title: Administration of standard-dose BEP regimen (bleomycin+etoposide+cisplatin) is essential for treatment of ovarian yolk sac tumour.
abstract: OBJECTIVE
  The aim of this study was to investigate prognostic factors, including postoperative chemotherapy regimen, for the treatment of ovarian yolk sac tumour (YST), and resulting fertility outcome.
  
  
  METHODS
  A multi-institutional retrospective investigation was undertaken to identify patients with ovarian pure or mixed YST who were treated between 1980 and 2007. Postoperative chemotherapy regimen and other variables were assessed in univariate and multivariate analyses. Additionally, the reproductive safety of the BEP (bleomycin, etoposide and cisplatin) regimen was evaluated.
  
  
  RESULTS
  There were 211 patients enrolled from 43 institutions. The BEP regimen and a non-BEP regimen were administered to 112 and 99 patients as postoperative chemotherapy, respectively. In univariate and multivariate analyses, age⩾22, alpha-fetoprotein⩾33,000 ng/ml, residual tumours after surgery and non-BEP regimen were independently and significantly associated with poor overall survival (OS). BEP was significantly superior to non-BEP in 5-year OS (93.6% versus 74.6%, P=0.0004). Reduced-dose BEP (<75% standard-dose bleomycin and<50% etoposide dose) was significantly associated with poorer 5-year OS compared with standard-dose BEP (89.4% versus 100%, P=0.02 and 62.5% versus 96.9%, P=0.0002). All patients who underwent fertility-sparing surgery recovered their menstrual cycles. Sixteen of 23 patients receiving BEP (70.0%) and 13 of 17 patients receiving non-BEP (76.5%) who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 21 and 19 healthy children, respectively.
  
  
  CONCLUSIONS
  The results of the present study suggest that standard-dose BEP should be administered for ovarian YST. BEP is as safe as non-BEP for preserving reproductive function.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: toyomi-s@md.tsukuba.ac.jp.
authors.forename: Toyomi
authors.initials: T
authors.lastname: Satoh
authors.affiliation: Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Naha, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Aoki
authors.affiliation: Department of Gynecologic, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kasamatsu
authors.affiliation: Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Ochiai
authors.affiliation: Department of Obstetrics and Gynecology, National Defense Medical College, Saitama, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Takano
authors.affiliation: Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Kikkawa
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takeshima
authors.affiliation: Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hatae
authors.affiliation: Department of Gynecology, Saitama Cancer Center, Ina, Japan.
authors.forename: Harushige
authors.initials: H
authors.lastname: Yokota
authors.affiliation: Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Obstetrics and Gynecology, Tohoku University, Sendai, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yaegashi
authors.affiliation: Department of Obstetrics and Gynecology, Graduate School of Medical Sciences Kyushu University, Fukuoka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Baba
authors.affiliation: Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kodama
authors.affiliation: Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Gynecology and Obstetrics, Hokkaido University, Sapporo, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakuragi
authors.affiliation: Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sumi
authors.affiliation: Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Kamura
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D018240:Endodermal Sinus Tumor / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007223:Infant; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin
keywords: BEP regimen; Fertility; Ovarian yolk sac tumour; Prognosis