title: Conservative treatment and long-term follow up of endodermal sinus tumor of the vagina.
abstract: OBJECTIVE
  Six cases of endodermal sinus tumor (EST) of the vagina were reported focusing on the results of conservative treatment and outcome of long-term follow up.
  
  
  METHODS
  We reviewed a cohort of six cases with EST of the vagina diagnosed and treated in our hospital. CT scan, detection of serum AFP level, examination under anesthesia and biopsy were performed before and after treatment to evaluate the tumor status. The diagnoses were confirmed by pathological and imaging findings. All patients were treated with bleomycin, etoposide and cisplatin (BEP) combination chemotherapy alone. Complete remission (CR) includes the normal level of serum AFP, no tumor detected by CT scan and the negative result of pathology. Long-term follow up was carried out according to our regulation.
  
  
  RESULTS
  The mean onset age was 18.2 months. The average tumor size was 4.5 cm. Serum AFP level was markedly elevated before treatment and decreased dramatically after chemotherapy and drop to the normal level after two to three courses of chemotherapy (average 2.5 courses). The patients received averagely six courses of chemotherapy and all the six patients obtained CR. The mean follow-up time is 75.5 months and there was no evidence of recurrent disease.
  
  
  CONCLUSIONS
  The result of this conservative treatment for EST of the vagina is excellent. BEP chemotherapy without surgery should be considered as a good choice of treatment. Close follow up with serial determinations of serum AFP level together with imaging tests and physical examination in the first two years of follow-up are recommended.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences & Peking Union Medical College, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Tao
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Yang
authors.forename: Dongyan
authors.initials: D
authors.lastname: Cao
authors.forename: Lina
authors.initials: L
authors.lastname: Guo
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Jinhe
authors.initials: J
authors.lastname: Lang
authors.forename: Keng
authors.initials: K
authors.lastname: Shen
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D018240:Endodermal Sinus Tumor / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009367:Neoplasm Staging; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins; D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin