MANAGEMENT OF OVARIAN ENDODERMAL SINUS TUMOR

Objective. To evaluate the role of combination chemotherapy and the op timal cycles of treatment in improving the prognosis of ovarian endode rmal sinus tumor, and to study the relationship between the type of su rgical management and the outcome of the disease. Patients and Method. Sixty-three patients with ovarian endodermal sinus tumor were divided into 3 groups according to the postoperative chemotherapy they had re ceived. Group 1 (37 patients) patients were treated with at least 6 cy cles of VAC (vincristine, actinomycin-D and cytoxan) or 4 cycles of PV B (cysplatin, vincristine and bleomycin). Group 2 (17 patients) patien ts were treated with VAC in less than 6 cycles or PVB in less than 4 c ycles. Group 3 (9 patients) patients received no VAC or PVB but some o ther drugs like TSPA, 5FU, MTX and cytoxan in various combinations. Th e sustained remission rates and survivals were compared among these 3 groups. For patients with full courses of treatment with VAC or PVB (G roup 1), different types of surgical management were studied about the ir relationship with the outcome of the disease. Results. The persiste nt remission rates are 81.8%, 23.5% and 11.8% for group 1, group 2 and group 3 patients respectively (P<0.001). The survival curve of group 1 is very much different from that of group 2 and group 3 patients. Wi th full courses of chemotherapy with VAC or PVB, it appears that the d ifferent types of surgical managements (unilateral vs bilateral adenec tomy; with vs without systemic lymphadenectomy; residual tumor < 2 cm vs > 2 cm) did not show definite relationship with the outcome of the disease. Conclusion. Combination chemotherapy with VAC or PVB dramatic ally improved the prognosis of ovarian endodermal sinus tumor but it s hould be emphasized that the favorable results could be obtained only when the treatment is given on time and in optimal cycles. Although ov arian endodermal sinus tumor is chemosensitive, appropriate surgical t reatment is still important, however, the surgical techniques need som e further studies.