Fertility-sparing surgery and outcome in fertile women with ovarian borderline tumors and epithelial invasive ovarian cancer

Abstract

Results: During the follow-up period of median 92 months, range 11-185 months, no relapse was found in the patients with stage Ia tumors including both the borderline tumors (n=12) and the invasive well (n=9) and moderately (n=1) differentiated ovarian cancers. One patient with poorly differentiated ovarian cancer stage 1c was pregnant at 13 weeks at the primary operation.Although, unilateral oophorectomy was performed she insisted in continuing the pregnancy. At 37 weeks she had a caesarian section and the ovarian cancer was disseminated. Chemotherapy was given but she died less than a year later. No other patient received chemotherapy. In total 30 children was born by 15 patients. Prophylactic removal of the remaining ovary +/-hysterectomy was accepted only in six of the women after completing their desire to have more children. However, several of these patients do not accept the recommendation of prophylactic oophorectomy of the contra lateral ovary and hysterectomy after completion of childbearing age. Conclusions4

Fertility-sparing surgery for early stage epithelial ovarian cancer

“…I ovarian cancer by substage, histology and grade in young women Stage IA, non-CCC, G1 FSS is recommended for patients with Stage IA non-CCC and G1 disease. When data from 10 papers containing sufficient information about patients with Stage IA non-CCC and G1 disease (2,4,(10)(11)(12)(13)(16)(17)(18)(19) were combined, the recurrence-free rate was 93.4% (282/302), and the survival rate was 98.0% (296/302) ( Table 2). FSS not followed by adjuvant chemotherapy is adequate treatment for patients in this group because the absolute prognosis is good.…”

“…When data from nine papers containing sufficient information about patients with Stage IA non-CCC and G2 disease (2,4,(10)(11)(12)(13)(17)(18)(19) were combined, although the recurrence-free rate was somewhat low, at 87.5% (70/80), the survival rate was high, at 95% (76/80) ( Table 3). One patient was alive with cancer, and for one the prognosis was unknown, but even if these two individuals were to be added to the number of deaths, the survival rate would still exceed 90%, at 92.5%.…”

“…As described above, most of the studies from countries other than Japan have counted CCC as G3 disease, but it is possible to identify the number of cases of G3 disease that are not CCC from some carefully written papers from overseas (although for papers that included patients of Stage II and above, we assumed that patients with CCC were only Stage I). When data from nine papers containing sufficient information about patients with Stage I cancer and G3 disease (not including those with CCC) (2,4,10,11,13,17,19,39,40) were combined, the recurrence-free rate was extremely low for Stage I, at 54.1% (20/37), and the survival rate was also low, at 67.6% (25/37) ( Table 8). One patient was alive with cancer, and if this individual were to be added to the number of deaths, the survival rate would be 64.9% (24/37).…”

Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma

“…* Values are presented as mean (range) or number of subjects (Zanetta et al, 1997;Borgfeldt et al, 2007). A French multicentric study [Groupe des Chirurgiens de Centre de Lutte Contre le Cancer (GCCLCC) and Société Française d′Oncologie Gynécologique (SFOG)] recommended that conservative surgery is acceptable in young patients with Stage Ia Grade 1 disease, but not suitable for stages higher than Ia (Morice et al, 2005).…”

Influence of Intraoperative Capsule Rupture on Outcomes in Stage I Epithelial Ovarian Cancer

“…3 However, it is generally agreed that after comprehensive staging, well-differentiated or moderately differentiated stage IA cancers do not benefit from adjuvant chemotherapy, because their overall prognosis is excellent without adjuvant treatment. 9,12,13,14 In addition, per the National Comprehensive Center Network guidelines, both comprehensively staged grade 1 and 2, stage IA and IB epithelial ovarian cancer can be observed. 15 For all other categories of stage I disease, adjuvant treatment is recommended.…”