-5% of all ovarian cancers and it's very common in young females of 15-19 years. And these ovarian tumors, malignant germ cell tumors, they were very notorious previously. So prior to establishment of chemotherapy in 1970s, we had a very poor prognosis for these diseases. But now, with the improvement in chemotherapy and surgical treatments, the five-year survival rate of the patients have reached up to more than 85%. So the main reason is definitely we are for the effectiveness of the platinum-based chemotherapy. And since these patients are young age, fertility concerns are the major issues in these patients or after the treatment among the cancer survivors. So the use of neoadjuvant chemotherapy has increased annually by around 10% from 2011 to 2016, mentioned in the studies. And in most countries, the occurrence rate of ovarian germ cell tumors are on an average of 3%. But in the Asian countries, it is more, that accounts to 4.3% due to the young age profile of the population in Asians. So as the various studies in epithelial ovarian tumors have shown that neoadjuvant chemotherapy followed by interval debulking surgery to be non-inferior to primary debulking surgery in terms of survival. So till now, only a few studies have reported neoadjuvant chemotherapy and malignant ovarian germ cell tumors. So in our study, the objective was to find the effectiveness of neoadjuvant chemotherapy and the success of fertility preservation surgeries. It was an observational descriptive study done from 2015 to 2023. And all patients with malignant ovarian germ cell tumors treated with neoadjuvant chemotherapy and fertility sparing surgery was taken into account. So the inclusion criteria was the malignant ovarian germ cell tumors below 30 years of age treated with neoadjuvant chemotherapy having fertility concerns. And the data was collected from the hospital cancer registry, and the outcome was measured with type of tumor, staging, and grade of tumor was taken into account. And the course of neoadjuvant chemotherapy and surgical procedures and adjuvant chemotherapy courses were also recorded. And the data collection later on was done in person interview and by telephone. And the data of survival length and oncologic outcome was acquired. And fertility information was also taken in respect to menstrual status and reproductive and obstetrical outcome of the patients were obtained. And the overall survival was evaluated as clinical outcomes. So in total, we had 18 patients of malignant ovarian germ cell tumors during this period. And among these, seven patients, which accounted for 39% of the patients received neoadjuvant chemotherapy with fertility sparing surgery were included. And the mean age was around 16.8 years. And the survival rate was high in the patients with distal minima and mixed type, which accounted for 100%. But in yolk sac tumor, we had 67% of survival rate. And among these patients, there were no menstrual issues in 85% of the patients. And only one patient had few problems, but he regained normal menstruation after six months of completing her chemotherapy. And all patients were of nulliparous. And there was five patients in stage 1C and two patients of stage 3C. This is another stating the type of histologic type. We had one patient of mixed germ cell tumor, three patients of distal minima, and three patients of yolk sac tumor. These were the few pictures of the surgery that was done. And coming to the oncologic outcome, we had complete remission in five patients, accounting to 72%. And the five patients were of two patients of distal minima in stage 1C, two patients of yolk sac tumor, one in stage 3C and 1C, and one patient of mixed germ cell tumor of stage 3C. And the overall survival of the patients ranged from 60 to 84 months till date now. And we had a recurrence rate in two patients of 28% accounting. One patient was of yolk sac tumor with stage 1C, but she was disease-free for 12 months, but later had recurrence. And completion surgery was done, but still the patient had died of diseases with an overall survival of 58 months. And another patient of recurrence was found in distal minima patients of stage 1C. And her repeat chemotherapy was given. And at now, she's disease-free with an overall survival of 67 months of duration. These are the few clinical details of successful conceptions and pregnancies among the patients of the, who received neoadjuvant chemotherapy and fertility sparing surgery. One patient, two patients of distal minima of stage 1C, they received four cycles of chemotherapy and they got married and was delivered a baby, reproductive age. So they had, obstetric outcome was good after six years and two years of duration. And another patient was a mixed germ cell tumor of stage 3C, which she received of six cycles of chemotherapy. And she had delivered a baby after two years of completion of treatment. And all the pregnancies were spontaneous conceptions. So with this, we had come to discussion that chemotherapy can cure majority of patients, even with advanced diseases. And conservative surgery would be a standard in all stages of germ cell tumors. And since they are the young age, so many patients, they opt for radical surgery over conservative surgery due to the anxiety of the cause due to the disease and thinking of the life-threatening conditions that they could get. And with the increase in the incidence of the ovarian cancers in these patients, they have led to the therapeutic dilemma to both patients and the treating physicians for us. So with this, we also have an overall survival of 100% in patients with fertility-sparing surgery followed by chemotherapy, found in the study done by Weinberg in 2011. So the neoadjuvant chemotherapy reduces the risk of post-operative mortality. It also reduces the time of surgery and for the need of stoma formations. So the survival rate was found to be high in disturbinoma and mixed type of germ cell tumors compared to the yolk sac tumors. That was similar to the findings done by the other studies. And it also states that in other comparative studies and in the interval debulking group had statistical significant advantage in the mean survival time of 26 months. And some of the literatures have also reported that the mean duration of 42 months from the cancer treatment to pregnancies. And one of the case studies also have reported a patient with a yolk sac tumor that was diagnosed at 12 weeks of pregnancy who underwent fertility-sparing surgery followed by adjuvant chemotherapy had a normal progression of pregnancy and delivered a healthy child. The study was done in 2012 by a mentor, Dr. Jitendra Parriar. And the other point is that 85% of patients had no menstrual issues in the patients who had this germ cell ovarian tumors. So coming to the conclusion, the study supports neoadjuvant chemotherapy to be beneficial in offering fertility-sparing surgery even in advanced stage malignant ovarian germ cell tumors and also a safe approach in terms of oncologic outcome. So irrespective of subtype and stage of neoadjuvant chemotherapy followed by fertility-sparing surgery could become the standard approach. So with this, I conclude my presentation. These are the pictures of the patients taken with their consent who had this germ cell tumors and later had delivered a successful pregnancy. After successful pregnancy, they have delivered a baby. Thank you.

neoadjuvant chemotherapy

malignant ovarian germ cell tumors

young females

fertility-sparing surgery

five-year survival rate