Factors influencing fertility-sparing treatment for gynecologic malignancies: A survey of Society of Gynecologic Oncology members

Shah, Jaimin S.; Guerra, Rosa; Bodurka, Diane C.; Sun, Charlotte C.; Chisholm, Gary B.; Woodard, Terri L.

doi:10.1016/j.ygyno.2017.09.019

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…In addition to conserving reproductive ability, FSS has the nonreproductive benefits of avoiding the negative sequelae of surgical menopause. In a recent survey of gynecologic oncologists, factors that influence the selection of women with ovarian cancer for FSS include tumor histology, stage, grade, age, and reproductive plans and desires . According to National Comprehensive Cancer Network guidelines, among women with select unilateral stage I tumors (stages IA and IC but not stage IB) and/or low‐risk ovarian tumors (ie, early‐stage, grade 1 tumors; borderline tumors), FSS can be considered if fertility preservation is desired and if conservation is technically feasible from a surgical perspective .…”

Section: Introductionmentioning

confidence: 99%

“…In a recent survey of gynecologic oncologists, factors that influence the selection of women with ovarian cancer for FSS include tumor histology, stage, grade, age, and reproductive plans and desires. 8 According to National Comprehensive Cancer Network guidelines, among women with select unilateral stage I tumors (stages IA and IC but not stage IB) and/or low-risk ovarian tumors (ie, early-stage, grade 1 tumors; borderline tumors), FSS can be considered if fertility preservation is desired and if conservation is technically feasible from a surgical perspective. 9 These recommendations are based on Cancer March 15, 2020 a limited body of observational evidence demonstrating no difference in survival between FSS and standard treatment among women with these tumor characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Fertility‐sparing surgery and survival among reproductive‐age women with epithelial ovarian cancer in 2 cancer registries

Crafton

Cohn

Llamocca

et al. 2019

Cancer

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Background This study examined predictors of fertility‐sparing surgery (FSS) among reproductive‐age women diagnosed with epithelial ovarian cancer (EOC). In addition, relationships between FSS and survival were assessed in models stratified by tumor characteristics. Methods The Surveillance, Epidemiology, and End Results (SEER) program and the National Cancer Database (NCDB) were queried for women 44 years old or younger with a primary EOC. FSS included unilateral salpingo‐oophorectomy and uterine preservation, whereas surgeries including bilateral salpingo‐oophorectomy and hysterectomy were categorized as non‐FSS. Logistic regression was used to estimate multivariable‐adjusted odds ratios and 95% confidence intervals (CIs) for associations between clinical characteristics (eg, age at diagnosis and race) and FSS odds. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% CIs for FSS and overall survival in subgroups defined by stage and grade or by stage and histology. Analyses were stratified by database (SEER vs NCDB). Results This analysis included 9017 women (SEER, n = 3932; NCDB, n = 5085) with EOC diagnosed between the ages of 15 and 44 years. In both cohorts, factors associated with significantly higher FSS odds included a younger age, a more recent ovarian cancer diagnosis, and no adjuvant chemotherapy. FSS was significantly associated with lower overall survival among women with stage II to IV, serous EOC (SEER HR, 1.61; 95% CI, 1.22‐2.12). Significant associations between FSS and survival were not observed in other subgroups defined by stage and grade or by stage and histology. Conclusions FSS appears to be safe for certain women with EOC but was related to poor survival among women with advanced‐stage, serous EOC. Confirmatory studies with information on fertility intentions are needed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fertility‐sparing surgery and survival among reproductive‐age women with epithelial ovarian cancer in 2 cancer registries

Crafton

Cohn

Llamocca

et al. 2019

Cancer

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“…Having provider-initiated conversations regarding future fertility are important as patients with a recent diagnosis of cervical cancer may be focusing more on the cancer and its treatment than on future fertility. Early preoperative counseling by a reproductive endocrinologist can complement oncologic care by helping patients understand how RT may affect future fertility, discuss reproductive outcomes and complications, and help standardize reproductive counseling [61218]. If counseling is done preoperatively, the reproductive endocrinologist can evaluate a patient's reproductive potential by evaluating a patient ovarian reserve, ruling out ovulatory dysfunction or tubal factor, and discuss any pertinent reproductive history (i.e., recurrent miscarriages, uterine cavity abnormalities) to ensure the patient is an appropriate candidate for RT from a future fertility standpoint.…”

Section: Discussionmentioning

confidence: 99%

“…If counseling is done preoperatively, the reproductive endocrinologist can evaluate a patient's reproductive potential by evaluating a patient ovarian reserve, ruling out ovulatory dysfunction or tubal factor, and discuss any pertinent reproductive history (i.e., recurrent miscarriages, uterine cavity abnormalities) to ensure the patient is an appropriate candidate for RT from a future fertility standpoint. In addition, the reproductive endocrinologist can discuss different fertility treatments and future management strategies if necessary [618]. Having reproductive and oncologic counseling in 2 separate sessions may allow patients to give the attention needed for the important information delivered by the physician.…”

Section: Discussionmentioning

confidence: 99%

Reproductive counseling and pregnancy outcomes after radical trachelectomy for early stage cervical cancer

et al. 2019

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ObjectiveTo evaluate patient perceptions of preoperative reproductive counseling and to evaluate complications and pregnancy outcomes in women who had radical trachelectomy (RT) for early stage cervical cancer.MethodsPatients who underwent RT from January 1, 2004, through July 31, 2017, and had been cancer free for more than 1 year after RT were eligible; consented patients were sent a 16-item online survey.ResultsOf the 58 eligible patients, 39 patients (67%) completed the questionnaire. Eighteen patients (46%) reported receiving reproductive counseling and 26 (68%) reported receiving counseling about pregnancy risks and complications prior to RT, mainly delivered by gynecologic oncologists. Twenty-nine patients (74%) reported having a complication after RT, and cervical stenosis was the most common complication, occurring in 13 patients (33%). Twenty-four patients actively attempted to conceive after RT, and 20 pregnancies were achieved in 13 patients for a pregnancy rate of 54%. Eight pregnancies were spontaneous and 12 required a fertility treatment. There were 5 spontaneous first-trimester miscarriages; 14 of the 20 pregnancies (70%) resulted in live births. The median time to conception was 13.5 months (range, 1–120).ConclusionA significant proportion of women with early stage cervical cancer do not receive adequate reproductive counseling before RT, and many women undergoing RT experience complications that can negatively impact their fertility. We recommend a preoperative consultation with a reproductive endocrinologist for all patients considering RT.

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“…As chemotherapy has improved patient survival, there has been a resurgence of interest in pursuing fertility sparing strategies due to the age of the patients affected most commonly by these diseases (Aviki and Abu-Rustum, 2017; Nasioudis et al, 2017b). There are many factors that influence the utilization of fertility-sparing treatment of gynecological malignancies (Shah et al, 2017). A shortage of reports describing successful cases of fertility preservation has led to a lack of consensus on treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Successful yolk-sac tumor treatment with fertility-sparing partial oophorectomy

Dunn

Khazaeian

Coffey

et al. 2019

Gynecologic Oncology Reports

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Yolk-sac tumors account for about 20% of ovarian germ cell tumors and occur predominantly in women below 35 years of age. Modern evidence-based treatment strategies have ensured long term post-treatment survival, but with increased survival, attention has been turned to an urgent need for developing fertility sparing treatment strategies. In this report we describe the successful treatment of a young woman who was able to conceive and deliver two children, in spite of the loss of one ovary two years prior to being diagnosed with an ovarian yolk-sac tumor on the remaining ovary.

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Factors influencing fertility-sparing treatment for gynecologic malignancies: A survey of Society of Gynecologic Oncology members

Cited by 12 publications

References 25 publications

Fertility‐sparing surgery and survival among reproductive‐age women with epithelial ovarian cancer in 2 cancer registries

Fertility‐sparing surgery and survival among reproductive‐age women with epithelial ovarian cancer in 2 cancer registries

Reproductive counseling and pregnancy outcomes after radical trachelectomy for early stage cervical cancer

Successful yolk-sac tumor treatment with fertility-sparing partial oophorectomy

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