Gynaecologic Oncology Society of Kenya (GOSK) clinical management protocol for malignant ovarian germ cell tumors in Kenya - 2026

Abstract

Objective: To develop a standardized, evidence-based national clinical management protocol for malignant ovarian germ cell tumors in Kenya, under the auspices of the Gynaecologic Oncology Society of Kenya (GOSK). The protocol addresses diagnosis and diagnostic workup, stage-specific surgical and adjuvant management, follow-up and surveillance, management of recurrent and chemoresistant disease, and supportive and palliative care.

Methods: A guideline-adaptation methodology was used. A multidisciplinary panel convened by GOSK conducted a systematic search of PubMed and Google Scholar to identify existing international guidelines on MOGCT management. Six candidate guidelines were retrieved and independently appraised by 2 trained panelists using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument across 6 quality domains. A tiebreaker mechanism was used to resolve disagreements. Guidelines that did not meet the prespecified thresholds for rigor of development and clarity of presentation were excluded. Recommendations from the retained guidelines were synthesized and contextualized to the Kenyan health care system and available resources.

Results: Of the 6 guidelines appraised, the following were evaluated: the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology; the American Society of Clinical Oncology (ASCO) guidelines; the British Gynaecological Cancer Society (BGCS) guidelines; the European Society of Gynaecological Oncology (ESGO) guidelines; the European Society for Medical Oncology (ESMO) guidelines; and the guidelines of the Council for Medical Schemes (CMS/PBS). Four guidelines (NCCN, ASCO, BGCS, and ESGO) met the prespecified quality thresholds and were retained for adaptation. The resulting protocol provides recommendations on clinical presentation and imaging; tumor marker and histopathological evaluation; fertility-sparing surgery and comprehensive surgical staging for early-stage disease; bleomycin, etoposide, and cisplatin (BEP)-based adjuvant and first-line chemotherapy for advanced disease; structured follow-up over a minimum 5-year surveillance period; management of recurrent and chemoresistant disease according to platinum sensitivity; and early integration of psychosocial and palliative support.

Recommendations: This protocol represents the first standardized, adapted, evidence-based national guideline for the management of malignant ovarian germ cell tumors in Kenya. Its adoption is anticipated to harmonize clinical practice, improve diagnostic accuracy and treatment outcomes, support the efficient use of limited resources, and reduce disparities in the quality of care delivered to this young and vulnerable patient population.