Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

Abstract

Aim Epithelial ovarian cancer (EOC) can be a devastating diagnosis in women of reproductive age who desire future fertility. However, in early‐stage disease, fertility‐sparing surgery (FSS) can be considered in appropriately selected patients. Methods This is a narrative descriptive review of the recent literature on FSS for EOC from oncologic, reproductive and endocrinologic perspectives. Results The recurrence rate following FSS performed for stage I EOC in published retrospective studies collectively is 13% but ranges from 5 to 29%, while mortality ranges from 0 to 18%. Five‐year disease‐free survival following FSS is over 90% but decreases with higher stage and grade. Recurrences following FSS are more likely to be localized with a more favorable prognosis compared to recurrences following radical surgery. Adjuvant chemotherapy is recommended in women with high‐risk disease, and strategies to minimize gonadotoxicity during chemotherapy such as gonadotropin‐releasing hormone (GnRH) agonists may be considered. Oocyte, embryo and/or ovarian cryopreservation can also be offered to patients desiring future biologic children. Reproductive outcomes following FSS, including pregnancy and miscarriage rates, resemble those of the general population, with a chance of successful pregnancy of nearly 80%. Conclusion In retrospective data, FSS appears to be oncologically safe in stage IA and IC grade 1–2 non‐clear cell EOC. In patients with grade 3 tumors or clear cell histology, treatment can be individualized, weighing a slightly higher risk of recurrence with fertility goals. A multidisciplinary approach with oncology and reproductive endocrinology may be of utility to help these patients achieve their fertility goals.

The value of fertility-sparing surgery for young females with epithelial ovarian cancer: a comparative study

“…Previous studies have considered cases with high-grade tumors, and stage IC tumors to have a higher risk of relapse and mortality, and that they could not be considered for a fertility-saving approach. However, recent studies showed that there is no clear evidence to support the fact that radical surgery in stage I EOC of any grade could improve patients' oncological outcomes (9)(10)(11)(12)(13)(14) , which supports our findings on the benefits of FSS after application of strict precautions and inclusion criteria of patients. Fruscio et al confirmed our findings (10) .…”

“…Fruscio et al confirmed our findings (10) . Mandelbaum et al showed that oncologic outcomes after FSS were nearly similar to radical surgery in females with stage I, grade 1 and 2 EOC with serous, mucinous or endometrioid histology (9) . Jiang et al showed that cancer specific survival rate was better in the FFS group than that in the radical surgery group; which results from the fact that most high risk patients with higher grade tumors and clear cell morphology underwent radical surgery in their studies (11) .…”

“…Surgical management of young females with ovarian cancer that is primarily limited to the ovary is a challenging issue, particularly if the patient was nulliparous and wishes to preserve her fertility (9) . There are few studies comparing radical surgery and fertility-saving surgery, and the management strategies have not been standardized yet (10) .…”

Fertility Preserving Surgery Outcomes for Ovarian Malignancy: Data from a Tertiary Cancer Centre in Central London

“…There was an overall successful pregnancy rate of 59%, which is comparable to a number of other studies which quote ranges of 54–67% [ 6 , 19 ]. The IVF rate of (12%) was comparable to other studies, but markedly higher than the general population [ 20 , 21 ]. The need for IVF is believed to be due to reduced ovarian reserve and alterations to pelvic anatomy following surgery [ 21 ].…”

Endometriosis-Associated Ovarian Cancer: The Origin and Targeted Therapy

“…In ovarian cancer, the prognosis for recurrence in the preserved ovaries after fertility-conserving treatment is good if radical surgery is performed again [ 61 ], and all six cases of EAOC (OEC and OCCC) have been reported to be cured [ 62 ]. That is, these recurrences may not be the result of hematogenous metastasis or intra-abdominal dissemination, but rather, the tumor cells may remain in the genital tract and be transported from the endometrium to the ovaries.…”