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Fertility Preservation in Women with Gynaecological Cancer
Table 3: Oncological and Obstetric Outcomes After Conservative Treatment of Early Endometrial Cancer
Authors Number of Patients Treatment Regression Relapse Pregnancy Live Births
Ushijima et al., 2007
35
22 MPA 600mg/day 12 8 12 7
Ota et al., 2005
33
12 MPA 600mg/day 5 3 5 –
Niwa et al.,2005
37
12 MPA 400–600mg/day 12 8 5 5
Gotlieb et al., 2003
34
13 Megestrol acetate or MPA 13 1 5 9
Wang et al., 2002
38
9 Megestrol acetate and/or 8 4 4 3
tamoxifen and or GnRH
Imai et al., 2001
39
14 MPA 400–800mg/day 8 3 3 3
Kaku et al., 2001
28
12 MPA 200–800mg/day 9 2 2 1
Randal et al.,1997
40
12 Megestrol acetate or MPA 9 1 4 5
Kim et al., 1997
41
7 Megestrol acetate 160mg/day 3 2 2 NA
MPA = medroxyprogesterone acetate; GnRH = gonadotropin-releasing hormone.
Table 4: Oncological and Obstetric Outcomes After Conservative Treatment of Epithelial Ovarian Cancer
Author/Year Number of Patients Recurrence Death Pregnancy
Colombo et al., 2005
53
24 7 2 7
Schilder et al., 2002
54
52 5 2 17
Morice et al., 2001
55
34 10 4 10
Duska et al., 1999
42
6112
Brown et al., 1998
52
16 2 2 16
Raspaglies et al.,1997
56
10 0 0 3
Zanetta et al.,1997
57
84 5 3 33
17 others with EH were treated medically. They were given undergo the definitive treatment upon completion of their family.
medroxyprogesterone acetate (MPA) 600mg daily with low-dose Women with stage IA EOC well-differentiated tumour have an
aspirin for 26 weeks. Endometrial sampling at eight and 16 weeks of excellent prognosis, with a five-year survival rate of >90% with surgical
treatment revealed complete response (CR) in 55% of the EC cases treatment only. In fact, adjuvant chemotherapy does not improve the
and in 82% of the EH cases. The overall CR rate was 67%.
35
In a review prognosis.
47–49
For these women, one can offer unilateral salpingo-
of 123 patients with EC, the authors found that conservative treatment oohorectomy and full surgical staging.
50–52
In a recent review of 282
led to regression in 96 cases (78%) and relapse in 31 others (25%); patients with conservatively treated EOC, 113 became pregnant (40%),
there were no reported deaths. There were 51 live births.
36
Oncological with 87 subsequent term deliveries (30%). There were 33 relapses
and obstetrics outcome following medical treatment for FIGO stage I (11%) and 16 disease-related deaths (4%).
36
Table 4 shows oncological
EC are shown in Table 3.
28,33–35,37–41
and obstetric outcomes for FIGO stage IA EOC.
42,52–57
Ovarian Cancer Borderline Ovarian Cancer
Ovarian cancer is the second most common gynaecological cancer Ovarian tumour is defined as borderline when atypical epithelial
and the leading cause of death from gynaecological malignancy. The proliferation without stromal invasion is observed histopathologically.
incidence increases with age and is more common in older women; It is also called a low-malignant-potential (LMP) tumour and represents
however, 3–17% of epithelial ovarian cancers (EOCs) occur in women 10% of ovarian neoplasms.
58
The highest frequency of these tumours is
under 40 years of age.
42
Symptoms of ovarian cancer are vague and in the 15–29-year-old age group, and 70% of borderline tumours are
non-specific, resulting in diagnosis at an advanced stage.
43
Treatment diagnosed at FIGO stage I, are limited to one ovary and carry an
of ovarian cancer is usually aggressive surgical management, excellent prognosis, with five-year survival of 99%. The survival rates of
including peritoneal washing for cytology, hysterectomy, BSO, advanced stage III and IV range between 77 and 96%.
59
Recurrence
omentectomy, pelvic and para-aortic lymph-node sampling and rates for all stages are between 12 and 15%.
60
Microinvasion is a
multiple peritoneal biopsies and debulking in advanced stages, special category, but it does not adversely influence the prognosis.
61
followed by adjuvant combination chemotherapy. Studies have Conservative surgery of borderline ovarian tumour by ovarian
consistently shown that the volume of residual disease after cystectomy or unilateral oophorectomy has been widely studied. The
cytoreductive surgery inversely correlates with survival, as well as results are promising, without deleterious effects on survival. The
stage of disease and grade of tumour differentiation.
44–46
recurrence after ovarian cystectomy is high (23–36%) compared with
salpingo-oophorectomy (0–20%).
62–64
In a recent review of 2,479 women
Fertility preservation is an option only for women with FIGO stage IA with borderline ovarian tumours, 923 women (37%) were treated by
EOC. If conservative surgery (unilateral salpingo-oophorectomy) is conservative surgery, which was associated with a pregnancy rate of
considered, one should perform full surgical staging, including 48% and a recurrence rate of 16%; there were five disease-related
peritoneal washing for cytology examination, multiple peritoneal deaths.
36
The oncological and obstetric outcomes of cases with
biopsies, omentectomy, appendectomy (if mucinous tumour) and node borderline ovarian tumour are summarised in Table 5.
42,60,64–70
sampling. A thorough abdominal exploration and biopsy of any
suspicious areas is mandatory, and endometrial biopsy should be Germ-cell Tumours
performed to exclude EC. Patients should be aware of the limits of the Ovarian germ-cell tumours are found primarily in young women
procedure and the uncertainty of recurrent disease. They should between 10 and 30 years of age. They represent 70% of ovarian
EUROPEAN OBSTETRICS & GYNAECOLOGY 37
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