Serous ovarian tumors of low malignant potential with peritoneal implants

Abstract

Between 1956 and 1985, 82 patients with metastatic low-grade serous ovarian carcinoma, subsequently reclassified by pathologic review as serous ovarian tumors of low malignant potential with peritoneal implants, were seen at the authors' institution. Median age was 34 years (range, 17-64 years). Original stage distribution was as follows: 32 Stage 11, 46 Stage 111, and four Stage IV. Peritoneal implants in 72 patients were classified as benign (22 patients), noninvasive (37), or invasive (13). For ten patients, implants were clinically documented but histologic material was unavailable. The most common sites of peritoneal implants included the pelvic peritoneum (42), omentum (33), uterus (33), and fallopian tube (26). All patients underwent primary surgery. Postoperative therapy consisted of radiotherapy in 18 patients, singleagent chemotherapy in 37 patients, combination chemotherapy in 25 patients, and no therapy in two patients. Second-look laparotomy documented response to chemotherapy in 42% of patients with no gross residual disease and in 80% of patients with macroscopic residual disease (40% complete response, 40% partial response). Disease-free survival rates were 95% a t 5 years and 91% a t 10 years. The International Federation of Gynecologists and Obstetricians (FIGO) stage, extent of residual disease, type of postoperative treatment, and type of peritoneal implants had no effect on survival. Based on a comparison of the present study's findings with those in the literature, the authors propose possible explanations for differences in survival by type of peritoneal implants and outline recommendations for clinical management until further studies elucidate the role of postoperative therapy.Cancer 65:578-585, 1990.EROUS OVARIAN TUMORS of low malignant potential S (LMP) were initially described in 1929 by Taylor.'It was several decades, however, before these tumors were officially recognized as a distinct entity by The International Federation of Gynecologists and Obstetricians (FIG0)2 and the World Health Organization (WHO).3 Over the last two decades, several studies4-" have clearly documented the less-aggressive natural history of Stage I ovarian tumors of LMP, with a 5-year survival rate in the range of 95% or better in most reports. Standard therapy for such patients consists of surgery alone. The survival rate of patients with metastatic ovarian tumors of LMP, however, is generally reported to be lower and more v a~-i e d .~~~-' -~~. '~ The optimal treatment of patients with metastatic tumors remains elusive. Several studies have attempted to characterize the peritoneal implants associated with metastatic serous ovarian tumors of LMP. Spontaneous regression of metastatic implants From the

Laparoscopic restaging of borderline ovarian tumours: results of 30 cases initially presumed as stage IA borderline ovarian tumours

“…It has been reported that invasive implants are associated with 66% of survival rate compared with 95.3% of patients with non-invasive implants ( P < 0.001) 20 .…”

“…The post-operative chemotherapy issue is controversial. No study has convincingly demonstrated efficiency of post-operative chemotherapy for patients with peritoneal implants of serous ovarian borderline tumours 10,19,20 . No case of pseudomyxoma peritonei was found in our series.…”

Ovarian Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology

“…Some clinicians feel that the appearance of invasive implants on the peritoneal surfaces in patients with borderline epithelial tumors portends a less favorable prognosis; therefore, postoperative chemotherapy with the same regimens used for grade 1 (low-grade) serous epithelial ovarian cancer can be considered for these patients (see LCOH-5 and LCOH-7; pages 1141 and 1142, respectively). 235,236,243 For the 2016 update, the NCCN Panel revised this recommendation for postoperative chemotherapy to category 2A (from category 2B); intravenous carboplatin with either docetaxel or paclitaxel is recommended. However, the benefit of chemotherapy, either intraperitoneal or intravenous, is controversial in patients with borderline epithelial tumors.…”

Epithelial Ovarian Cancer

“…148 In contrast to patients with frankly invasive ovarian carcinoma, women with borderline disease tend to be younger and are often diagnosed with stage I disease. 149,150 The benefit of postoperative chemotherapy has not been shown for patients who have no microscopically demonstrable invasive implants.…”