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Fertility Preservation
Table 5: Oncological and Obstetric Outcomes After Conservative Surgery of Borderline Epithelial Ovarian Cancer
Authors Number of Patients Unilateral Salpingo-oophorectomy (%) Recurrence (%) Pregnancy
Fauvet et al., 2005
64
360 162 (45) 27 (16.6) 30
Boran et al., 2005
65
142 62 (44) 4 (6.5) 13
Donnez et al., 2003
66
75 16 (21) 3 (18.7) 12
Camatte et al., 2002
67
17 17 (100) 9 (52.9) 8
Zanetta et al., 2001
68
339 189 (56) 35 (18) 44
Morice et al., 2001
60
174 49 (28) 9 (29.5) 14
Morris et al., 2000
69
518 43 (8.3) 14 (33) 25
Duska et al., 1999
42
46 25 (54.3) NA 14
Gotlieb et al., 1998
70
82 39 (43) 3 (7) 22
Table 6: Oncological and Obstetric Outcomes After Conservative Surgery with or without Chemotherapy for
Germ-cell Ovarian Tumours
Author/Year Number of Patients Recurrence Pregnancy Term Delivery
Nishio et al., 2006
78
30 0 8 NA
Tangir et al., 2003
79
64 NA 47 38
Gershenson et al., 2002
80
133 NA 37 22
Zanetta et al., 2001
81
138 16 41 28
Low et al., 2000
82
74 7 19 14
Kanazawa et al., 2000
83
21 1 11 9
tumours in this age group and are highly malignant.
71
These tumours unilateral salpingo-oophorectomy. Due to oestrogen production by
grow rapidly and are usually symptomatic. Diagnosis can be made at the tumour, endometrial sampling should be performed to rule out EH
an early stage and most patients present with stage IA disease. or cancer. Children with advanced-stage juvenile GCTs require
adjuvant chemotherapy.
88–90
Late recurrences have been reported
Surgery is essential for diagnosis and proper staging. Most patients can after 40 years of age.
91
Powell et al. reported pregnancy and live births
be treated by unilateral salpingo-oophorectomy. They should receive a few years after conservative treatment.
92
adjuvant chemotherapy except those with stage I dysgerminoma and
well-differentiated stage I immature teratoma. These tumours produce Another rare tumour is the androgen-producing Sertoli-Leydig cell
tumour markers, including alpha-fetoprotein, lactate dehydrogenase tumour, which accounts for fewer than 0.5% of ovarian tumours.
93
and human chorionic gonadotropin, which can be used to monitor the Approximately 75% occur in women <40 years of age. Similar to
response to chemotherapy and for subsequent follow-up. The cure rate GCTs, unilateral salpingo-oophorectomy is the preferred treatment
is >95%, which is high for early-stage disease.
72
The standard when preservation of fertility is desired.
94
A few pregnancies have
chemotherapy is bleomycin, etoposide, cisplatin (BEP).
73–75
Although been reported.
95,96
ovarian failure can occur, most patients resume regular menses after
completion of chemotherapy. In a review, 27 of 40 patients maintained Gestational Trophoblastic Disease
regular menses consistently after completion of chemotherapy, and 12 and Choriocarcinoma
of 16 patients who attempted pregnancy conceived.
76
One of the Most cases of localised GTD are due to invasive molar pregnancy, but a
adverse effects of etoposide is acute myelocytic leukaemia, which has few are due to choriocarcinoma.
97
These tumours are highly malignant;
been found to be dose- and schedule-dependent.
77
In a review of 278 however, the cure rate with modern chemotherapy is high.
98
In women
patients with germ-cell tumour treated conservatively, there were who have completed their family, hysterectomy is usually performed
28 recurrences (10%) and eight deaths (2.8%). The obstetric outcome is before chemotherapy. Hysterectomy prevents the persistence of drug-
excellent, with 185 pregnancies and 118 live births in a total of 515 resistant local disease, and can shorten the duration and amount of
patients.
36
The oncological and obstetrics outcomes of patients with chemotherapy required to produce remission.
99
Treatment for invasive
germ-cell tumours are shown in Table 6.
78–83
mole or choriocarcinoma is generally the same: both are treated with
either a single agent of methotrexate or a combination treatment
Sex Cord-stromal Tumours with etoposide, methotrexate, dactinomycin, cyclophosphamide and
Sex cord-stromal tumours are LMP neoplasia that develop from the cells vincrisitin (EMA/CO).
surrounding the oocytes, and represent 5–8% of all primary ovarian
neoplasms.
84
Most of these tumours secrete oestrogen or androgen. In women who wish to conceive, chemotherapy is the treatment of
Clinical manifestations include precocious puberty, abnormal uterine choice. Pregnancy should be avoided for at least one year following
bleeding or virilisation. They are usually diagnosed at an early stage. The treatment. Single-agent chemotherapy with methotrexate does not
juvenile subtype of granulosa cell tumour (GCT) accounts for 5% of all affect future pregnancy potential or increase the rate of congenital
GCTs and typically develops before puberty. They have a low recurrence malformation. In a report of 445 long-term survivors after
rate.
85
Several cases have been reported during pregnancy.
86,87
chemotherapy for GTD, 97% of women who desired fertility conceived
and 86% had at least one live birth.
100
Women who received three or
The conventional treatment of sex cord-stromal tumour is TAH and more drugs were less likely to have a live birth than those who
BSO. For women who wish to preserve their fertility, one can perform received one or two drugs.
101,102
38 EUROPEAN OBSTETRICS & GYNAECOLOGY
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