CHEMOTHERAPY OF OVARIAN GERM-CELL TUMORS AND SEX CORD-STROMAL TUMORS

Malignant ovarian germ cell tumors (OGCT) and sex cord stromal tumors (SCST) are much less common than epithelial ovarian cancer, each accou nting for less than 5% of all ovarian malignancies. The combination of vincristine, dactinomycin, and cyclophosphamide (VAC) became the stan dard chemotherapy for patients with OGCT in the 1970s; it produced exc ellent sustained remission rates in patients with stage I disease but less than 50% sustained remission rates in those with metastatic tumor . With the introduction of cisplatin for the treatment of testicular c ancer in the late 1970s, platinum-based regimens replaced the VAC regi men by the mid-1980s. Currently, the most popular regimen for all pati ents with OGCT is the combination of bleomycin, etoposide, and cisplat in (BEP). The BEP regimen appears to be superior to VAC, with sustaine d remission rates of more than 75% in patients with metastatic tumor. For patients with metastatic pure dysgerminoma, chemotherapy appears t o have supplanted radiotherapy as standard treatment with the advantag e of preserving fertility in most patients. For patients with SCST, no standard therapy exists. Surgery alone is currently acceptable treatm ent for all patients with SCST except those with metastatic disease, s arcomas, or Sertoli-Leydig cell tumors with poor differentiation or he terologous elements. Currently, platinum-based combination chemotherap y is favored for these latter patients but activity with such regimens is only modest. (C) 1994 Wiley-Liss, Inc.