Reproductive function after treatment of malignant germ cell ovarian
tumors
Satoru Sagae
a,
*, Hiroshi Sasaki
b
, Yoshihiro Nishioka
a
, Katsuhiko Terasawa
a
,
Ryuichi Kudo
a
a
Department of Obstetrics and Gynecology, School of medicine, Sapporo Medical University, South 1 West 16, Chuou-ku, Sapporo 060-0061, Japan
b
Department of Obstetrics and Gynecology, School of medicine, Tokyo Jikei Medical University, Tokyo, Japan
Abstract
The outcome and reproductive function were examined among patients with malignant ovarian germ cell tumors treated since
1980. Between 1980 and 2001, fertility-sparing surgery was performed in 26 women, 23 of whom received adjuvant chemotherapy.
With a median follow-up of 66.6 months, all patients have been alive, with histological types of 6 immature teratomas, 8
dysgerminomas, 6 yolk sac tumors, and 6 mixed types. Clinical stages were involved of 17 early stage and 9 advanced stage patients.
After treatment, 20 women out of 26 recovered menstruation within 6 months. During follow-up, two chemotherapy-untreated and
one treated patients experienced 4 conceptions in total. A treated patient conceived but selected artificial termination by affection of
chemotherapy. Conservative surgery with adjuvant chemotherapy is the standard approach to treat patients with malignant ovarian
germ cell tumors. In these 20 years, we experienced no delivery, so that fertility seems to be seriously affected by treatments.
# 2003 Elsevier Science Ireland Ltd. All rights reserved.
Keywords: Ovarian germ cell tumor; Reproductive function; Chemotherapy; Conservative surgery; Fertility
1. Introduction
Fertility-sparing surgery is popular in early stage and
younger age for ovarian cancer depending on histologi-
cal type, especially malignant ovarian germ cell tumor
(Gershenson, 1993). Malignant ovarian germ cell tu-
mors are characteristic of younger patients, higher
chemosensitivity, almost unilateral tumor, and no
benefit of contra-lateral adnexectomy. Therefore, only
Unilateral salpingo-oophorectomy plus chemotherapy is
standard procedure for patients with no macroscopic
disease (Peccatori et al., 1995).
Current rationale is how much ovarian function is
keeping after chemotherapy and how severely che-
motherapeutic agents affect the ovarian function? The
ovarian failure induced by chemotherapeutic agents is
mainly both follicle destruction and ovarian stromal
fibrosis. As an experimental approach for follicle
destruction, egg toxicities at the intraperitoneal admin-
istration of anticancer drugs were evaluated as 50% egg
destructured dose (ED50), 50% lethal dose of mouse
(LD50), and human single dose (HUD) (Takizawa et al.,
1989). In concern with ED50/LD50 and ED50/HUD,
adriamycin was 0.081, 2.23, cyclophosphamide was
0.058, 2.59, cisplatin was 0.42, 5.19, respectively. These
drugs were considered as much more toxic for the ovary.
The effects of chemotherapeutic agents for ovarian
toxicity were generally evaluated with higher toxicities
with alkylating agents, such as cyclophosphamide,
nitrogen mustard, melphalan, moderate toxicity with
cisplatin, adriamycin, with mild toxicities with actino-
mycin D, bleomycin (Feldman, 1989).
Current chemotherapy for malignant ovarian germ
cell tumors are including with VAC regimen (vincristin,
Actinomycin-D, and cyclophosphamide), PVB regimen
(CDDP, vinblastin, and bleomycin), and BEP regimen
(bleomycin, etoposide, and CDDP). The aim of this
study was to evaluate the outcome and reproductive
function in patients with malignant ovarian germ cell
tumors treated by these regimens at our institutions
since 1980.
* Corresponding author. Tel.: '
/
81-11-611-2111x3373; fax: '
/
81-11-
614-0860.
E-mail address: sagaes@sapmed.ac.jp (S. Sagae).
Molecular and Cellular Endocrinology 202 (2003) 117 Á
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121
www.elsevier.com/locate/mce
0303-7207/03/$ - see front matter # 2003 Elsevier Science Ireland Ltd. All rights reserved.
doi:10.1016/S0303-7207(03)00072-8