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The combination of vincristine sulfate (VCR), cyclophosphamide (CTX), and dactinomycin (Act-D) was used in the treatment of 21 girls under 16 years of age following surgical removal of a malignant ovarian tumor to determine the effect of this combination on the survival and prognosis of these patients. A second look operation was performed in patients who were clinically free of disease at the end of 2 years of chemotherapy. Chemotherapy was stopped in patients who had no histologic evidence of malignancy at the second look operation. Of the 21 cases, there were eight malignant teratomas, six malignant germ cell tumors, six endodermal sinus tumors, and one Sertoli-Leydig tumor. In 14 of 21 patients who had a second look operation, no evidence of malignancy was found. This group included seven patients with Stage I, one with Stage II, five with Stage III, and one with Stage IV disease. One patient with Stage I disease is still on chemotherapy after 18 months. All patients with Stage I and II disease are surviving at 18–80 months, six of seven of Stage III for 25–120 months, and one of five with Stage IV for 47 months. One patient with Stage III and four with Stage IV are dead. Our conclusions are that adjunctive chemotherapy with modified VAC following surgical removal improves the survival and reduces the death rate significantly in children with ovarian cancers, including malignant teratomas, endodermal sinus tumors, mixed germ cell tumors and Sertoli-Leydig tumors, maximal surgical removal of these tumors is essential before chemotherapy with modified VAC, and irradiation is not indicated in the treatment of these tumors, unless radiosensitive elements have been demonstrated within the malignant tissues.
Cangır et al. (Fri,) studied this question.
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