A study on postoperative therapy for recurrent ovarian granulosa cell tumor in our hospital

Abstract

卵巣顆粒膜細胞腫（granulosa cell tumor: GCT）に対する術後療法の基準は明確には定まっていない。 再発を反復する症例の臨床経過から、術後療法の要否や化学療法レジメンに関する検討を行った。2006年以降、当科で経験した顆粒膜細胞腫全9症例の病期はⅠa期4例、Ⅰc期4例、Ⅳ期1例で、4例（Ⅰc期3例、Ⅳ期1例）に再発を認めた。全9症例のうち、初回術後療法としてⅣ期1例及びⅠa期の1例に対してBEP（bleomycin+etoposide+cisplatin）療法が、Ⅰa期1例に対してCAP療法（cyclophosphamide+doxorubicin+cisplatin）が施行された。再発を反復している2症例のうち1例では4度目の再発術後にddTC（dose-dense paclitaxel+carboplatin）+ Bev（bevacizumab）、Bev維持療法を行い、長期間の無病生存を得ることが可能であった。顆粒膜細胞腫 Ⅰc期は再発リスクが高く慎重な経過観察の必要性が示唆された。再発腫瘍の術後維持療法にはddTC+Bev、Bev維持療法が有用である可能性がある。Since there are no clear postoperative guidelines for ovarian granulosa cell tumor (GCT) yet, we aimed to investigate its necessity along with a well-defined chemotherapy regimen based on the clinical course of patients with repeated recurrences. Nine cases of GCT have been reported at our department since 2006, of which 4 cases were stage Ia and stage Ic each, and 1 case was stage IV. Among these cases, 4 patients (3 at stage Ic, 1 at stage IV) experienced recurrence. Among the nine enrolled patients, the initial postoperative therapy was BEP (bleomycin+etoposide+cisplatin) in one stage IV patient and one stage Ia patient, whereas one stage Ia patient received CAP (cyclophosphamide+doxorubicin+cisplatin) treatment . Furthermore, in one of the two cases with repeated recurrences, ddTC (dose-dense paclitaxel+carboplatin)+ Bev (bevacizumab) and Bev maintenance therapy after the 4th recurrence surgery resulted in long-term disease-free survival. We observed a high risk of recurrence in stage Ic GCT, necessitating a comprehensive follow-up. Furthermore, it can be concluded that ddTC+Bev along with Bev maintenance therapy may prove to be more effective postoperatively for such recurrent tumors