Is conservative therapy ever justified in Stage I (IA) cancer of the ovary?

Background/Aims: To discuss the latest findings on oncologic and reproductive outcomes of fertility-sparing surgery in epithelial ovarian cancer (EOC) and to suggest proper indications for this treatment. Methods: A search of Medline database was performed for articles dealing with fertility-sparing surgery for EOC published in the English literature between January 1, 1969, and October 1, 2012. Results: To date, 918 patients with EOC underwent fertility-sparing surgery; 109 (11.9%) had disease recurrence and 48 (5.2%) died of disease. Retrospective studies suggest that fertility-sparing surgery may be safely performed in young women with a strong desire to preserve fertility and with nonclear cell histology, FIGO stage IA, IC and grade 1-2 disease or clear cell histology and FIGO stage IA disease. To date, 177 patients have succeeded in achieving 242 pregnancies, resulting in 214 term (88%) and 1 preterm (0.4%) births. Miscarriage rate was about 10% (25/242) and ectopic pregnancy rate was 0.8% (2/242) after fertility-sparing surgery. No congenital anomaly has been reported. Conclusions: Although randomized controlled trials have yet to be performed, many studies have suggested that fertility-sparing surgery is safe, with promising reproductive outcomes. Cautious selection of patients is important because of 5.2% mortality and 11% recurrence after this surgery.

Section: Text Of Reviewmentioning

confidence: 99%

Fertility-Sparing Surgery for Young Women with Early-Stage Epithelial Ovarian Cancer

Nam

2013

“…We can hypothesize, as previously highlighted, that this good clinical outcome may be related to the favorable tumor biology, such as the endometrioid histotype and the intermediate grade of differentiation, together with the absence of a family history for ovarian/breast cancer. In addition, although specific data about stage II disease are lacking, if the contralateral ovary appears grossly normal, the risk of occult malignancy is 7-12% [12,13], leading to a low incidence of recurrence in the remaining ovary [8,11], thus supporting our choice to preserve the contralateral ovary. Furthermore, as recently reported in early-stage disease by Fruscio et al [8], recurrence in the remaining ovary can be quite often surgically managed with favorable survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

Fertility-Sparing Surgery in Ovarian Cancer Extended beyond the Ovaries: A Case Report and Review of the Literature

Petrillo

Legge²,

Ferrandina

et al. 2013

Background: Much attention has been recently focused on the role of fertility-sparing surgery in patients with ovarian cancer. However, few data are currently available on the feasibility of conservative approaches in women with disease extending beyond the ovaries. Aim: This review article aims at summarizing the oncologic and obstetric outcome of patients with stage II-III ovarian cancer treated with fertility-sparing surgery. We also describe a successful conservative management of a stage IIC endometrioid ovarian carcinoma. Methods: A literature search through Medline was carried out to locate published articles using the following keywords for selection: ‘Fertility-sparing surgery and ovarian cancer'. From every single case series, we retrieved data on patients with stage II-III disease submitted to conservative surgery. Results: We identified 21 patients with stage II-III disease receiving fertility-sparing surgery. Recurrent disease was observed in 9 women (42.8%), and 5 (23.8%) of them died of disease. In contrast, a successful obstetric outcome has been reported in 3 cases (14.2%). Conclusions: Radical surgical staging remains the standard of care for all women with stage II-III disease. A fertility-sparing approach may be considered only in the presence of a favorable histology and a very strong fertility desire.

“…As the prognosis in patients with epithelial tumors is better than that in patients with nonepithelial tumors in the natural course, we can use aggressive conservative surgical therapies in the former. Not only in malignant nonepithelial tumors but also in malignant epithelial tumors in young women, distinct histological characteristics have been well recognized [16,17]. Therefore, adequate chemotherapy should be selected on the basis of the histology of malignant ovarian tumors.…”

Section: Discussionmentioning

confidence: 99%

Management of Malignant Ovarian Tumors in Young Women

Koshiyama

Yoshida²,

Takemura³

et al. 1998

To evaluate the management of malignant ovarian tumors in young women who wish to maintain fertility, we retrospectively reviewed ovarian malignancies in 21 young women who were both nulliparous and under 40 years of age. With stage 1a disease, all 9 patients were treated with conservative surgical therapies, and all of them are still alive, irrespective of histological type. With stage 1c disease, 5 (83%) of 6 patients were treated with conservative surgical therapies. Among them, 2 patients with epithelial tumors, who were treated with conservative surgical therapies and potent cis-diamminedichloroplatinum (CDDP)-based combined chemotherapies, are still alive. Furthermore, one of them had a successful pregnancy. On the other hand, 3 out of 4 patients with nonepithelial tumors were treated with conservative surgical therapies. However, 2 (67%) out of 3 died; both of them were treated with non-CDDP-based chemotherapy. In 6 patients with disease beyond stage 2, 4 (67%) were treated with radical surgical therapies, but 2 (33%) were treated with conservative surgery and CDDP-based combined chemotherapy, one of which was followed by a successful pregnancy in spite of nonepithelial tumor. As above, we could obtain some successful pregnancies in cases beyond stage 1c after conservative surgery by adding definite CDDP-based combined chemotherapy. However, we must carefully select the patients with nonepithelial tumors for conservative therapy by adding definite CDDP-based combined chemotherapy and inform them of the risks of therapy.