Tay S. -K., Tan L. -K.
Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
Int J Gynecol Cancer. 2000 Jan;10(1):13-18. doi: 10.1046/j.1525-1438.2000.00010.x.
The outcome of 31 patients with malignant ovarian germ cell tumors treated by surgery and a medium dose etoposide containing short chemotherapy regimen between 1988 and 1997 is reported. Of the 31 patients, 16 (51.6%) had malignant teratomas, 8 (25.8%) had dysgerminomas, 6 (19%) endodermal sinus tumors and one (3.2%) mixed germ cell tumor. Twenty-four (77.4%) patients were at FIGO stage I (of which 18 were stage IA), 2 (6.5%) at stage II, 4 (12.9%) at stage III and 1 (3.2%) at stage IV. Twenty-five (80.6%) patients underwent conservative surgery, 1 (3.2%) underwent bilateral salpingo-oophorectomy and 4 (12.9%) had total hysterectomy with bilateral salpingo-oophorectomy and omentectomy. One (3.2%) patient refused definitive treatment. Three patients with stage IA grade 1 immature teratomas were not treated with adjuvant chemotherapy and one patient with a stage IA dysgerminoma refused chemotherapy. Two patients with endodermal sinus tumor returned to their countries of origin after surgery. Twenty-five patients received bleomycin, etoposide, and cisplatin (BEP) regimen with etoposide dosage fixed at 120 mg/m2 on day 1 and day 2, bleomycin 15 mg intravenous bolus on days 1 and 2 and cisplatin 100 mg/m2 on day 1. Chemotherapy was administered at four weekly intervals for 4 cycles or until complete response was achieved. The median number of cycles of chemotherapy was four (range 3-6) for stage I, 6 (range 4-7) for stage II and 5 (range 5-6) for stage III tumors. Of the entire cohort of 29 patients analyzed, the median follow up period was 5 years. One patient died from stage IIIC endodermal sinus tumor and one patient had persistent teratoma in the lungs. The overall disease free survival control rate was 93.1%. There were three cases of the growing teratoma syndrome involving the liver, abdominal peritoneum, and the pelvis, respectively. No mortality resulted from the growing teratomas. No pulmonary complications, secondary primary tumor or leukemia was detected. Menstrual function returned in all patients with fertility-preserving surgery and one pregnancy occurred. This interesting data suggest that a medium dose 2-day BEP postsurgical adjuvant chemotherapy regimen is effective and superior to expectant treatment of malignant ovarian germ cell tumors. This report, however, should be viewed as a pilot study. The result indicates that a prospective randomised controlled trial to demonstrate equivalence of this regimen with the standard BEP regimen is warranted.
报告了1988年至1997年间31例接受手术及含中等剂量依托泊苷的短程化疗方案治疗的恶性卵巢生殖细胞肿瘤患者的治疗结果。31例患者中，16例（51.6%）为恶性畸胎瘤，8例（25.8%）为无性细胞瘤，6例（19%）为内胚窦瘤，1例（3.2%）为混合性生殖细胞肿瘤。24例（77.4%）患者处于FIGO I期（其中18例为IA期），2例（6.5%）为II期，4例（12.9%）为III期，1例（3.2%）为IV期。25例（80.6%）患者接受了保守手术，1例（3.2%）接受了双侧输卵管卵巢切除术，4例（12.9%）接受了全子宫切除加双侧输卵管卵巢切除术及大网膜切除术。1例（3.2%）患者拒绝确定性治疗。3例IA期1级未成熟畸胎瘤患者未接受辅助化疗，1例IA期无性细胞瘤患者拒绝化疗。2例内胚窦瘤患者术后返回原籍国。25例患者接受了博来霉素、依托泊苷和顺铂（BEP）方案，依托泊苷剂量固定为第1天和第2天120mg/m²，博来霉素第1天和第2天静脉推注15mg，顺铂第1天100mg/m²。化疗每4周进行1次，共4个周期或直至达到完全缓解。I期肿瘤化疗周期中位数为4（范围3 - 6），II期为6（范围4 - 7），III期为5（范围5 - 6）。在分析的29例患者的整个队列中，中位随访期为5年。1例患者死于IIIC期内胚窦瘤，1例患者肺部有持续性畸胎瘤。总体无病生存控制率为93.1%。有3例分别累及肝脏、腹膜和盆腔的生长性畸胎瘤综合征病例。生长性畸胎瘤未导致死亡。未检测到肺部并发症、第二原发性肿瘤或白血病。所有接受保留生育功能手术患者的月经功能均恢复，且发生了1次妊娠。这些有趣的数据表明，中等剂量2天BEP术后辅助化疗方案对恶性卵巢生殖细胞肿瘤有效且优于期待治疗。然而，本报告应视为一项初步研究。结果表明，有必要进行一项前瞻性随机对照试验以证明该方案与标准BEP方案等效。
