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Zhang YF, Fan Y, Mu Y, Zhang P, Wang MY, Li JK. Reproductive and oncological outcomes of fertility-sparing surgery in patients with stage I epithelial ovarian cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29929. [PMID: 35945736 PMCID: PMC9351938 DOI: 10.1097/md.0000000000029929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We meta-analyzed available evidence on fertility, survival, and cancer recurrence in patients with stage I epithelial ovarian cancer (EOC) after fertility-sparing surgery (FSS). METHODS We systematically reviewed PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials to identify studies reporting reproductive and oncological outcomes of patients with stage I EOC who underwent FSS. Random-effects models were used to calculate pooled rates of disease outcomes, along with 95% confidence intervals (CIs). Subgroup and sensitivity analyses were conducted to identify sources of heterogeneity in the data. RESULTS We included 23 observational retrospective studies involving 1126 patients. The pooled pregnancy rate was 30% (95% CI, 0.26-0.34), while the pooled natural conception rate was 26% (95% CI, 0.20-0.33). The pooled live birth rate was 27% (95% CI, 0.22-0.32). The pooled rate of EOC recurrence was 12% (95% CI, 0.09-0.14), which did not differ significantly from the rate among patients who underwent radical surgery (odds ratio, 0.77; 95% CI, 0.45-1.33). CONCLUSIONS FSS is associated with good oncological outcomes but less than satisfactory reproductive outcomes. All in all, the procedure appears to be a safe alternative to radical surgery for EOC patients who want to preserve fertility.
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Affiliation(s)
- Yu-fei Zhang
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
| | - Yu Fan
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yi Mu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People’s Republic of China
| | - Peng Zhang
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Meng-yao Wang
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Jin-ke Li
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China
- *Correspondence: Jin-ke Li, Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, No. 20, Sector 3, Renminnan Road, Chengdu, Sichuan 610041, China (e-mail: )
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Canlorbe G, Chabbert-Buffet N, Uzan C. Fertility-Sparing Surgery for Ovarian Cancer. J Clin Med 2021; 10:jcm10184235. [PMID: 34575345 PMCID: PMC8466872 DOI: 10.3390/jcm10184235] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022] Open
Abstract
(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.
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Affiliation(s)
- Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France;
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
- Correspondence:
| | - Nathalie Chabbert-Buffet
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France;
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France;
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
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Nasioudis D, Mulugeta-Gordon L, McMinn E, Byrne M, Ko EM, Cory L, Haggerty AF, Latif NA. Oncologic outcomes of uterine preservation for pre-menopausal patients with stage II epithelial ovarian carcinoma. Int J Gynecol Cancer 2021; 31:480-483. [PMID: 33649017 DOI: 10.1136/ijgc-2020-001747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Fertility-sparing surgery is rarely offered for patients with stage II epithelial ovarian carcinoma. The aim of the present study was to evaluate the overall survival of pre-menopausal patients with stage II epithelial ovarian carcinoma who did not undergo hysterectomy. METHODS The National Cancer Database was accessed, and patients aged ≤40 years without a history of another tumor diagnosed between 2004 and 2015 with a pathological stage II epithelial ovarian carcinoma, who underwent lymphadenectomy and received multi-agent chemotherapy, were identified. Overall survival was compared with the log-rank test after generation of Kaplan-Meier curves. A Cox model was constructed to control for tumor histology. RESULTS A total of 185 patients met the inclusion criteria. The rate of uterine preservation was 24.3% (45 patients). Patients who did not undergo hysterectomy were younger (median 32 vs 37 years, p<0.001) and less likely to have high-grade tumors compared with those who underwent hysterectomy. The two groups were comparable in terms of presence of co-morbidities and performance of adequate lymphadenectomy (p>0.05). Median follow-up of the present cohort was 62.3 months (95% CI 53.6 to 71.0) and a total of 22 deaths occurred. There was no difference in overall survival between patients who did and did not undergo hysterectomy (p=0.50; 5-year overall survival rates 87.5% and 91.4%, respectively). After controlling for tumor histology, grade and substage, omission of hysterectomy was not associated with worse survival (HR 0.69, 95% CI 0.22 to 2.12). CONCLUSIONS Uterine preservation was not associated with worse survival in this cohort of pre-menopausal patients with stage II epithelial ovarian carcinoma.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Lakeisha Mulugeta-Gordon
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erin McMinn
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maureen Byrne
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Lori Cory
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
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Schuurman T, Zilver S, Samuels S, Schats W, Amant F, van Trommel N, Lok C. Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review. Cancers (Basel) 2021; 13:1008. [PMID: 33670929 PMCID: PMC7975326 DOI: 10.3390/cancers13051008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
Fertility-sparing surgery (FSS) is increasingly being offered to women with a gynecological malignancy who wish to preserve fertility. In this systematic review, we evaluate the best evidence currently available on oncological and reproductive outcome after FSS for early stage cervical cancer, epithelial ovarian cancer, and endometrial cancer. An extensive literature search was conducted using the electronic databases Medline (OVID), Embase, and Cochrane Library to identify eligible studies published up to December 2020. In total, 153 studies were included with 7544, 3944, and 1229 patients who underwent FSS for cervical, ovarian, and endometrial cancer, respectively. We assessed the different FSS techniques that are available to preserve fertility, i.e., omitting removal of the uterine body and preserving at least one ovary. Overall, recurrence rates after FSS are reassuring and therefore, these conservative procedures seem oncologically safe in the current selection of patients with low-stage and low-grade disease. However, generalized conclusions should be made with caution due to the methodology of available studies, i.e., mostly retrospective cohort studies with a heterogeneous patient population, inducing selection bias. Moreover, about half of patients do not pursue pregnancy despite FSS and the reasons for these decisions have not yet been well studied. International collaboration will facilitate the collection of solid evidence on FSS and the related decision-making process to optimize patient selection and counseling.
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Affiliation(s)
- Teska Schuurman
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (T.S.); (S.S.); (F.A.); (N.v.T.)
| | - Sanne Zilver
- Department of Gynecology, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - Sanne Samuels
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (T.S.); (S.S.); (F.A.); (N.v.T.)
| | - Winnie Schats
- Department of Scientific Information Service, Netherlands Cancer Institute, Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands;
| | - Frédéric Amant
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (T.S.); (S.S.); (F.A.); (N.v.T.)
- Department of Oncology, Catholic University of Leuven, 3000 Leuven, Belgium
| | - Nienke van Trommel
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (T.S.); (S.S.); (F.A.); (N.v.T.)
| | - Christianne Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands; (T.S.); (S.S.); (F.A.); (N.v.T.)
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Bartalot A, White M, Pejovict T, Tortoriello D, Nezhat FR. Conservative management of stage IIB ovarian carcinoma with favorable oncology and fertility outcomes. Gynecol Oncol Rep 2021; 35:100691. [PMID: 33521219 PMCID: PMC7820025 DOI: 10.1016/j.gore.2020.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/06/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
•Fertility treatment prior to definitive cancer therapy in stage IIB EOC.•Both fertility and oncologic outcomes were successful.•The role of Multidisciplinary team is critical.
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Affiliation(s)
- Ashley Bartalot
- New York Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA
| | - Michael White
- NYU Winthrop Hospital, 259 First Street, Mineola, NY 11501, USA
| | - Tanja Pejovict
- Oregon Health & Science University Hospital, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA
| | - Drew Tortoriello
- Sher Fertility Institute New York, 425 Fifth Ave., 3rd Floor, New York, NY 10016, USA
| | - Farr R Nezhat
- Nezhat Surgery for Gynecology/Oncology, 70 East Sunrise Highway, Suite 515W, Valley Stream, NY 11581, USA
- NYU Winthrop Hospital, 259 First Street, Mineola, NY 11501, USA
- Weill Cornell Medical College of Cornell University, 1300 York Ave., New York, NY 10065, USA
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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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Nasioudis D, Mulugeta-Gordon L, McMinn E, Frey MK, Chapman-Davis E, Holcomb K. Fertility sparing surgery for patients with FIGO stage I clear cell ovarian carcinoma: a database analysis and systematic review of the literature. Int J Gynecol Cancer 2020; 30:1372-1377. [DOI: 10.1136/ijgc-2020-001716] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 01/15/2023] Open
Abstract
ObjectiveFertility sparing surgery for patients with early stage ovarian clear cell carcinoma is controversial. We aimed to investigate the impact of fertility sparing surgery on the oncologic outcomes of young patients with stage I ovarian clear cell carcinoma.MethodsThe National Cancer Database was accessed and patients with pathological stage IA or IC ovarian clear cell carcinoma, aged <45 years, were selected. Based on site specific surgery codes, patients who underwent fertility sparing or radical surgery were identified. Overall survival was evaluated following generation of Kaplan–Meier curves, and compared with the log rank test. Multivariate Cox analysis was performed to control for possible confounders. A systematic review of literature of the Pubmed, EMBASE and Web of Science databases was also performed to summarize all reported cases.ResultsA total of 57 (35.8%) and 102 (64.2%) patients underwent fertility sparing and radical surgery. There was no difference in overall survival between patients who had fertility sparing and radical surgery (p=0.92); 5 year overall survival rates were 89% and 87.9%, respectively. After controlling for the performance of lymphadenectomy and disease substage, fertility sparing surgery was not associated with worse survival (hazard ratio 0.83, 95% confidence interval 0.30 to 2.32). A systematic review of the literature identified 132 patients with stage I disease who underwent fertility sparing surgery; a total of 20 patients (15.2%) experienced a relapse at a median of 18 months from surgery.ConclusionsIn a large cohort of young patients with stage I ovarian clear cell carcinoma, fertility sparing surgery was not associated with worse survival.
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Mandelbaum RS, Klar M, Takiuchi T, Bainvoll L, Matsuzaki S, Paulson RJ, Matsuo K. Fertility-sparing treatment for early-stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives. J Obstet Gynaecol Res 2020; 46:1263-1281. [PMID: 32500605 DOI: 10.1111/jog.14302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/21/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Liat Bainvoll
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Richard J Paulson
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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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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10
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Poorvu PD, Frazier AL, Feraco AM, Manley PE, Ginsburg ES, Laufer MR, LaCasce AS, Diller LR, Partridge AH. Cancer Treatment-Related Infertility: A Critical Review of the Evidence. JNCI Cancer Spectr 2019; 3:pkz008. [PMID: 31360893 PMCID: PMC6649805 DOI: 10.1093/jncics/pkz008] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/08/2019] [Accepted: 03/12/2019] [Indexed: 12/15/2022] Open
Abstract
Cancer treatments may compromise the fertility of children, adolescents, and young adults, and treatment-related infertility represents an important survivorship issue that should be addressed at diagnosis and in follow-up to ensure optimal decision-making, including consideration of pursuing fertility preservation. Risk of infertility varies substantially with patient and treatment factors. The ability to accurately assess fertility risk for many patients is hampered by limitations of the current literature, including heterogeneity in patient populations, treatments, and outcome measures. In this article, we review and synthesize the available data to estimate fertility risks from modern cancer treatments for both children and adult cancer survivors to enable clinicians to counsel patients about future fertility.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ann H Partridge
- Correspondence to: Ann H. Partridge, MD, MPH, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215-5450 (e-mail: .)
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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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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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Fruscio R, Ceppi L, Corso S, Galli F, Dell'Anna T, Dell'Orto F, Giuliani D, Garbi A, Chiari S, Mangioni C, Milani R, Floriani I, Colombo N, Bonazzi CM. Long-term results of fertility-sparing treatment compared with standard radical surgery for early-stage epithelial ovarian cancer. Br J Cancer 2016; 115:641-8. [PMID: 27537385 PMCID: PMC5023783 DOI: 10.1038/bjc.2016.254] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/21/2016] [Accepted: 07/20/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The objective of this study is to evaluate the safety of fertility-sparing surgery (FSS) for early-stage epithelial ovarian cancer (EOC). METHODS A retrospective analysis was performed to identify patients treated for early-stage EOC and to compare the clinical outcomes of patients treated with FSS and radical surgery (RS). RESULTS A total of 1031 patients were treated at two Institutions, 242 with FSS (group A) and 789 with RS (group B). Median duration of follow-up was 11.9 years. At univariate analyses, FSS was associated with decreased risk of relapse (P=0.002) and of tumour-related death (P=0.001). Multivariate analysis did not confirm the independent positive role of FSS neither on relapse-free interval (RFI) nor on cancer-specific survival (CSS). Tumour grade was associated with shorter RFI (P<0.001) and shorter CSS (P=0.001). The type of treatment did not influence CSS or RFI in any grade group. We also found a significant association between low-grade tumours and younger age. CONCLUSIONS Fertility-sparing surgery is an adequate treatment for patients with stage I EOC. The clinical outcome of patients with G3 tumours, which is confirmed to be the most important prognostic factor, is not determined by the type of treatment received.
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Affiliation(s)
- Robert Fruscio
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan 20126, Italy
| | - Lorenzo Ceppi
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan 20126, Italy
| | - Silvia Corso
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
| | - Francesca Galli
- Laboratory of Methodology for Clinical Research, Department of Oncology, IRCCS - Istituto di Ricerche Farmacologiche ‘Mario Negri', Via La Masa 19, Milan 20156, Italy
| | - Tiziana Dell'Anna
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
| | - Federica Dell'Orto
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan 20126, Italy
| | - Daniela Giuliani
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan 20126, Italy
| | - Annalisa Garbi
- Division of Gynecologic Oncology, European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy
| | - Stefania Chiari
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
| | - Costantino Mangioni
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan 20126, Italy
| | - Rodolfo Milani
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan 20126, Italy
| | - Irene Floriani
- Laboratory of Methodology for Clinical Research, Department of Oncology, IRCCS - Istituto di Ricerche Farmacologiche ‘Mario Negri', Via La Masa 19, Milan 20156, Italy
| | - Nicoletta Colombo
- Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan 20126, Italy
- Division of Gynecologic Oncology, European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy
| | - Cristina Maria Bonazzi
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, Monza 20900, Italy
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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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15
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Abstract
Objective: To show the feasibility and safety of robotic-assisted laparoscopic fertility-sparing surgery for early-stage ovarian cancer in women of reproductive age. Methods and Design: The first patient was a 29-year-old para 0 woman with well-differentiated endometrioid adenocarcinoma of the ovary and complex endometrial hyperplasia with marked atypia. The second patient was a 31-year-old para 0 woman with an immature grade 1 teratoma. Both patients underwent robotic-assisted laparoscopic surgical staging. Results: In the first patient, there were no intra- or postoperative complications. Operative time was 5 hours 43 minutes and estimated blood loss was 100 mL. She was discharged home on postoperative day 1. She received 3 cycles of carboplatin and paclitaxel, as well as medroxyprogesterone acetate for the duration of chemotherapy. She conceived twice spontaneously since surgery and had two successful deliveries. She currently has no evidence of disease. In the second patient, there were no intra- or postoperative complications. Operative time was 2 hours 52 minutes and estimated blood loss was 200 mL. She was discharged home on postoperative day 1. She declined adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. She conceived spontaneously 4 months later and had a normal vaginal delivery. She currently has no evidence of disease. Conclusions: Because fertility-sparing surgery is now accepted as a viable option in young women with early-stage ovarian cancer, less invasive techniques are being used. With the advent of robotic-assisted surgery and its advantages over conventional laparoscopy, we show that it is a safe and feasible approach in select patients. This is the first reported series on robotic fertility-sparing surgery, but more research is needed.
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Affiliation(s)
| | - Farr Reza Nezhat
- St Luke's-Roosevelt Hospital Center, 425 W 59th St, Suite 9B, New York, NY, 10019, USA..
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16
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Laparoscopic fertility-sparing surgery for early stage ovarian cancer: a single-centre case series and systematic literature review. J Ovarian Res 2014; 7:59. [PMID: 24917888 PMCID: PMC4050219 DOI: 10.1186/1757-2215-7-59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/12/2014] [Indexed: 01/12/2023] Open
Abstract
Background There is as yet limited evidence about fertility-sparing surgery for early ovarian cancer (EOC) carried out laparoscopically. We sought to analyze recurrence patterns and fertility outcome in a cohort of ovarian cancer patients who underwent fertility-saving laparoscopic surgical staging. Methods We conducted a retrospective analysis of prospectively collected data on all patients undergoing fertility-sparing laparoscopic staging procedures for presumed EOC at a single gynecologic oncology service. Oncologic safety and reproductive outcome were the main outcome measures. The pertinent literature is reviewed. Results The study cohort consisted of 12 women. Cases included 5 invasive epithelial tumors and 7 nonepithelial tumors. The disease was reclassified to a higher stage in one woman. After a median follow up period of 38 months (range: 14–108), the overall survival was 100% and recurrence-free survival 90.9%. Five (100%) of patients who attempted pregnancy conceived spontaneously. Three of them had uneventful term pregnancy delivering healthy babies. The literature search yielded 62 cases of laparoscopic fertility conserving surgery for ovarian cancer. There were 4 (6.2%) recurrences. Cumulative pregnancy and live birth rate were not estimable as earlier publications lack essential data. Conclusions Laparoscopic staging may represent a viable option for premenopausal women seeking fertility preservation in the setting of early ovarian cancer. More research is needed to determine whether laparoscopy may offer reproductive benefits to this particular population.
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Nam JH, Park JY. Fertility-Sparing Surgery for Young Women with Early-Stage Epithelial Ovarian Cancer. Gynecol Obstet Invest 2013; 76:14-24. [DOI: 10.1159/000350797] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 03/20/2013] [Indexed: 11/19/2022]
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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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Ng JS, Low JJ, Ilancheran A. Epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2012; 26:337-45. [DOI: 10.1016/j.bpobgyn.2011.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/14/2011] [Indexed: 11/16/2022]
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