Interventions for the treatment of borderline ovarian tumours

Abstract

Background The safety of conservative surgery and the benefit of additional interventions after surgery for borderline ovarian tumours are unknown. Objectives To evaluate the benefits and harm of different treatment modalities offered for borderline ovarian tumours. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register to 2009, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE and EMBASE to 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies. Selection criteria Randomised controlled trials (RCTs) that compared different interventions in adult women diagnosed with borderline ovarian tumours of any histological variant. Data collection and analysis Two review authors independently abstracted data and assessed risk of bias. Main results We identified seven RCTs that enrolled 372 women. We could not pool results of trials as the treatment comparisons differed. Six RCTs (n = 340) conducted over 15 years ago, evaluated adjuvant therapy (chemotherapy, pelvic external irradiation or intraperitoneal radioactive isotope therapy) after radical surgery; over 87% of participants had Stage I tumours. Most participants were followed up for over 10 years. Overall and recurrence-free survival were similar between both arms of these trials, except that one trial (n = 66) showed a significantly lower survival (P = 0.03) in women who received chemotherapy (thio-TEPA). Adverse effects of treatment were incompletely reported and all six trials were at high risk of bias. One further trial (n = 32) that recruited participants with bilateral serous tumours who were wishing fertility preservation, revealed a significantly increased chance of pregnancy (hazard ratio (HR) = 3.3, 95% CI 1.4 to 8.0) but non-significantly earlier disease recurrence (HR = 1.5, 95% CI 0.6 to 3.8) in the women who had ultra-conservative surgery (bilateral cystectomy) than in those who had conservative surgery (cystectomy and contralateral oophorectomy). This trial was at low risk of bias. Quality of life (QoL) was not documented in any included trial. We did not find any trials that compared radical with conservative surgery or laparoscopy with laparotomy. Authors’ conclusions We did not find evidence to support the use of any specific type of adjuvant therapy for borderline ovarian tumours. RCTs evaluating the benefit of adjuvant therapy with optimally dosed chemotherapy and newer targeted drugs are necessary, particularly for advanced borderline ovarian tumours. The low mortality from borderline ovarian tumours should make recurrence-free survival, time to recurrence and morbidity important end points in such trials. Bilateral cystectomy may be offered to women with bilateral borderline ovarian tumours diagnosed intra-operatively who are wishing to preserve their fertility. Similarly, women who had RCTs comparing radical with conservative surgery and comparing laparoscopy with laparotomy are neede...

Recurrence and Fertility Rate in Females with Borderline Ovarian Tumor

“…Faluyi showed that there was no difference in recurrence rate between cystectomy and USO (14). Chen found the same result from his research (15).…”

Borderline ovarian tumors: the issues of chemotherapy and prognosis

“…В заключении авторы не нашли фактов, подтвер-ждающих пользу от проведения дополнительных ме-тодов лечения, таких как химио-и лучевая терапия, при ПОЯ, и пришли к выводу, что ультраконсерватив-ные операции должны широко применяться в случаях двусторонних опухолей у больных, желающих сохра-нить фертильность [7].…”

High-Risk Borderline Ovarian Tumors: Analysis of Clinicopathological Features and Prognostic Impact of Different Follow-Up Strategies

“…Surgery is the backbone component of management either at diagnosis and when the recurrence is diagnosed. No alternative treatments have reported substantial activity: a recent Cochrane meta-analysis [12] on BOTs concluded that no evidence supports the use of any type of adjuvant chemotherapy in high-risk patients, and even if concern persists for patients with invasive peritoneal implants the effectiveness of this option continues to be debated. In contrast to high-grade serous ovarian cancer, different biological pathways seem to be involved in the carcinogenesis of MS-BOT and low-grade carcinoma, suggesting that targeted treatments should be used in this disease instead of chemotherapy [13,14,15].…”

“…Prognostic significance has been reported in several studies for peritoneal implants, especially invasive ones [32], and it has been postulated that the presence of invasive implants represents the most important risk factor for the transformation into invasive carcinoma [12], suggesting that these patients should be followed very closely. In our population, all patients with invasive implant developed recurrent disease differently from patients with non-invasive implants in which the recurrence appeared less frequently (100 vs. 62.5%) and delayed (28 vs. 46 months, respectively).…”