난소의 난황낭종양을 가진 환자에서 bleomycin, etoposide 및 cisplatin의 병합 항암화학요법 후 결과 분석
Outcomes after bleomycin, etoposide and cisplatin combination chemotherapy in patients with ovarian yolk sac tumor
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목적: 난소의 난황낭종양에서 시행하는 bleomycin, etopside, cisplatin (BEP)의 항암화학요법 후의 치료 결과 및 부작용에 대해 연구하고자 한다. 연구 방법: 1994년 10월부터 2008년 12월까지 서울아산병원에 내원하여 난소의 난황낭종양으로 진단받고 BEP 병합화학요법을 시행한 43명의 환자를 대상으로 의무기록을 후향적으로 분석하였다. 결과: 전체 43명 중 39명(90.7%)이 완전관해를 보였다. 1명(2.3%)이 부분관해를 보였고 3명이 암의 진행을 보였다. 43명의 환자들이 총 179 주기의 BEP 병합 항암화학 요법을 받았다. 혈액학적 독성 중 호중구 감소증은 21명의 환자에서 총 46주기에서 나타났으며, 빈혈은 40명의 환자에서 총 138주기에서 나타났다. 혈소판 감소증은 6명의 환자에서 총 8주기에서 나타났다. 간독성은 16명의 환자에서 총 27주기, 호흡기 독성은 1주기, 신독성은 보이지 않았다. 근치적 수술을 받은 환자 8명과 사망환자 4명을 제외한 31명의 환자 중에서 규칙적 생리를 보이는 환자는 29명(93.5%)이고, 불규칙 생리를 보이는 환자는 1명(3.2%)이었다. 치료 후 임신을 시도한 경우는 5명이며 임신을 한 경우는 3명이고, 이 중 2명은 정상만삭 질식분만, 1명은 현재 임신 중이다. 결론: BEP 항암화학요법은 난소의 난황낭종양을 가진 환자들에서 매우 효과적이며 안전한 치료이고, 치료 후 월경 및 생식기능은 대부분의 환자에서 보존되었고, 임신결과 또한 좋은 것으로 생각된다.
Abstract
Objective: The aim of this study was to evaluate the oncologic and reproductive outcomes of patients with ovarian yolk sac tumor after bleomycin, etoposide, cisplatin (BEP) chemotherapy following surgery. Methods: Of 145 patients with histologically confirmed malignant ovarian germ cell tumor, 43 had yolk sac tumor and received BEP chemotherapy after surgery. A retrospective analysis of these patients was performed. Results: The mean age of 43 patients was 24.8 years (range, 7 to 59 years). Thirty eight patients were nulliparous. Of 179 BEP chemotherapy cycles, grade 1~2 hematologic and non-hematologic adverse events occurred in 46 cycles in 21 patients. Thirty nine patients showed complete remission, 1 patient showed partial remission, and 3 patient had progressive disease during BEP chemotherapy. After median follow-up time of 57 months (range, 3 to 153 months), 5 patients had recurrent disease and three of them died of disease. The 5-year recurrence free survival rate and overall survival rate were 86% and 94%, respectively. After chemotherapy, all but one premenarchal patients had normal menstruation. Of them 5 patients tried to conceive and 3 of them succeeded in pregnancy. Conclusion: BEP chemotherapy was very safe and effective in patients with ovarian yolk sac tumor. Survival outcomes are excellent and reproductive outcomes are promising after BEP chemotherapy.
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