COMBINATION CHEMOTHERAPY IN THE MANAGEMENT OF OVARIAN GERM-CELL MALIGNANCIES

  • 1 January 1984
    • journal article
    • research article
    • Vol. 64  (4) , 564-572
Abstract
Patients (24) with ovarian germ cell malignancies received combination chemotherapy in the present series. Fifteen patients received intensive vincristine, actinomycin-D, and cyclophosphamide therapy for 12-18 courses, and 13 are alive and free of disease 34-86 mo. later. One patient with a stage III pure endodermal sinus tumor and 1 patient with a stage III mixed germ cell tumor composed predominantly of endodermal sinus tumor elements failed vincristine, actinomycin-D, and cyclophosphamide therapy, but each transiently responded to cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy. Nine patients subsequently were treated on a new protocol that used the intensive vincristine, actinomycin-D, and cyclophosphamide regimen for 5-6 courses for all stage 1 ovarian germ cell malignancies and cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy for advanced stage tumors containing endodermal sinus tumor. Each patient on the new protocol is alive and free of disease 14-26 mo. later. Short-term intensive vincristine, actinomycin-D, and cyclophosphamide therapy is recommended for all stage 1 ovarian germ cell malignancies requiring adjuvant chemotherapy. Preservations of ovarian and reproductive function is appropriate in the present group of patients. Vincristine, actinomycin-D, and cyclophosphamide therapy is also recommended for biomarker negative advanced stage ovarian germ cell malignancies. Cis-diamminedichloroplatinum, vinblastine, and bleomycin therapy is recommended for advanced stage biomarker positive ovarian germ cell malignancies. Serial .alpha.-fetoprotein (AFP) titers accurately reflect the status of endodermal sinus tumor elements and may be used as a guide to discontinue treatment for patients with pure endodermal sinus tumor malignancies, obviating the need for 2nd-look surgery.