Desfechos reprodutivos e de sobrevida em adolescente tratada com cirurgia preservadora de fertilidade por tumor borderline de ovário em estádio avançado: relato de caso e revisão da literatura / Reproductive and survival outcomes in an adolescent treated with fertility- sparing surgery for advanced stage borderline ovarian tumor: case report and review of the literature

Existem poucos dados na literatura sobre os resultados obstétricos e oncológicos de adolescentes com tumores borderline de ovário em estádio avançado trata- das com cirurgia preservadora da fertilidade. Uma adolescente de 15 anos com diagnóstico de tumor borderline de ovário estádio IIIc foi inicialmente tratada com tumorectomia ovariana bilateral e quimioterapia adjuvante com esquema de platina/taxano (seis ciclos). Durante o seguimento, foi submetida a outras três tumorectomias devido a tumor borderline de ovário (duas vezes) e cistadenoma ovariano (uma vez). Outra recidiva de tumor borderline de ovário ocorreu seis anos após o diagnóstico inicial, quando ela estava grávida; foi tratada com tumorecto- mia realizada durante a cesariana. Em sua última consulta ambulatorial, a mulher de 27 anos não apresentava evidência da doença e tinha um filho saudável. Mesmo em estádio avançado, a cirurgia de preservação da fertilidade foi segura e factível nessa paciente com tumor borderline de ovário.

There are few data in the literature regarding obstetric and oncological outcomes of adolescents with advanced-stage borderline ovarian tumors treated with fertility spa- ring surgery. A 15 years old adolescent who was diagnosed with a stage IIIc borderline ovarian tumor, was treated with bilateral ovarian tumorectomies and adjuvant chemotherapy with platinum/taxane regimen (six cycles). During follow up she was submitted to other three tumorectomies due to borderline ovarian tumor(twice) and ovarian cysta- denoma (once). Another borderline ovarian tumorrecurren- ce occurred six years after initial diagnosis, when she was pregnant; treated with tumorectomy performed during ce- sarean section. At her last outpatient visit, the 27-year-old woman had no evidence of disease and a had healthy child. Even at an advanced stage, fertility sparing surgery was safe and feasible in this patient with borderline ovarian tumor.

Reproductive outcome of FIGO stage IA and IC ovarian cancer after fertility-sparing surgery: A retrospective cohort study / Philippine Journal of Obstetrics and Gynecology

Background@#Early stage ovarian cancer may be managed with fertility-sparing surgery, to preserve the uterus and contralateral ovary, thus preserving future reproductive function. The aim of this study was to determine the reproductive outcome of early stage ovarian cancer managed conservatively by unilateral salpingooophorectomy, and to compare the survival and recurrence rate among those who had and did not have pregnancy after treatment. @*Methodology:@#A retrospective cohort study was conducted on 34 patients with early stage ovarian cancer who underwent fertility-sparing surgery from January 2005 to December 2018. Fertility outcome following treatment was determined. Survival and recurrence rate was analyzed between those who had and did not have pregnancy after surgery.@*Results@#A total of 34 out of 661 (5.14%) new cases of ovarian cancer who underwent fertility-sparing surgery were analyzed, with a mean age of 23.71 ± 5.57 years (range: 12-36 years old), with the most common complaints of increasing abdominal girth (11/34, 32.35%) or palpable abdominal mass (11/34, 32.35%). Successful pregnancy was seen in 9 cases (26.47%), with 2 of them currently pregnant. Overall recurrence and survival rates were 14.71% and 91.18%, respectively. There was no statistically significant difference in the survival rate (88.89% vs 92%, p-value 0.7778) and rate of recurrence (22.22% and 12%, p-value 0.4578) between those who got pregnant after fertility-sparing surgery for early stage ovarian cancer, FIGO Stage IA and IC, compared to those who did not get pregnant.@*Conclusions@#Fertility-sparing surgery can be effectively offered to young patients with early stage ovarian cancer, to preserve reproductive function, with 26.47% successful pregnancy rate. Pregnancy had no significant effect on recurrence and survival among FIGO stage IA and IC ovarian cancer who underwent fertility-sparing surgery by unilateral salpingooophorectomy.

Clinical features and management of women with borderline ovarian tumors in a single center in Brazil / Características clínicas e manejo de mulheres com tumores borderline de ovário em um hospital no Brasil

Abstract Objective The aim of the present study was to describe and analyze data of 57 women with borderline ovarian tumors (BOTs) regarding histological characteristics, clinical features and treatment management at the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas (Unicamp, in the Portuguese acronym). Methods The present retrospective study analyzed data obtained from clinical and histopathological reports of women with BOTs treated in a single cancer center between 2010 and 2018. Results A total of 57 women were included, with a mean age of 48.42 years old (15.43- 80.77), of which 30 (52.63%) were postmenopausal, and 18 (31.58%) were < 40 years old. All of the women underwent surgery. A total of 37 women (64.91%) were submitted to complete surgical staging for BOT, and none (0/57) were submitted to pelvic or paraortic lymphadenectomy. Chemotherapy was administered for two patients who recurred. The final histological diagnoses were: serous in 20 (35.09%) cases, mucinous in 26 (45.61%), seromucinous in 10 (17.54%), and endometrioid in 1 (1.75%) case. Intraoperative analyses of frozen sections were obtained in 42 (73.68%) women, of which 28 (66.67%) matched with the final diagnosis. The mean follow-up was of 42.79 months (range: 2.03-104.87 months). Regard ingthe current status of the women, 45(78.95%) are alive without disease, 2(3.51%) arealive with disease, 9 (15.79%) had their last follow-up visit > 1 year beforethe performanceof the present study but arealive, and 1 patient(1.75%) died of another cause. Conclusion Women in the present study were treated according to the current guidelines and only two patients recurred.

Resumo Objetivo O objetivo do presente estudo foi descrever uma série de 57 mulheres com tumores borderline de ovário (TBO) em relação às características histológicas, clínicas, e ao manejo do tratamento realizado no Departamento de Obstetrícia e Ginecologia da Universidade Estadual de Campinas (Unicamp). Métodos O presente estudo retrospectivo analisou dados obtidos dos registros clínicos e histopatológicos de mulheres com TBO tratadas em um único centro oncológico de 2010 a 2018. Resultados Um total de 57 mulheres foram incluídas, com uma média de idade de 48,42 anos (15,43-80,77), das quais 30 (52,63%) eram menopausadas, e 18 (31,58%) tinham < 40 anos. Todas as mulheres foram operadas. Um total de 37 mulheres (64,91%) foram submetidas a cirurgia de estadiamento completo para TBO, e nenhuma foi submetida a linfadenectomia pélvica ou paraórtica. O tratamento com quimioterapia foi administrado em duas pacientes que recidivaram. Os diagnósticos histológicos finais foram: seroso em 20 mulheres (35,09%), mucinoso em 26 (45,61%), seromucinoso em 10 (17,54%) e endometrióide em 1 (1,75%). A avaliação histológica intraoperatória foi realizada em 42 (73,68%) das mulheres, das quais 28 (66,67%) foram compatíveis com os diagnósticos finais. O tempo médio de seguimento foi de 42,79 meses (variando de 2,03 a 104,87 meses). Em relação ao status atual das mulheres, 45 (78.95%) estão vivas sem doença, 2 (3,51%) estão vivas com doença, 9 (15.79%) tiveram a última consulta de seguimento há > 1 ano antes da realização do presente estudo, mas estão vivas, e 1 paciente faleceu por outra causa. Conclusão As mulheres do presente estudo foram tratadas de acordo com as recomendações atuais e apenas duas mulheres apresentaram recorrência.

Abdominal radical trachelectomy preserving fertility for ⅠB1 cervical cancer patients whose tumor≥2cm:the evidence and controversy of "Fudan Criteria" / 中国实用妇科与产科杂志

Abdominal radical trachelectomy was usually utilized in ⅠB1 cervical cancer patients whose tumor ≥2 cm since the procedure removed more parametrial tissue than the vaginal approach.We raised selection criteria for ART in such patients in 2011. In this article,we will further discuss issues regarding fertility-sparing surgery in ⅠB1 cervical cancer with tumor ≥2 cm.

Fertility-sparing treatment for early stage epithelial ovarian cancer / 中国实用妇科与产科杂志

With the onset age of tumor becomingyounger,the preservation of reproductive function ofcancer patients has become a hot issue in cancertreatment.Ovarian cancer is one of the most commongynecological malignancies. The fertility-sparingtreatment for patients with epithelial ovarian cancer atthe childbearing age is receiving increasing attention.This article will address the issues related to the fer-tility-sparing treatment for patients with early epi-thelial ovarian cancer.

Fertility preservation in nonepithelial ovarian malignancy / 中国实用妇科与产科杂志

Non-epithelial ovarian malignant tumors account for about 10% of ovarian tumors,and mostly develops in young women.Although surgery and radiotherapy and chemotherapy can make patients get the chances of survival,but often lead to different degrees of damage to reproductive function,causing physical and psychological suffering.While improving the survival rate of patients with malignant ovarian tumors,it is an important research issue to protect the reproductive function of patients as much as possible in the treatment of malignant ovarian tumors.The fertilitysparing treatment has a good effect on non-epithelial ovarian malignant tumors,especially malignant ovarian germ tumors.In this article,we discuss the surgical treatment of fertility protection,the implementation of postoperative adjuvant treatment and the application of assisted reproductive technology in non-epithelial ovarian malignant tumors.

Oncological outcomes of the fertility-sparing surgery for the gynecologic malignancies / 中国实用妇科与产科杂志

Cervical cancer,ovarian cancer and endometrial carcinoma are most common maligancies in gynecology.More and more women suffer from gynecologic malignancies at a younger age.For these young women with hoping to preserve fertility,the fertilitysparing surgery without increasing the rise of tumor has been paid much attention.How are the oncological outcomes of these patients after the fertility-sparing surgeries ? We try to discuss this in the article.

Reproductive outcomes of fertility-sparing treatment for gynecologic malignancies / 中国实用妇科与产科杂志

Cervical cancer,endometrial cancer and ovarian cancer are common gynecologic malignancies.Recently,with the younger onset age and delay of childbearing,the fertility-sparing treatment has been increasingly used.In the fertility-sparing treatment for gynecologic malignancies,we should protect the fertility of patients without increasing tumor recurrence,which requires the multidisciplinary cooperation to develop individualized treatment strategy,provide optimal reproductive guidance and finally improve the reproductive outcomes.

Fertility-sparing surgery for a prepubertal female with malignant ovarian germ cell tumor

@#<p style="text-align: justify;">Malignant ovarian germ cell tumors are rare ovarian malignancies accounting for 3 to 5% of all ovarian malignancies. They are mostly seen in adolescents and young women and are usually unilateral making fertility preservation imperative. Raised alpha-feto protein level is the hallmark of this tumor. Presented is a case of a premenarcheal 13 year old female diagnosed with yolk sac tumor and who underwent fertility-sparing surgery and adjuvant platinum-based chemotherapy post-operatively, with good outcome. In young patients, conservative surgery with adjuvant chemotherapy has made the preservation of fertility possible, even in patients with advanced disease. The increase in cure rates has shifted the focus of recent studies to the long term menstrual, reproductive, and gynecologic outcomes in these patients. </p>

Possibility of women treated with fertility-sparing surgery for non-epithelial ovarian tumors to safely and successfully become pregnant-a Chinese retrospective cohort study among 148 cases / 医学前沿

This study was performed to evaluate the oncological and reproductive outcomes of childbearing-age women treated with fertility-sparing surgery (FSS) for non-epithelial ovarian tumors in China. One hundred and forty eight non-epithelial ovarian tumor women treated with FSS between January 1, 2000 and August 31, 2015 from two medical centers in China were identified. Progression-free survival (PFS) was 88.5%, whereas overall survival (OS) was 93.9%. Univariate analysis suggested that delivery after treatment is related to PFS (P = 0.023), whereas histology significantly influenced OS. Cox regression analysis suggested that only histology was associated with PFS and OS (P < 0.05). Among the 129 women who completed adjuvant chemotherapy (ACT), none developed amenorrhea. Among the 44 women who desired pregnancy, 35 (79.5%) successfully had 51 gestations including 35 live births without birth defects. Non-epithelial ovarian tumors can achieve fulfilling prognosis after FSS and chemotherapy. Histology might be the only independent prognostic factor for PFS and OS. FSS followed by ACT appeared to have little or no effect on fertility. Meanwhile, postoperative pregnancy did not increase the PFS or OS. Use of gonadotropin-releasing hormone agonist was not beneficial for fertility.

Prognosis after fertility-sparing management with oralprogestin for women with complex endometrial hyperplasia and endometrial cancer / 基础医学与临床

Objective To investigate the oncologic and reproductive outcomes after progestin treatment of complex endometrial hyperplasia(CEH) and grade 1 endometrial carcinoma(EC).Methods In a retrospective study, data were obtained for patients with CEH or grade 1 EC at presumed stage IA(without myometrial invasion) who wished to preserve fertility and were treated at the Peking Union Medical College Hospital, China, between January 1, 2000 and December 31, 2011.Patients had received oral medroxyprogesterone acetate(250-500 mg/d) or megestrol acetate(160-480 mg/d) for at least 6 months.Results Among 55 included patients, median age was 32 years(range 21-41 years).41(75%) achieved complete response after a median period of 6(3-24) months.Complete response was less frequent among obese than nonobese patients(4/12 [33%] vs 37/43 [86%];P=0.001).Disease recurrence was recorded in 10(24%) patients with complete response;the 5-year recurrence-freesurvival rate was 71%.Among the 33 patients who retained a desire to conceive, 17(52%) became pregnant.Conclusions Fertility-sparing management with oral progestin is effective and safe.Obesity is associated with a lower probability of long-term success.

Fertility preservation for patients with gynecologic malignancies: The Korean Society for Fertility Preservation clinical guidelines / 대한생식의학회지

Fertility preservation plays a central role in cancer care since an increasingly large number of cancer patients are surviving as a result of improvements in diagnostic and therapeutic strategies. Physicians who take part in the initial diagnosis and management of gynecologic cancer should understand the importance of fertility preservation. Since indications for fertility preservation are limited to early-stage gynecologic cancer, a surgeon must carefully consider each indication. Before performing fertility-sparing surgery, health professionals should compare its oncologic and pregnancy outcomes with those of other standard treatments. Individualized treatment strategies should be delivered depending on the patient's situation, and physicians should provide timely information and appropriate counseling.

Research Progress of Fertility-sparing Management in Young Endometrial Cancer Patients Based on ESGO Recommendations / 中国微创外科杂志

[Summary] A more conservative approach for endometrial cancer ( EC ) is desirable in women who have requirement to preserve fertility, without compromising their survival .In this article, we tried to formulate clinical recommendations of preserving fertility based on suggestions of European Society of Gynaecological Oncology ( ESGO) in 2015 and relevant research progress .

Outcomes of laparoscopic fertility-sparing surgery in clinically early-stage epithelial ovarian cancer / 부인종양

OBJECTIVE: Fertility-sparing surgery (FSS) is becoming an important technique in the surgical management of young women with early-stage epithelial ovarian cancer (EOC). We retrospectively evaluated the outcome of laparoscopic FSS in presumed clinically early-stage EOC. METHODS: We retrospectively searched databases of patients who received laparoscopic FSS for EOC between January 1999 and December 2012 at Samsung Medical Center. Women aged < or =40 years were included. The perioperative, oncological, and obstetric outcomes of these patients were evaluated. RESULTS: A total of 18 patients was evaluated. The median age of the patients was 33.5 years (range, 14 to 40 years). The number of patients with clinically stage IA and IC was 6 (33.3%) and 12 (66.7%), respectively. There were 7 (38.9%), 5 (27.8%), 3 (16.7%), and 3 patients (16.7%) with mucinous, endometrioid, clear cell, and serous tumor types, respectively. Complete surgical staging to preserve the uterus and one ovary with adnexa was performed in 4 patients (22.2%). Two out of them were upstaged to The International Federation of Gynecology and Obstetrics stage IIIA1. During the median follow-up of 47.3 months (range, 11.5 to 195.3 months), there were no perioperative or long term surgical complications. Four women (22.2%) conceived after their respective ovarian cancer treatments. Three (16.7%) of them completed full-term delivery and one is expecting a baby. One patient had disease recurrence. No patient died of the disease. CONCLUSION: FSS in young patients with presumed clinically early-stage EOC is a challenging and cautious procedure. Further studies are urgent to determine the safety and feasibility of laparoscopic FSS in young patients with presumed clinically early-stage EOC.

Cervical cancer: what's new? / Câncer de colo do útero: o que há de novo?

SUMMARY Cervical cancer is the most common gynecological cancer in Brazil. Among women, it is the second most frequent, second only to breast cancer. It is the fourth leading cause of cancer death in the country, with estimated 15,590 new cases (2014) and 5,430 deaths (2013). In order to update information to improve outcomes, reduce morbidity and optimize the treatment of this cancer, this article will address the advancement of knowledge on cervical cancer. The topics covered include the role of surgery in different stages, treatment of locally advanced carcinomas, fertility preservation, the role of the sentinel lymph node technique, indications and techniques of radiotherapy and chemotherapy, and some special situations.

RESUMO O câncer de colo uterino é o câncer ginecológico mais frequente em nosso meio. Entre as mulheres, é o segundo mais frequente, atrás apenas do câncer de mama. É a quarta causa de morte por câncer no Brasil, com estimativa de 15.590 casos novos (2014) e com 5.430 mortes (2013). No intuito de atualizar informações para a melhora do prognóstico, redução da morbidade e otimização do tratamento dessa neoplasia, serão abordados neste artigo os avanços nos conhecimentos sobre o câncer cervical. Entre os temas apresentados, estão o papel da cirurgia nos diferentes estádios, o tratamento dos carcinomas localmente avançados, a preservação da fertilidade, o papel da técnica do linfonodo sentinela, indicações e técnicas da radio e quimioterapia, além de situações especiais.

Safety of Fertility-Sparing Surgery in Primary Mucinous Carcinoma of the Ovary / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study is to evaluate the safety of fertility-sparing surgery as the treatment for patients with primary mucinous epithelial ovarian cancer. MATERIALS AND METHODS: A retrospective study of patients with mucinous ovarian cancer between 1991 and 2010 was performed. The demographics and survival outcomes were compared between patients who underwent fertility-sparing surgery and those who underwent radical surgery. RESULTS: A total of 110 patients underwent primary surgery. At the time of surgery, tumors appeared to be grossly confined to the ovaries in 90 patients, and evidence of metastasis was definite in 20 patients. Of the 90 patients with tumors that appeared to be grossly confined to the ovaries at surgical exploration, 35 (38.9%) underwent fertility-sparing surgery. The Kaplan- Meier curve and the log rank test showed no difference in either recurrence-free survival (p=0.792) or disease-specific survival (p=0.706) between the two groups. Furthermore, there was no significant difference in recurrence-free survival (p=0.126) or disease-specific survival (p=0.377) between the two groups, even when the analysis was limited to women below the age of 40. In a multivariate Cox model, fertility-sparing surgery had no effect on either recurrence-free survival (recurrence hazard ratio [HR], 1.20; 95% confidence interval [CI], 0.25 to 5.71) or disease-specific survival (death HR, 0.88; 95% CI, 0.17 to 4.60). CONCLUSION: Fertility-sparing surgery in primary mucinous cancer grossly confined to the ovaries may be a safe option and one not associated with an increase in recurrence or mortality.

Neoadjuvant chemotherapy followed by fertility-sparing surgery for women with stage IB1 cervical cancer / 부인종양

Fertility-sparing surgery was optimal to patients with tumor diameter smaller than 2 cm. For patients with larger tumors, neoadjuvant chemotherapy can debulk the tumor and offer the chance of surgery. We report 2 cases of stage IB1 cervical cancer treated by neoadjuvant chemotherapy and fertility-sparing surgery. Relevant literature was reviewed. Its safety, efficacy, and reproductive outcome need to be validated in the future.

Research progress on fertility-sparing surgery for early-stage cervical cancer / 肿瘤研究与临床

The emergence of fertility-sparing surgery for early-stage cervical cancer is one of the important progresses in the treatment of cervical cancer.How to optimize the selection and assessment of patients,how to improve the efficacy and reduce complications,how to improve tumor outcome and increase the likelihood of pregnancy,are the current hot issues.The new progress and controversial issues of the treatment in recent years were reviewed in order to promote the future treatment in the direction of safe,efficient and minimally invasive surgery,and hope the surgery can better improve the quality of life of patients in clinical cure.

Oncofertilidade: opções na manutenção da fertilidade no tratamento do câncer ginecológico / Oncofertility: fertility considerations in the management of gynecological cancer

O diagnóstico do câncer ginecológico ocorre em pacientes cada vez mais jovens e em estadios mais precoces. Muitas dessas pacientes se encontram em idade fértil e desejam prole. A detecção mais precoce e a maior efetividade do tratamento têm propiciado, em casos selecionados, a conservação da fertilidade nesse grupo de paciente, sem prejuízo na cura oncológica. Foi realizada uma revisão da literatura com artigos entre 2004 e 2011, dos quais foram selecionados os mais relevantes. Revisamos as principais opções de preservação da fertilidade no tratamento do câncer ginecológico, abrangendo os tumores do colo uterino, do ovário e do endométrio

The diagnosis of gynecological cancer is increasingly occurring in younger patients and in earlier stages. Many of these patients are fertile and wish to become pregnant. The earlier detection and more effective treatment have allowed the preservation of fertility without prejudice to cure cancer, in selected cases. We conducted a literature review of articles between 2004 and 2011, which we selected the most relevant. We reviewed the main options for fertility preservation in the treatment of gynecological cancers including tumors of the cervix, ovary and endometrium