Pregancy after bilateral dysgerminoma treated with conservative surgery and BEP chemotherapy

Abstract

16039 Background: Pregnancy after treatment of germ cell tumours of ovary is common. However patients with bilateral dysgerminoma treated with unilateral oophorectomy, wedge biopsy of opposite ovary, and conservation of uterus face difficulty in conception. This study was conducted with the objective to evaluate the fertility status of ovarian dysgerminoma patients treated with conservative surgery and BEP chemotherapy. Methods: Patients of bilateral dysgerminoma who underwent conservative surgery and chemotherapy with cisplatin 20 mg / m2 and etoposide 100 mg / m2 day 1 to 5 and bleomycin 30 mg on day 1, 8 and 15 of three weekly cycles were eligible. A normal AFP and beta HCG at baseline was required. Post treatment CT scans of abdomen and pelvis were obtained. Patients were regularly followed on monthly basis. Pregnancy was allowed 2 years after completion of last cycle of chemotherapy. Results: From January 1998 to December 2003, 11 patients were enrolled. Medain age was 16 years (range 13–18). All patients had complete disappearance of disease after treatment. Treatment related amenorrhea did not last beyond one year. During a median follow up of 5 years, all patients conceived and a total of 14 pregnancies were completed successfully.Three patients required use of clomiphene citrate for ovulation induction. No patient was treated with gonadotrophins. Six patients underwent lower segment caesarean section for obstetric indications and seven delivered vaginally. All babies were healthy without the signs of birth abnormalities or retardation. Conclusions: With conservative surgery and BEP chemotherapy for treatment of bilateral dysgerminoma the fertility is retained with good pregnancy outcome, when conception occurs at least two years after the last dose of chemotherapy. No significant financial relationships to disclose.