Experience of a 2-day BEP regimen in postsurgical adjuvant chemotherapy ofovarian germ cell tumors

The outcome of 31 patients with malignant ovarian germ cell tumors treated by surgery and a medium dose etoposide containing short chemotherapy regime n between 1988 and 1997 is reported. Of the 31 patients, 16 (51.6%) had mal ignant teratomas, 8 (25.8%) had dysgerminomas, 6 (19%) endodermal sinus tum ors 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 unde rwent conservative surgery, 1 (3.2%) underwent bilateral salpingo-oophorect omy and 4 (12.9%) had total hysterectomy with bilateral salpingo-oophorecto my and omentectomy. One (3.2%) patient refused definitive treatment. Three patients with stage IA grade 1 immature teratomas were not treated with adj uvant chemotherapy and one patient with a stage IA dysgerminoma refused che motherapy. Two patients with endodermal sinus tumor returned to their count ries of origin after surgery. Twenty-five patients received bleomycin, etop oside, and cisplatin (BEP) regimen with etoposide dosage fixed at 120 mg/m( 2) on day 1 and day 2, bleomycin 15 mg intravenous bolus on days 1 and 2 an d cisplatin 100 mg/m(2) on day 1. Chemotherapy was administered at four wee kly intervals for 4 cycles or until complete response was achieved. The med ian number of cycles of chemotherapy was four (range 3-6) for stage I, 6 (r ange 4-7) for stage II and 5 (range 5-6) for stage III tumors. Of the entir e 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 contro l rate was 93.1%. There were three cases of the growing teratoma syndrome i nvolving 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 return ed in all patients with fertility-preserving surgery and one pregnancy occu rred. This interesting data suggest that a medium dose 2-day BEP postsurgic al adjuvant chemotherapy regimen is effective and superior to expectant tre atment of malignant ovarian germ cell tumors. This report, however, should be viewed as a pilot study. The result indicates that a prospective randomi sed controlled trial to demonstrate equivalence of this regimen with the st andard BEP regimen is warranted.