Outcomes after bleomycin, etoposide and cisplatin combination chemotherapy in patients with ovarian yolk sac tumor

Ji Young Kim; Yu Jung Shin; Jei-Won Moon; Jeong-Yeol Park; Dae-Yeon Kim; Joo Hak Lee; Jong-Hyeok Kim; Yong-Man Kim; Young-Tak Kim; Joo-Hyun Nam

doi:10.5468/kjog.2010.53.11.1007

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Kim, Shin, Moon, Park, Kim, Lee, Kim, Kim, Kim, and Nam: Outcomes after bleomycin, etoposide and cisplatin combination chemotherapy in patients with ovarian yolk sac tumor

Original Article

Korean Journal of Obstetrics and Gynecology

Korean Journal of Obstetrics and Gynecology 2010; 53(11): 1007-1013.

Published online: 30 November 2010

DOI: https://doi.org/10.5468/kjog.2010.53.11.1007

Outcomes after bleomycin, etoposide and cisplatin combination chemotherapy in patients with ovarian yolk sac tumor

Ji Young Kim, M.D.¹, Yu Jung Shin, M.D.¹, Jei-Won Moon, M.D.¹, Jeong-Yeol Park, M.D.¹, Dae-Yeon Kim, M.D.¹, Joo Hak Lee, M.D.², Jong-Hyeok Kim, M.D.¹, Yong-Man Kim, M.D.¹, Young-Tak Kim, M.D.¹, Joo-Hyun Nam, M.D.¹

¹Department of Obsterics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Western Medicine, Life University School of Oriental Medicine, Gardena, USA.

Corresponding author (catgut1-0@hanmail.net)

Received 31 May 2010 Revised 7 October 2010 Accepted 12 October 2010

Abstract

Objective

The aim of this study was to evaluate the oncologic and reproductive outcomes of patients with ovarian yolk sac tumor after bleomycin, etoposide, cisplatin (BEP) chemotherapy following surgery.

Methods

Of 145 patients with histologically confirmed malignant ovarian germ cell tumor, 43 had yolk sac tumor and received BEP chemotherapy after surgery. A retrospective analysis of these patients was performed.

Results

The mean age of 43 patients was 24.8 years (range, 7 to 59 years). Thirty eight patients were nulliparous. Of 179 BEP chemotherapy cycles, grade 1~2 hematologic and non-hematologic adverse events occurred in 46 cycles in 21 patients. Thirty nine patients showed complete remission, 1 patient showed partial remission, and 3 patient had progressive disease during BEP chemotherapy. After median follow-up time of 57 months (range, 3 to 153 months), 5 patients had recurrent disease and three of them died of disease. The 5-year recurrence free survival rate and overall survival rate were 86% and 94%, respectively. After chemotherapy, all but one premenarchal patients had normal menstruation. Of them 5 patients tried to conceive and 3 of them succeeded in pregnancy.

Conclusion

BEP chemotherapy was very safe and effective in patients with ovarian yolk sac tumor. Survival outcomes are excellent and reproductive outcomes are promising after BEP chemotherapy.

Keywords: Malignant ovarian germ cell tumor, Yolk sac tumor, Bleomycin, Etoposide, Cisplatin

Figures and Tables

Figure 1

Disease-free survival (A) and overall survival (B) of 43 patients with ovarian yolk sac tumor.

Table 1

Patient characteristic (n=43)

Values are presented as mean (range) or number (%).

BMI: body mass index, Preop: preoperative, αFP: alpha-fetoprotein, CA-125: cancer antigen-125, FIGO: International Federation of Gynecology and Obstetrics.

^*mean (range).

Table 2

Histologic feature of tumor (n=43)

YST: yolk sac tumor, IMT: immature teratoma, Emb: embryonal carcinoma, Choiro: choriocarcinoma.

Table 3

Type of procedures performed (n=43)

USO: unilateral salpingoophorectomy, UOWR: unilateral ovary wedge resection, UO: unilateral oophorectomy, BOC: bilateral ovarian cystectomy, UOC: unilateral ovarian cystectomy, BSO: bilateral salpingoophorectomy, TAH: total abdominal hysterectomy.

Table 4

Toxicity of BEP regimen according to WHO criteria (n=179 cycles).

BEP: bleomycin, etoposide, cisplatin, WHO: World Health Organization, AST: aspartate transminase, ALT: alanine transaminase.

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