Chemotherapy of germ-cell ovarian tumours: first-line treatment with etoposide, bleomycin and cisplatin or carboplatin.

Of 9 patients with malignant ovarian germ-cell tumours (OGCT) treated with combination chemotherapy between 1980 and 1985, 8 are alive and disease-free at 6-62 months. All patients received etoposide and bleomycin and 8 out of 9 also received a platinum analogue; in one case carboplatin, in a second carboplatin plus cisplatin, and in the remainder, cisplatin. In one patient treated prior to the introduction of carboplatin, poor renal function precluded the use of cisplatin. Two patients with Stage III dysgerminomas are disease-free at 44 and 62 months after receiving chemotherapy followed by radiotherapy to the whole abdomen or pelvis. Of 7 patients with non-dysgerminomatous OGCT, including 2 dysgerminomas with raised serum alphafetoprotein, 6 are disease-free at 6-56 months. On the basis of these observations and experience reported elsewhere, surveillance after removal of the primary tumour is proposed for early-stage dysgerminoma, and chemotherapy is suggested for advanced presentations as an alternative to surgery and post-operative radiotherapy. Combination chemotherapy is indicated for all stages of non-dysgerminomatous OGCT.