Fertility‐sparing treatment for early‐stage epithelial ovarian cancer: Contemporary oncologic, reproductive and endocrinologic perspectives

• Published in: The journal of obstetrics and gynaecology research 2020-08, Vol.46 (8), p.1263-1281
• Main Authors: Mandelbaum, Rachel S., Klar, Maximilian, Takiuchi, Tsuyoshi, Bainvoll, Liat, Matsuzaki, Shinya, Paulson, Richard J., Matsuo, Koji
• Format: Article
• Language: English
• Subjects: Carcinoma, Ovarian Epithelial; Chemotherapy; Cryopreservation; Endocrinology; epithelial ovarian cancer; Female; Fertility; Fertility Preservation; fertility‐sparing surgery; Gonadotropin-releasing hormone; Gonadotropins; Humans; Medical prognosis; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Oncology; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Patients; Pituitary (anterior); Pregnancy; Retrospective Studies; Surgery; Tumors
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.14302

Aim Epithelial ovarian cancer (EOC) can be a devastating diagnosis in women of reproductive age who desire future fertility. However, in early‐stage disease, fertility‐sparing surgery (FSS) can be considered in appropriately selected patients. Methods This is a narrative descriptive review of the recent literature on FSS for EOC from oncologic, reproductive and endocrinologic perspectives. Results The recurrence rate following FSS performed for stage I EOC in published retrospective studies collectively is 13% but ranges from 5 to 29%, while mortality ranges from 0 to 18%. Five‐year disease‐free survival following FSS is over 90% but decreases with higher stage and grade. Recurrences following FSS are more likely to be localized with a more favorable prognosis compared to recurrences following radical surgery. Adjuvant chemotherapy is recommended in women with high‐risk disease, and strategies to minimize gonadotoxicity during chemotherapy such as gonadotropin‐releasing hormone (GnRH) agonists may be considered. Oocyte, embryo and/or ovarian cryopreservation can also be offered to patients desiring future biologic children. Reproductive outcomes following FSS, including pregnancy and miscarriage rates, resemble those of the general population, with a chance of successful pregnancy of nearly 80%. Conclusion In retrospective data, FSS appears to be oncologically safe in stage IA and IC grade 1–2 non‐clear cell EOC. In patients with grade 3 tumors or clear cell histology, treatment can be individualized, weighing a slightly higher risk of recurrence with fertility goals. A multidisciplinary approach with oncology and reproductive endocrinology may be of utility to help these patients achieve their fertility goals.