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Vesztergom D, Székely B, Hegyi B, Masszi A, Pintér T, Csákó B, Kenessey I, Rubovszky G, Novák Z. [Fertility preservation in female cancer patients.]. Orv Hetil 2023; 164:1134-1145. [PMID: 37481767 DOI: 10.1556/650.2023.32824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 07/25/2023]
Abstract
In Hungary, an average of 2066 women under the age of 40 are diagnosed with cancer each year according to data from the National Cancer Registry. Approximately two-thirds of these patients require gonadotoxic treatment for their disease, which could potentially reduce their chances of future conception and childbirth. Currently, there are no professional guidelines on fertility preservation in Hungary, however, it is important to inform patients about their options. In our previous paper, we presented the gonadotoxic effects of oncotherapies and the currently available fertility preservation techniques. This second paper provides current treatment methods and recommends fertility preservation techniques in different cancer types. The success of an oncofertility program relies heavily on the effective communication and collaboration between oncologists and reproductive specialists involved in fertility preservation. This paper may be the first step in elaborating a guideline towards improving access to oncofertility services and ultimately improving the quality of life for young cancer survivors in Hungary. Orv Hetil. 2023; 164(29): 1134-1145.
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Affiliation(s)
- Dóra Vesztergom
- 1 Országos Kórházi Főigazgatóság, Humánreprodukciós Igazgatóság Budapest Magyarország
- 6 Szegedi Tudományegyetem, Szentgyörgyi Albert Orvostudományi Kar, Klinikai Orvostudományi Doktori Iskola Szeged Magyarország
- 7 Semmelweis Egyetem, Általános Orvostudományi Kar, Asszisztált Reprodukciós Centrum Budapest Magyarország
| | - Borbála Székely
- 3 Országos Onkológiai Intézet, Mellkasi és Hasüregi Daganatok és Klinikai Farmakológiai Osztály Budapest Magyarország
| | - Barbara Hegyi
- 3 Országos Onkológiai Intézet, Mellkasi és Hasüregi Daganatok és Klinikai Farmakológiai Osztály Budapest Magyarország
| | - András Masszi
- 4 Országos Onkológiai Intézet, Gyógyszerterápiás Központ, Hematológia és Lymphoma Osztály, "Kemoterápia A" Budapest Magyarország
| | - Tamás Pintér
- 3 Országos Onkológiai Intézet, Mellkasi és Hasüregi Daganatok és Klinikai Farmakológiai Osztály Budapest Magyarország
| | - Bence Csákó
- 2 Országos Onkológiai Intézet, Nőgyógyászati Osztály Budapest Magyarország
| | - István Kenessey
- 5 Országos Onkológiai Nemzeti Rákregiszter és Biostatisztikai Központ Budapest Magyarország
- 8 Semmelweis Egyetem, Általános Orvostudományi Kar, Patológiai Igazságügyi és Biztosítási Orvostani Intézet Budapest Magyarország
| | - Gábor Rubovszky
- 3 Országos Onkológiai Intézet, Mellkasi és Hasüregi Daganatok és Klinikai Farmakológiai Osztály Budapest Magyarország
| | - Zoltán Novák
- 2 Országos Onkológiai Intézet, Nőgyógyászati Osztály Budapest Magyarország
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Bercow A, Nitecki R, Brady PC, Rauh-Hain JA. Outcomes after Fertility-sparing Surgery for Women with Ovarian Cancer: A Systematic Review of the Literature. J Minim Invasive Gynecol 2021; 28:527-536.e1. [PMID: 32861046 DOI: 10.1016/j.jmig.2020.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare reproductive and oncologic outcomes of patients diagnosed with early-stage epithelial ovarian carcinoma, borderline ovarian tumors, or nonepithelial ovarian carcinoma according to receipt of fertility-sparing surgery or conventional surgery. DATA SOURCES PubMed was searched from January 1, 1995, to May 29, 2020. METHODS OF STUDY SELECTION Studies were included if they (1) enrolled women of childbearing age diagnosed with ovarian cancer between the ages of 18 years and 50 years, (2) reported on oncologic and/or reproductive outcomes after fertility-sparing surgery for ovarian cancer, and (3) included at least 20 patients. TABULATION, INTEGRATION, AND RESULTS The initial search identified 995 studies. After duplicates were removed, we abstracted 980 unique citations. Of those screened, 167 publications were identified as potentially relevant, and evaluated for inclusion and exclusion criteria. The final review included 44 studies in epithelial ovarian cancer, 42 in borderline ovarian tumors, and 31 in nonepithelial ovarian carcinoma. The narrative synthesis demonstrated that overall survival does not seem to be compromised in patients undergoing fertility-sparing surgery compared with those undergoing conventional surgery, although long-term data are limited. Areas of controversy include safety of fertility-sparing surgery in the setting of high-risk factors (stage IC, grade 3, and clear cell histology), as well as type of surgery (salpingo-oophorectomy vs cystectomy). It seems that although there may be some fertility compromise after surgery, pregnancy and live-birth rates are encouraging. CONCLUSION Fertility-sparing surgery is safe and feasible in women with early-stage low-risk ovarian cancer. Pregnancy outcomes for these patients also seem to be similar to those of the general population.
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Affiliation(s)
- Alexandra Bercow
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital (Dr. Bercow); Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital (Dr. Bercow), Boston, Massachusetts
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (Drs. Nitecki and Rauh-Hain), Houston, Texas
| | - Paula C Brady
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center (Dr. Brady), New York, New York
| | - J Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (Drs. Nitecki and Rauh-Hain), Houston, Texas.
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Subramanyeshwar Rao T, Raju KVVN, Gupta V, Rajagopalan Iyer R. Fertility preserving surgery in carcinoma ovary: a single institution experience. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-020-00472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fertility preserving surgery for high-grade epithelial ovarian carcinoma confined to the ovary. Eur J Obstet Gynecol Reprod Biol 2020; 248:63-70. [DOI: 10.1016/j.ejogrb.2020.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/21/2022]
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Watanabe T, Soeda S, Nishiyama H, Kiko Y, Tokunaga H, Shigeta S, Yaegashi N, Yamada H, Ohta T, Nagase S, Shoji T, Kagabu M, Baba T, Shimizu D, Sato N, Terada Y, Futagami M, Yokoyama Y, Fujimori K. Clinical and reproductive outcomes of fertility-sparing surgery in stage I epithelial ovarian cancer. Mol Clin Oncol 2019; 12:44-50. [PMID: 31832189 PMCID: PMC6904870 DOI: 10.3892/mco.2019.1954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to evaluate the oncologic safety and reproductive outcome in patients with stage I epithelial ovarian cancer (EOC) treated with fertility-sparing surgery (FSS). Women aged ≤40 years with stage I EOC who had undergone FSS between 2000 and 2010 were retrospectively reviewed. Survival was examined using the Kaplan-Meier method and statistical significance was analyzed using the log-rank test. A total of 29 EOC patients (stage IA, n=14; stage IC1 n=6; stage IC3, n=9) from seven participating institutions belonging to the Tohoku Gynecologic Cancer Unit were enrolled. After a median follow-up duration of 60.6 months (range, 6–135 months), five patients (17.2%) experienced tumor recurrence. The respective five-year relapse-free survival (RFS) and overall survival (OS) rates were 90.9 and 100% for stage IA/IC1, and 43.8 and 87.5% for stage IC3. Significant differences in RFS were observed between stage IA/IC1 and IC3 patients (P=0.026). However, there was no significant difference in OS between patients with 1A/1C1 and those with 1C3 (P=0.712). After FSS, seven pregnancies occurred in five patients, which resulted in the birth of six healthy children. The results of the present study confirmed that FSS may be an acceptable treatment method for stage IA and IC1 EOC, exhibiting a favorable reproductive outcome. However, the safety of FSS for treating stage IC3 EOC is uncertain and warrants further investigation.
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Affiliation(s)
- Takafumi Watanabe
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiroshi Nishiyama
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yuichiroh Kiko
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Shogo Shigeta
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hidekazu Yamada
- Miyagi Cancer Center, Medeshima-shiote, Natori, Miyagi 981-1293, Japan
| | - Tsuyoshi Ohta
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Tadahiro Shoji
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Masahiro Kagabu
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan
| | - Dai Shimizu
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Naoki Sato
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Masayuki Futagami
- Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8563, Japan
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8563, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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[Epithelial ovarian cancer and fertility preservation: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:180-186. [PMID: 30704956 DOI: 10.1016/j.gofs.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To study the methods and strategies of fertility preservation in young women with stage I epithelial ovarian cancer (EOC), in order to provide recommendations for clinical practice. METHODS The PubMed database was searched for english and french language articles, between 2005 and 2001, according to predefined search equations. RESULTS Young patients with stage IA EOC willing to conceive should be informed that conservative treatment (contralateral ovary and salpinx, uterus) is possible (GradeC), associated with a 6 % to 13 % recurrence risk (GradeC) on the remaining ovary. This conservative surgical treatment includes adnexectomy, peritoneal and lymph node staging for all subtypes, and additional endometrial curettage for endometriosis and mucinous subtypes (GradeC). In case of positive staging conservative treatment is not possible. In case of mucinous EOC with an infiltrative pattern, lymph node staging is not necessary. Multidisciplinary analysis (including oncologists and reproductive medicine specialists) of the risk-benefit balance for a conservative surgery is recommended and must rely on a complete final pathology report (GradeC). No recommendation on bilateral adnexectomy and uterine conservation to allow pregnancy using egg donation can be provided in case of low-grade stage IA EOC, in the absence of data. Bilateral adnexectomy and uterine conservation to allow pregnancy using egg donation can be offered in case of serous, mucinous or endometrioid high-grade FIGO stage IA or low-grade FIGO stage IC1 or IC2 EOC (GradeC). Preservation of the uterus and contralateral ovary and Fallopian tube can be discussed with a specialized rare ovarian tumors multidiciplinary staff in case of clear cell stage I EOC.
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Jiang X, Yang J, Yu M, Xie W, Cao D, Wu M, Pan L, Huang H, You Y, Shen K. Oncofertility in patients with stage I epithelial ovarian cancer: fertility-sparing surgery in young women of reproductive age. World J Surg Oncol 2017; 15:154. [PMID: 28806962 PMCID: PMC5557507 DOI: 10.1186/s12957-017-1222-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fertility-sparing surgery is indicated for patients with stage I epithelial ovarian cancers. We sought to evaluate the clinical outcomes and oncofertility in a cohort of patients of reproductive age with stage I epithelial ovarian cancer (EOC). METHODS Overall, 108 patients of reproductive age (≤ 40 years) diagnosed with stage I EOC who were treated at Peking Union Medical College Hospital between 1999 and 2013 were included in the study. The Kaplan-Meier model and Cox regression analyses were used for the survival analysis. RESULTS The type of surgery included fertility-sparing surgery (FSS) (48.1%) and radical surgery (RS) (51.9%). After a median follow-up of 83 months, we observed that grade 3 or clear-cell carcinoma was the only independent risk factor for disease-free survival and tumor-specific survival in the multivariate analysis. Patients with grade 3 or clear-cell carcinoma tended to be older than 30 years, have endometriosis, and undergo RS (p < 0.05). Fertility-sparing surgery did not affect disease-free survival or tumor-specific survival among patients of reproductive age with stage I EOC and among high-risk patients with stage IC2-3, grade 3, or clear-cell carcinoma. Thirty-four out of 52 (65.4%) FSS patients attempted to get pregnant. Twenty-eight (82.4%) achieved a successful pregnancy with a full-term delivery. CONCLUSIONS Grade 3 or clear-cell carcinoma was the only independent risk factor for survival of patients of reproductive age with stage I EOC. FSS can be safely performed on patients of reproductive age with grade 1-2, stage I EOC. The safety of FSS for grade 3 and clear-cell carcinoma warrants further investigation.
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Affiliation(s)
- Xuan Jiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Weimin Xie
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Huifang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yan You
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Shuai Fu Yuan No.1, Dongcheng District, Beijing, 100730, People's Republic of China
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Bentivegna E, Gouy S, Maulard A, Pautier P, Leary A, Colombo N, Morice P. Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues. Ann Oncol 2016; 27:1994-2004. [DOI: 10.1093/annonc/mdw311] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/26/2016] [Indexed: 11/14/2022] Open
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Satoh T, Yoshikawa H. Fertility-sparing surgery for early stage epithelial ovarian cancer. Jpn J Clin Oncol 2016; 46:703-10. [PMID: 27284094 DOI: 10.1093/jjco/hyw069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/06/2016] [Indexed: 11/12/2022] Open
Abstract
Discussion of fertility-sparing treatment is an important part of pretreatment counseling for young patients with early epithelial ovarian cancer. As a result of late childbearing nowadays, fertility preservation has become a major issue in ovarian cancer patients. The purpose of this review is to update current knowledge on fertility-sparing treatment for early stage epithelial ovarian cancer, which may be useful for pretreatment counseling for reproductive-age patients. The multicenter study data on the fertility-sparing treatment published by Japan Clinical Oncology Group in 2010 confirmed that fertility-sparing surgery is a safe treatment for Stage IA patients with non-clear cell histology and Grade 1 or 2 and suggested that Stage IA patients with clear cell histology and Stage IC patients with non-clear cell histology and Grade 1 or 2 can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy. In the current review, we added the recent case series and review, and discussed the fertility-sparing treatment on young patients with early epithelial ovarian cancer. We need not to change the proposal by the Japan Clinical Oncology Group study, but we should wait for the results of an ongoing prospective study to strongly recommend the proposal of the Japan Clinical Oncology Group study.
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Affiliation(s)
- Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba
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Bentivegna E, Morice P, Uzan C, Gouy S. Fertility-sparing surgery in epithelial ovarian cancer. Future Oncol 2016; 12:389-98. [DOI: 10.2217/fon.15.319] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Since the last two decades, the feasibility of fertility-sparing surgery in early-stage epithelial ovarian cancer has been explored by several teams. Despite the impossibility of conducting a randomized trial to validate this management, evidence-based data suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. Conservative surgery maintains organ function, enables patients of childbearing age to preserve their fertility and improves their quality of life. In this review, we analyze the main series in the literature on this topic in order to highlight the selected criteria for conservative management and to summarize oncological and fertility outcomes.
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Affiliation(s)
- Enrica Bentivegna
- Service de Chirurgie Gynécologique, Gustave-Roussy, 114 Rue Edouard-Vaillant, 94805 Villejuif Cedex, France
| | - Philippe Morice
- Service de Chirurgie Gynécologique, Gustave-Roussy, 114 Rue Edouard-Vaillant, 94805 Villejuif Cedex, France
| | - Catherine Uzan
- Service de Chirurgie Gynécologique, Gustave-Roussy, 114 Rue Edouard-Vaillant, 94805 Villejuif Cedex, France
| | - Sebastien Gouy
- Service de Chirurgie Gynécologique, Gustave-Roussy, 114 Rue Edouard-Vaillant, 94805 Villejuif Cedex, France
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Bentivegna E, Fruscio R, Roussin S, Ceppi L, Satoh T, Kajiyama H, Uzan C, Colombo N, Gouy S, Morice P. Long-term follow-up of patients with an isolated ovarian recurrence after conservative treatment of epithelial ovarian cancer: review of the results of an international multicenter study comprising 545 patients. Fertil Steril 2015; 104:1319-24. [PMID: 26149354 DOI: 10.1016/j.fertnstert.2015.06.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the long-term outcomes of patients with an isolated ovarian recurrence after fertility sparing surgery (FSS) for epithelial ovarian cancer (EOC) and to evaluate the recurrence rates (and location) according to the new 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system. DESIGN Retrospective multicenter study. SETTING Teams having reported recurrence after FSS for EOC. PATIENT(S) Four series comprising 545 patients undergoing FSS and 63 (12%) recurrences. INTERVENTION(S) FSS (salpingo-oophorectomy for a majority of cases) for EOC. MAIN OUTCOMES MEASURE(S) Recurrences rates and characteristics of recurrent disease. RESULT(S) Among 63 recurrent patients, 24 (38%) recurrences were isolated on the spared ovary, and 39 (62%) arose at an extraovarian site. Among the patients with an isolated ovarian recurrence, three patients died after a median follow-up period of 186 months (range: 28-294 months). Among the patients with recurrent extraovarian disease, 24 died and 7 were alive with persistent disease after a median follow-up period of 34 months (range: 3-231 months). The overall rate of isolated ovarian and extrapelvic recurrences was higher for grade 3 tumors (compared with grades 1/2). CONCLUSION(S) The long-term survival of patients with an isolated ovarian recurrence after FSS for EOC remains favorable. The prognosis of patients with an extraovarian recurrence is poor compared with those who have an isolated recurrent ovarian tumor. Grade 3 tumors (compared to grades 1/2) give rise to a higher rate of extraovarian recurrences.
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Affiliation(s)
- Enrica Bentivegna
- Department of Gynecologic Surgery, Institut Gustave Roussy, Villejuif, France
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University Milano-Bicocca, Milan, Italy
| | - Stephanie Roussin
- Department of Gynecologic Surgery, Institut Gustave Roussy, Villejuif, France
| | - Lorenzo Ceppi
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University Milano-Bicocca, Milan, Italy
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Kajiyama
- Nagoya University Graduate School of Medicine, University of Nagoya, Nagoya, Japan
| | - Catherine Uzan
- Department of Gynecologic Surgery, Institut Gustave Roussy, Villejuif, France; Unit INSERM 30-10, Villejuif, France
| | - Nicoletta Colombo
- Department of Surgery and Interdisciplinary Medicine, University Milano-Bicocca, Milan, Italy
| | - Sebastien Gouy
- Department of Gynecologic Surgery, Institut Gustave Roussy, Villejuif, France
| | - Philippe Morice
- Department of Gynecologic Surgery, Institut Gustave Roussy, Villejuif, France; Unit INSERM 30-10, Villejuif, France; University Paris Sud, Paris, France.
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Kajiyama H, Mizuno M, Shibata K, Yamamoto E, Kawai M, Nagasaka T, Kikkawa F. Recurrence-predicting prognostic factors for patients with early-stage epithelial ovarian cancer undergoing fertility-sparing surgery: a multi-institutional study. Eur J Obstet Gynecol Reprod Biol 2014; 175:97-102. [DOI: 10.1016/j.ejogrb.2014.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/12/2013] [Accepted: 01/09/2014] [Indexed: 12/20/2022]
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Huber D, Cimorelli V, Usel M, Bouchardy C, Rapiti E, Petignat P. How many ovarian cancer patients are eligible for fertility-sparing surgery? Eur J Obstet Gynecol Reprod Biol 2013; 170:270-4. [DOI: 10.1016/j.ejogrb.2013.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 05/14/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022]
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Szatmári E, Máté S, Sipos N, Szánthó A, Silhavy M, Rigó J. [Methods and conditions of fertility preservation in early-stage ovarian tumors]. Orv Hetil 2013; 154:523-30. [PMID: 23545230 DOI: 10.1556/oh.2013.29581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study is to review the literature of fertility-sparing techniques and their safety in early-stage malignant ovarian tumors, especially in epithelial ovarian cancer. Fertility preservation is widely accepted in early-stage borderline, germ cell and sex cord-stromal tumors. Based on data from retrospective studies, fertility-sparing surgery in epithelial ovarian cancer can be recommended in stage IA, grade 1-2 and favorable hystologic type ovarian cancer. Above stage IA, or in grade 3, or in clear-cell tumors decision making process about fertility-sparing surgery should be individual. Correct surgical staging is mandatory and oncologic safety should be of primary importance. In the group of carefully selected patients oncological outcomes are identical to those of radical surgery. Spontaneous pregnancy rates vary, but they are generally high. Adequate counseling with patients, detailed documentation and careful follow-up is of outstanding importance. In order to improve the quality of fertility preservation techniques, establishment of treatment centers is recommended.
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Affiliation(s)
- Erzsébet Szatmári
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest.
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du Bois A, Heitz F, Harter P. Fertility-Sparing Surgery in Ovarian Cancer: A Systematic Review. ACTA ACUST UNITED AC 2013; 36:436-43. [DOI: 10.1159/000353598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer 2011; 21:951-63. [PMID: 21697684 DOI: 10.1097/igc.0b013e31821bec6b] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In young patients with borderline ovarian tumor a conservative treatment approach does not seem to have a significant impact on survival, and the outcome regarding fertility is good in general. It can be considered even if noninvasive peritoneal implants are discovered at the time of the initial surgery. In contrast, in patients with epithelial ovarian cancer, conservative surgery should be considered only in adequately staged patients, with a stage IA grade 1 (and probably 2) serous, mucinous or an endometrioid tumor, including a careful follow-up. Such an approach could also probably be discussed in stage IC grade 1 disease.In patients with nonepithelial malignant ovarian tumors, conservative surgery is also feasible, particularly in patients with malignant germ cell tumors because of their high chemosensitivity leading to an excellent prognosis in general.
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Satoh T, Hatae M, Watanabe Y, Yaegashi N, Ishiko O, Kodama S, Yamaguchi S, Ochiai K, Takano M, Yokota H, Kawakami Y, Nishimura S, Ogishima D, Nakagawa S, Kobayashi H, Shiozawa T, Nakanishi T, Kamura T, Konishi I, Yoshikawa H. Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection. J Clin Oncol 2010; 28:1727-32. [DOI: 10.1200/jco.2009.24.8617] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The objective of this study was to assess clinical outcomes and fertility in patients treated conservatively for unilateral stage I invasive epithelial ovarian cancer (EOC). Patients and Methods A multi-institutional retrospective investigation was undertaken to identify patients with unilateral stage I EOC treated with fertility-sparing surgery. Favorable histology was defined as grade 1 or grade 2 adenocarcinoma, excluding clear cell histology. Results A total of 211 patients (stage IA, n = 126; stage IC, n = 85) were identified from 30 institutions. Median duration of follow-up was 78 months. Five-year overall survival and recurrence-free survival were 100% and 97.8% for stage IA and favorable histology (n = 108), 100% and 100% for stage IA and clear cell histology (n = 15), 100% and 33.3% for stage IA and grade 3 (n = 3), 96.9% and 92.1% for stage IC and favorable histology (n = 67), 93.3% and 66.0% for stage IC and clear cell histology (n = 15), and 66.7% and 66.7% for stage IC and grade 3 (n = 3). Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children. Conclusion Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy.
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Affiliation(s)
- Toyomi Satoh
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Masayuki Hatae
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Yoh Watanabe
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Nobuo Yaegashi
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Osamu Ishiko
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Shoji Kodama
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Satoshi Yamaguchi
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Kazunori Ochiai
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Masashi Takano
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Harushige Yokota
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Yosuke Kawakami
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Sadako Nishimura
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Daiki Ogishima
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Shunsuke Nakagawa
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Hiroaki Kobayashi
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Tanri Shiozawa
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Toru Nakanishi
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Toshiharu Kamura
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Ikuo Konishi
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
| | - Hiroyuki Yoshikawa
- From the Department of Obstetrics and Gynecology, University of Tsukuba, Tsukuba; Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima; Department of Obstetrics and Gynecology, Tohoku University, Sendai; Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine; Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka; Department of Gynecology, Niigata Cancer Center Hospital, Niigata; Department of Gynecologic Oncology, Hyogo
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Bats AS, Larousserie F, Le Frère Belda MA, Metzger U, Lécuru F. Tumeurs non épithéliales malignes de l’ovaire. ACTA ACUST UNITED AC 2009; 37:627-32. [DOI: 10.1016/j.gyobfe.2009.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
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Current World Literature. Curr Opin Obstet Gynecol 2009; 21:101-9. [DOI: 10.1097/gco.0b013e3283240745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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