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Annals of Oncology Advance Access originally published online on April 11, 2008
Annals of Oncology 2008 19(8):1435-1441; doi:10.1093/annonc/mdn162
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

gynecologic tumors

Survival and reproductive function of 52 women treated with surgery and bleomycin, etoposide, cisplatin (BEP) chemotherapy for ovarian yolk sac tumor

T. de La Motte Rouge1, P. Pautier1, P. Duvillard2, A. Rey3, P. Morice4, C. Haie-Meder5, P. Kerbrat6, S. Culine7, F. Troalen2 and C. Lhommé1,*

1 Department of Medical Oncology, Institut Gustave Roussy, Villejuif
2 Department of Biopathology, Institut Gustave Roussy, Villejuif
3 Department of Biostatistics, Institut Gustave Roussy, Villejuif
4 Department of Surgery, Institut Gustave Roussy, Villejuif
5 Department of Radiotherapy, Institut Gustave Roussy, Villejuif
6 Centre Eugène Marquis, Université de Rennes 1, Rennes
7 Centre Régional de Lutte Contre le Cancer Val d'Aurelle, Montpellier, France

* Correspondence to: Dr C. Lhommé, Consultation de gynécologie médicale, Institut Gustave Roussy, 39 rue Camille Desmoulins, F-94800 Villejuif, France. Tel: +33-1-42-11-43-77; Fax: +33-1-42-11-52-14; E-mail: lhomme{at}igr.fr

Background: Ovarian yolk sac tumor (YST) is a very rare malignancy arising in young women. Chemotherapy has dramatically improved the prognosis. Current treatment consists of surgery followed by bleomycin, etoposide, and cisplatin (BEP) chemotherapy. However, given the rarity of this tumor, ovarian YST-specific survival and outcome after such treatment are not precisely known.

Patients and methods: This report concerns prospectively recorded cases that were either treated at Institut Gustave Roussy (Villejuif, France) or referred there for advice about therapy. From 1990 to 2006, 52 patients underwent surgery followed by BEP chemotherapy. Data on patient characteristics, treatment, survival, and fertility outcome were analyzed to assess treatment efficacy and gonadal toxicity after achieving a complete remission.

Results: Thirty-five patients had stage I/II tumors while 17 patients presented with stage III/IV disease. With a median follow-up of 68 months, the overall 5-year survival and disease-free survival rates were 94% and 90%, respectively. Forty-one women underwent fertility-sparing surgery. Pregnancy was achieved in 12 of 16 (75%) women who attempted conception. Overall, 19 pregnancies have been recorded.

Conclusions: BEP chemotherapy following fertility-sparing surgery is a very effective treatment of ovarian YSTs. Most of the patients who attempt conception after complete remission will have children.

Key words: alpha-fetoprotein, BEP, endodermal sinus tumor, fertility, malignant ovarian germ-cell tumor

Received for publication November 30, 2007. Revision received February 6, 2008. Accepted for publication March 17, 2008.


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