Analysis of the Safety and Pregnancy Outcomes of Fertility-sparing Surgery in Ovarian Malignant Sex Cord-stromal Tumours: A Multicentre Retrospective Study

Purpose of review Gynecological cancer is a very important cause of comorbidity and mortality in women. The current delay in motherhood is increasing the incidence of women under 40 years of age that have not yet achieved their maternity goals when they are diagnosed and standard treatment negatively impacts the reproductive potential of cancer survivors. In this review, we update the information available about the safety of fertility-sparing treatments in young gynecological cancer patients, as well as the safety and efficacy of assisted reproductive techniques (ART) in such group. We also evaluate the long-term gynecological cancer risk in women requiring ART. Recent findings Although eligibility criteria continue to be very strict, there are more and more reports of fertility-sparing approaches outside of what traditionally has been considered safe. Molecular assessment is starting to be used in the selection of appropriate candidates. Data increasingly shows the long term safety and the efficacy of ART and pregnancy in these patients. Summary Appropriate selection is key to safely preconize fertility-sparing alternatives. Because subfertility may be a result of these procedures, ART could be indicated in this setting. Neither ART nor pregnancy appear to increase recurrences or affect survival rates.

Section: Key Pointsmentioning

confidence: 87%

“…The commonly used chemotherapy regimen only rarely disrupts endocrine ovarian function [27], making fertility-sparing surgery a valid option. Pregnancy rates are similar to those of epithelial ovarian tumors, although data are scarce [17].…”

Section: Safety Of Fertility-sparing Treatments and Assisted Reproduc...mentioning

confidence: 95%

Safety of assisted reproductive techniques in gynecological cancer patients

Caballero

Domingo

Garcia-Velasco

2023

“…In a multicenter retrospective cohort of 107 patients, of whom 54 (50.5%) women underwent ovarian preservation and 53 (49.5%) received radical surgery, there was no significant difference in DFS between the two groups. Moreover, stage IC, tumor diameter more than 8 cm, incomplete staging surgery, and no adjuvant chemotherapy were the four high-risk factors associated with a shorter DFS [80]. Also, in the study by Wang et al [81], incomplete staging was associated with an increased risk of recurrence.…”

Section: Nonepithelial Ovarian Cancermentioning

confidence: 89%

Ovarian preservation in gynecologic oncology: current indications and techniques

Bizzarri

Pavone

Loverro

et al. 2023

Purpose of review Early menopause represents a relevant clinical issue for women. Nevertheless, this issue should be balanced with the risks of ovarian metastasis, ovarian recurrence, and the risk of recurrence in hormone-sensitive gynecological cancers. The purpose of this review was to provide an overview on current indications and techniques of ovarian preservation in patients with gynecological cancers. Recent findings The potential discussion about ovarian conservation could be proposed to patients with FIGO-stage IA grade 1-2 endometrioid endometrial cancer aged 40 years or less, FIGO-stage IB1-IB2 node-negative cervical cancer with squamous cell carcinoma and HPV-associated adenocarcinoma, FIGO-stage IA-IC grade 1-2 serous, endometrioid, mucinous expansile pattern ovarian cancer, any stage germ cell ovarian tumors, and FIGO-stage IA sex cord-stromal tumors. Technique to perform ovarian transposition in cervix cancer is also reported. Summary Ovarian conservation is a surgical approach that involves preserving one or both ovaries during the treatment of gynecologic cancers. This approach has gained popularity in recent years, as it offers several benefits to the patient, including the preservation of hormonal function and fertility. The decision to perform ovarian conservation depends on several factors, such as the stage and type of cancer, the patient's age, fertility desire, and should be carefully discussed with patients.

“…Conservative treatment of SCST seems to be well tolerated in patients with stage IA. In other FIGO stages, FSS remains controversial [20,21,22 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Current limits of conservative treatment in ovarian cancer

Gracia¹,

Alonso-Espías²,

Zapardiel³

2023

Purpose of review Fertility-sparing surgery in ovarian cancer is an increasing need in gynecology–oncology clinical practice because of the frequent childbearing delay in developed countries. As the evidence in literature is based on observational studies, this review focuses on summarizing the most recent and relevant evidence for the conservative management of young patients with ovarian cancer. Recent findings Staging surgery is mandatory in epithelial ovarian tumors. In sex cord-stromal tumors, fertility-sparing surgery is only recommended in FIGO stage IA. Due to its good prognosis, conservative treatment is possible in some cases of advanced disease of germ cell tumors and borderline tumors. Cystectomy is a reasonable option in serous borderline tumors but is not recommended in other tumor subtypes. Successful conception rates after fertility-sparing surgery ranges from 30 to 60%. Summary Fertility-sparing surgery is a well tolerated option in young women with early-stage ovarian cancer with acceptable reproductive outcomes.