Excellent Outcomes in Children, Adolescents, and Young Adults with Ovarian Germ Cell Tumors Treated by Either Reduced- or Standard-Dose Bleomycin

SIMPLE SUMMARY: In a study analyzing 61 patients under the age of 39 diagnosed with malignant ovarian germ cell tumors (MOGCTs) between 2006 and 2022, the 5-year overall survival (OS) rate was 98.3%, and the event-free survival (EFS) rate was 84.9%. In total, 57 patients received bleomycin, etoposide, and cisplatin combined chemotherapy, with 44 having a reduced dose of bleomycin and 13 having the standard dose of bleomycin. The reduced bleomycin dose did not negatively impact survival. Histology and stage did not significantly impact EFS, whereas the rapid normalization of all tumor markers after surgery was associated with better EFS. Dose reduction of bleomycin did not adversely influence survival, and the overall chemotherapy-related toxicity was manageable, with no therapy-related toxic deaths. ABSTRACT: To investigate the outcomes of children, adolescents, and young adults (AYAs) with malignant ovarian germ cell tumors (MOGCTs), we analyzed the data of 61 patients aged ≤39 years diagnosed with MOGCT between 2006 and 2022. Among 59 patients who received chemotherapy after initial diagnosis, 57 received BEP (standard dose of bleomycin with 30 units per week, n = 13) or bEP (reduced dose of bleomycin with 15 units/m(2) on day 1, n = 44). The 5-year overall survival (OS) and event-free survival (EFS) rates were 98.3% and 84.9%, respectively. Reduced bleomycin dose did not adversely affect survival. Normalization of tumor markers within 3 months after surgery was significantly associated with better EFS (p < 0.01). Of the 59 surviving patients, 8 experienced surgery-related menopause, while 49 demonstrated menstrual recovery. After completion of chemotherapy, there was no significant difference in pulmonary function regarding bleomycin dose, and no overt nephrotoxicity. Approximately 60% and 25% of survivors experienced peripheral neuropathy at the end of chemotherapy and after 1 year, respectively (p < 0.01). Children and AYAs with MOGCT have favorable survival rates with minimal long-term toxicity, which are not influenced by a reduced bleomycin dose. Rapid normalization of tumor markers is associated with improved outcomes.