Ovarian tumors of borderline malignancy: a review of 247 patients from 1991 to 2004

2007 ◽  
Vol 17 (2) ◽  
pp. 342-349 ◽  
Author(s):  
H. F. Wong ◽  
J. J.H. Low ◽  
Y. Chua ◽  
I. Busmanis ◽  
E. H. Tay ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Conservative Surgery ◽  
Figo Stage ◽  
Ovarian Tumors ◽  
Reproductive Age ◽  
Time To Recurrence ◽  
Fertility Sparing ◽  
Significant Difference ◽  
Oncology Unit

Borderline ovarian tumors account for 15% of epithelial ovarian cancers and are different from invasive malignant carcinoma. Majority are early stage, occurring in women in the reproductive age group, where fertility is important. We reviewed retrospectively 247 such cases treated at the Gynaecological-Oncology Unit, KK Women's and Children's Hospital, between January 1991 and December 2004. The mean age was 38 years (16–89 years). Majority of the cases (92%) were FIGO stage I (Ia, 75%; Ib, 1%; and Ic, 16%). Seven (3.5%) patients were diagnosed as having stage II disease, six (2.5%) as stage IIIa, two (1%) as stage IIIb, and four (2%) as stage IIIc. Histological origin was as follows: mucinous (68%), serous (26%), endometrioid (2.6%), and clear cell (1.2%). Primary surgical procedures undertaken were as follows: hysterectomy with bilateral salpingo-oophorectomy (52%), unilateral salpingo-oophorectomy (33%), or ovarian cystectomy (15%). Adjuvant chemotherapy was administered in 13 patients (5.2% of cases), of which 4 patients were given chemotherapy only because of synchronous malignancies. There were six recurrences (2.4% of cases). Overall mean time to recurrence was 59 months. Recurrence rate for patients who underwent a primary pelvic clearance was 1.6% compared to fertility-sparing conservative surgery (3.3%; although P= 0.683). No significant difference was noted in recurrence and mortality between staged versus unstaged procedures. The overall survival rate was 98.0%. There were a total of five deaths (2.8%): three (1.5%) from invasive ovarian/peritoneal carcinoma and two from synchronous uterine malignancies. It appears that surgical resection is the mainstay of treatment, with conservative surgery where fertility is desired or pelvic clearance if the family is complete. Surgical staging is important to identify invasive extraovarian implants that portend an adverse prognosis. The role of adjuvant chemotherapy is not established.

Survival and Reproductive Function After Treatment of Malignant Germ Cell Ovarian Tumors

2001 ◽  
Vol 19 (4) ◽  
pp. 1015-1020 ◽  
Author(s):  
Gerardo Zanetta ◽  
Cristina Bonazzi ◽  
Maria Grazia Cantù ◽  
Sergio Bini† ◽  
Anna Locatelli ◽  
...  
Keyword(s):  
Survival Rate ◽  
General Population ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Reproductive Function ◽  
Conservative Surgery ◽  
Ovarian Tumors ◽  
Fertility Sparing ◽  
Significant Difference

PURPOSE: Germ cell ovarian tumors are curable. The possible sequelae of chemotherapy on long-term survivors are still unknown, but these patients may expect normal lives. The aim of this study was to evaluate the outcome and reproductive function in a population of women treated since 1982. MATERIALS AND METHODS: Between 1982 and 1996, 169 women with malignant germ cell ovarian tumors were seen (70 dysgerminomas, 28 endodermal sinus tumors, 24 mixed tumors, and 47 immature teratomas). Seventy-one had advanced or recurrent disease. Fertility-sparing surgery was performed in 138 (81%) women, 81 of whom received postoperative chemotherapy. RESULTS: With a median follow-up of 67 months, the survival rate was 94% for dysgerminoma, 89% for endodermal sinus tumors, 100% for mixed types, and 98% for immature teratoma. For women who were treated conservatively, the survival rate was 98%, 90%, 100%, and 100%, respectively. Two women had adnexal recurrences, and both received salvage treatment. After treatment, all but one postpubertal woman had recovery of menses within 9 months. During follow-up, 12 untreated and 20 treated patients had 55 conceptions. We recorded 40 pregnancies at term, six terminations, and nine miscarriages. Four malformations were observed: one in 14 conceptions of patients who had not received chemotherapy and three in 41 conceptions of treated patients. CONCLUSION: Irrespective of subtype and stage, conservative surgery should become the standard approach to treating most patients with malignant ovarian germ cell tumors. Fertility seems to be only marginally affected by treatments. Miscarriages are in the expected range for the general population. The malformation rate is slightly higher than in the general population, but no significant difference was seen between patients who did and did not receive chemotherapy.

Conservative treatment in cervical cancer

2016 ◽  
Vol 4 (2) ◽  
pp. 7-11
Author(s):  
Alice Bergamini ◽  
Philippe Morice
Keyword(s):  
Cervical Cancer ◽  
Conservative Treatment ◽  
Early Stage ◽  
Figo Stage ◽  
Reproductive Age ◽  
Current Evidence ◽  
Obstetric Outcomes ◽  
Controversial Issues ◽  
Fertility Sparing ◽  
Cervical Tumors

Cervical cancer (CC) is increasingly being diagnosed in women of reproductive age, and fertility-sparing treatment has become an essential part of the therapeutic strategy for early stage CC (FIGO stage IA1-IB1). Conization is currently considered a safe and feasible treatment for stage IA1 CC without lymphovascular space invasion (LVSI). After the first report proposing vaginal radical trachelectomy (VRT) for the treatment of stage IB1 cervical tumors, several studies have evaluated vaginal, abdominal, and minimally-invasive approaches. Recent decades have been characterized by increased conservative treatment of more advanced tumors; in addition, several series assessing the oncological and obstetric outcomes of less radical surgery have been published. This review provides and overview of current evidence-based knowledge about the conservative management of CC, focusing on new perspectives and controversial issues.

Borderline ovarian tumors: A study of 100 cases

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 15069-15069
Author(s):  
C. E. Taner ◽  
M. Oztekin ◽  
S. Mun ◽  
S. Sehirali ◽  
C. Büyüktosun ◽  
...  
Keyword(s):  
Early Stage ◽  
Young Patients ◽  
Disease Free Survival ◽  
Conservative Surgery ◽  
Ovarian Tumors ◽  
Histopathological Diagnosis ◽  
Early Stage Disease ◽  
Borderline Ovarian Tumors ◽  
Stage Disease ◽  
Fertility Sparing

15069 Background: The purpose of the study was to evaluate the patients with borderline ovarian tumors. Methods: Clinical features, treatment and survival status of 100 patients with borderline ovarian tumors were retrospectively evaluated between 1998 and 2005. Results: Mean age was 37.75 (Range: 15–72) years. 22 cases were in postmenapausal status. Histopathological diagnosis was serous, musinous, endometrioid and clear cell in 54%, 41%, 2%, 3% of the patients, respectively. 19 cases underwent restaging laparotomy. In 52 cases fertility sparing surgery was performed. 70 patients had stage IA, 8 patients had stage IB, 16 cases had stage IC, 2 cases had stage IIIA, 3 cases cases had stage IIIB and a case had stage IIIC disease. 22 cases were administered chemotherapy because of advanced stage disease. All cases were alive. 5 year disease free survival of 51 cases was 100%. Conclusions: Borderline ovarian tumors have excellent prognosis and conservative surgery can be performed in young patients with early stage disease. No significant financial relationships to disclose.

Outcome of patients with borderline ovarian tumors: Results of the multicenter AGO ROBOT study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5005-5005 ◽  
Author(s):  
Nikolaus De Gregorio ◽  
Klaus H. Baumann ◽  
Mignon-Denise Keyver-Paik ◽  
Alexander Reuss ◽  
Ulrich Canzler ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Disease Progression ◽  
Invasive Carcinoma ◽  
Residual Disease ◽  
Figo Stage ◽  
Ovarian Tumors ◽  
Surgical Staging ◽  
Data Set ◽  
Borderline Ovarian Tumors ◽  
Fertility Sparing

5005 Background: Borderline ovarian tumors (BOT) are a rare entity; current standard of care is based on the available data of predominantly small retrospective trials. Therefore we performed a pattern of care study including central pathology review. Methods: All consecutive patients diagnosed with BOT between 1998 and 2008 in 24 German institutions were included. Tumor samples were prospectively sent for central histopathological review to specialized gynecopathologists, clinical data were collected and patient follow-up was prospectively updated. Results: Pathological review was obtained in 1,042 of 1,236 pts resulting in 950 confirmed BOT cases analyzed here. Under- and overdiagnosis occurred in 3.8% and 5.0% of cases, respectively. Median age was 49 years; 84% of patients had FIGO stage I disease; serous type (S-BOT) was diagnosed in 64% and mucinous type (M-BOT) in 31%. Primary/re-staging surgery led to complete debulking in 92.3% of pts (residual disease 1.3%, unknown 6.4%). Adjuvant chemotherapy was given to 33 (3.5%) pts only. 165 (17%) underwent fertility preserving surgery and 31 (19%) of these patients had documented pregnancies thereafter. Overall, 74 (7.8%) pts experienced relapse and 43 (4.5%) died. Disease progression in the form of invasive carcinoma occurred in 30% of the relapses. Inadequate surgical staging, residual tumor, fertility sparing surgery and higher FIGO stage were associated with shorter progression-free survival (PFS). M-BOT showed a non-significant trend to longer PFS compared to S-BOT (p = 0.07). No differences were observed for laparatomy vs. laparoscopy as initial surgical approach or application of adjuvant chemotherapy. Conclusions: To this day, this is the largest data set available for BOT. Prognosis is favorable even without adjuvant therapy if correct surgical staging is performed. Both tumor characteristics and treatment variables had a significant impact on relapse rate and outcome. In contrast to previous studies, disease progression in the form of invasive carcinoma occurred in a significant amount of patients with relapsed disease.

Low value of staging in detecting extraovarian occult metastasis in mucinous borderline ovarian tumors

2020 ◽  
Vol 30 (11) ◽  
pp. 1780-1783
Author(s):  
Hee-Jung Jung ◽  
Jeong-Yeol Park ◽  
Dae-Yeon Kim ◽  
Dae-Shik Suh ◽  
Jong-Hyeok Kim ◽  
...  
Keyword(s):  
Medical Center ◽  
Figo Stage ◽  
Lymph Node Biopsy ◽  
Ovarian Tumors ◽  
Occult Metastasis ◽  
Borderline Ovarian Tumors ◽  
Time To Recurrence ◽  
Significant Difference ◽  
Adnexal Surgery ◽  
The Impact

ObjectivesStaging procedure in borderline ovarian tumors is a topic of controversy. Upstaging in non-serous borderline ovarian tumors that are confined to the ovary is rare. The aim of this study was to assess the impact of surgical staging on clinical outcomes in mucinous borderline ovarian tumors.MethodsThis was a retrospective study conducted at the Asan Medical Center, Seoul, Korea between January 1990 and December 2015, that included 432 patients with mucinous borderline ovarian tumors and at least 6 months follow-up. These patients were divided into a ‘staging group’ and ‘unstaged group’. The staging group referred to patients who, in addition to hysterectomy and/or adnexal surgery, underwent at least one of the following: cytology, omental biopsy/omentectomy, peritoneal biopsy, lymph node biopsy/lymphadenectomy, or appendectomy. The unstaged group referred to patients who did not undergo any staging procedure but underwent adnexal surgery (cystectomy or oophorectomy).ResultsMedian patient age was 40 (range 9–87) years. A total of 367 patients (85%) underwent a staging procedure (staging group) and 65 (15.0%) patients did not (unstaged group). Among the staging group, 258, 4, 100, and 5 patients were FIGO stage IA, IB, IC, or II-III, respectively. Overall recurrence was confirmed in 15 patients and median time to recurrence was 13.4 (range 0.4–127.3) months. One patient was in the unstaged group and had borderline recurrence. Fourteen were in the staging group, and 11 of them had borderline and three had invasive recurrence. Extraovarian disease was found at recurrence only in two patients. There was no significant difference in recurrence-free survival (p=0.39) and in overall survival between the staging group and the unstaged group (p=0.40). In total, 16 (4.4%) of 367 patients who underwent a staging procedure were upstaged.ConclusionStaging in mucinous borderline ovarian tumors may be omitted if there is no obvious evidence of gross extraovarian disease.

scholarly journals Sertoli-Leydig Cell Ovarian Tumors: Is Fertility or Endocrine-Sparing Surgery an Option upon Relapse?

2020 ◽  
Vol 13 (2) ◽  
pp. 935-940
Author(s):  
Stéphanie J. Seidler ◽  
Alexandre Huber ◽  
James Nef ◽  
Daniela E. Huber
Keyword(s):  
Leydig Cell ◽  
Early Stage ◽  
Young Patients ◽  
Hormonal Treatment ◽  
Conservative Surgery ◽  
Good Prognosis ◽  
Ovarian Tumors ◽  
Fertility Sparing ◽  
Bep Chemotherapy

Sertoli-Leydig cell ovarian tumors (SLCT) are rare ovarian tumors of the sex cord-stroma subset. Their incidence peaks in the second to third decade of life. Most SCLT are diagnosed at an early stage and have a good prognosis. Fertility-sparing surgery may thus be offered. Adjuvant chemotherapy may be indicated according to prognostic factors. However, outcome in relapsing SLCT is poor. There is no evidence supporting a best treatment option upon relapse, but most publications combine radical surgery, chemotherapy, and rarely radiotherapy. Two years after left adnexectomy for FIGO IA SLCT, a now 22-year-old patient presented with peritoneal recurrence without involvement of the remaining ovary and uterus. Since there is no evidence of a survival benefit in the literature of macroscopically healthy contralateral ovary ablation in relapse and hormonal replacement therapy is contraindicative, we consented to endocrine-sparing surgery with conservation of the contralateral ovary, followed by 3 cycles of BEP chemotherapy regimen. Our patient is disease-free 16 months after relapse diagnosis. Since recurrence of SLCT has a very poor prognosis and hormonal treatment is contraindicated, endocrine-sparing surgery for young patients with a normal contralateral ovary might be a legitimate option. This is one of the first reported cases of conservative surgery in SLCT recurrence, we therefore aimed to illustrate its management in a young patient with considerations of contraception, fertility- and then endocrine-sparing surgery, and quality of life.

scholarly journals Fertility-Preserving Surgery in Patients with Early Stage Cervical Carcinoma

ISRN Oncology ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Spyridon Kardakis
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Conservative Surgery ◽  
Reproductive Age ◽  
Adjuvant Radiation ◽  
Fertility Sparing ◽  
Golden Standard ◽  
Recent Developments ◽  
Early Stage Cervical Cancer ◽  
Early Cervical Cancer

Fertility preservation is an important issue for patients in reproductive age with early stage cervical cancer. In view of recent developments, our purpose was to review and discuss available surgical alternatives. A literature search was conducted using PUBMED, including papers between 1980 and December 2011. In patients with stage IA1 cervical cancer, conization is a valid alternative. Patients with stage IA2-IB1 disease can be conservatively treated by radical trachelectomy. This is as well-established conservative approach and appears to be safe and effective in allowing a high chance of conception. Prematurity is the most serious issue in pregnancies following trachelectomy. Less invasive options such as simple trachelectomy or conization seem to be feasible for stages IA2-IB1, but more and better evidence is needed. Neoadjuvant therapy might allow conservative surgery to be performed also in patients with more extensive lesions. Ovarian transposition is important when adjuvant radiation is needed. In conclusion, available literature shows that there are interesting fertility-sparing treatment alternatives to the “golden standard” for the management of early cervical cancer in young women.

Systematic review of adjuvant therapy for early stage (epithelial) ovarian cancer

2003 ◽  
Vol 13 (4) ◽  
pp. 395-404 ◽  
Author(s):  
B. Winter-Roach ◽  
L. Hooper ◽  
H. Kitchener
Keyword(s):  
Systematic Review ◽  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Early Stage ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Significant Difference ◽  
Well Differentiated ◽  
Platinum Chemotherapy

A systematic review and meta analysis has been undertaken in order to evaluate the effectiveness of adjuvant therapy following surgery for early ovarian cancer. Trials reported since 1990 have been of a higher quality enabling a meta analysis of adjuvant chemotherapy vs adjuvant radiotherapy and a meta analysis of adjuvant chemotherapy vs observation. There was no significant difference between radiotherapy and chemotherapy, though these comprised studies which demonstrated considerable heterogeneity. Chemotherapy did confer significant benefit over observation in terms of both overall and disease free survival. Except for women in whom adequate surgical staging has revealed well differentiated disease confined to one or both ovaries with intact capsule, platinum chemotherapy should be offered to reduce risk of recurrence.

scholarly journals The effect of prophylactic bilateral salpingectomy on ovarian reserve in patients who underwent laparoscopic hysterectomy

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Shizhuo Wang ◽  
Jiahui Gu
Keyword(s):  
Ovarian Cancer ◽  
Ovarian Reserve ◽  
Premenopausal Women ◽  
Laparoscopic Hysterectomy ◽  
Ovarian Tumors ◽  
Reproductive Age ◽  
Control Group ◽  
Significant Difference ◽  
Bilateral Salpingectomy ◽  
The Impact

Abstract Background Bilateral salpingectomy has been proposed to reduce the risk of ovarian cancer, but it is not clear whether the surgery affects ovarian reserve. This study compares the impact of laparoscopic hysterectomy for benign disease with or without prophylactic bilateral salpingectomy on ovarian reserve. Methods Records were reviewed for 373 premenopausal women who underwent laparoscopic hysterectomy with ovarian reserve for benign uterine diseases. The serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and three-dimensional antral follicle count (AFC) were assessed before surgery and 3 and 9 months postoperatively to evaluate ovarian reserve. Patients were divided into two groups according to whether they underwent prophylactic bilateral salpingectomy. The incidence of pelvic diseases was monitored until the ninth month after surgery. Results There was no significant difference between the two surgery groups in terms of baseline AMH, E2, FSH, LH, and AFC (all P > 0.05). There was no difference in potential bias factors, including patient age, operative time, and blood loss (all P > 0.05). There was also no significant difference between the two groups 3 months after surgery with respect to AMH (P = 0.763), E2 (P = 0.264), FSH (P = 0.478), LH (P = 0.07), and AFC (P = 0.061). Similarly, there were no differences between groups 9 months after surgery for AMH (P = 0.939), E2 (P = 0.137), FSH (P = 0.276), LH (P = 0.07) and AFC (P = 0.066). At 9 months after the operation, no patients had malignant ovarian tumors. The incidences of benign ovarian tumors in the salpingectomy group were 0 and 2.68 % at 3 and 9 months after surgery, respectively, and the corresponding values in the control group were 0 and 5.36 %. The incidences of pelvic inflammatory disease in the salpingectomy group were 10.72 and 8.04 % at 3 and 9 months after surgery, respectively, while corresponding values in the control group were 24.13 and 16.09 %. Conclusions Prophylactic bilateral salpingectomy did not damage the ovarian reserve of reproductive-age women who underwent laparoscopic hysterectomy. Prophylactic bilateral salpingectomy might be a good method to prevent the development of ovarian cancer. Larger clinical trials with longer follow-up times are needed to further evaluate the risks and benefits.

scholarly journals Postoperative adjuvant chemotherapy combined with intracavitary brachytherapy achieved the equivalent survival compared with concurrent chemoradiotherapy in cervical cancer patients with intermediate-risk

2019 ◽  
Vol 49 (8) ◽  
pp. 714-718
Author(s):  
Hao Yu ◽  
Linlin Zhang ◽  
Dapeng Li ◽  
Naifu Liu ◽  
Yueju Yin ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Disease Free Survival ◽  
Intracavitary Brachytherapy ◽  
Intermediate Risk ◽  
Postoperative Adjuvant Chemotherapy ◽  
Significant Difference ◽  
Grade Iii

Abstract Objectives The current study was aimed to evaluate the efficacy and toxicity of postoperative adjuvant chemotherapy (CT) combined with intracavitary brachytherapy (ICRT) in cervical cancer patients with intermediate-risk. Methods We analyzed the medical records of 558 patients who were submitted to radical surgery for Stage IB-IIA cervical cancer. A total of 172 of those 558 patients were considered intermediate-risk according to the GOG criteria. Among those 172 patients, 102 were subjected to CT combined with ICRT (CT+ICRT) and the remaining 70 patients were treated with concurrent chemoradiation (CCRT). The 3-year disease free survival (DFS), overall survival (OS), and complications of each group were evaluated and analyzed. Results No significant difference was observed in 3-year DFS or OS of the patients submitted to CT+ICRT and CCRT. Importantly, the frequencies of grade III to IV acute complications were significantly higher in patients submitted to CCRT than in those treated with CT+ICRT (Hematologic, P = 0.016; Gastrointestinal, P = 0.041; Genitourinary, P = 0.019). Moreover, the frequencies of grade III–IV late complications in patients treated with CCRT were significantly higher compared with CT+ICRT-treated patients (Gastrointestinal, P = 0.026; Genitourinary, P = 0.026; Lower extremity edema, P = 0.008). Conclusions Postoperative adjuvant CT+ICRT treatment achieved equivalent 3-year DFS and OS but low complication rate compared to CCRT treatment in early stage cervical cancer patients with intermediate-risk.

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