i tumori rari tra patologo e clinico

I TUMORI RARI TRA PATOLOGO E CLINICO
NEOPLASIA DELL’OVAIO BORDERLINE
Dott Fedro Peccatori
CREMONA 19 NOVEMBRE
Borderline Ovarian Tumors (BOT)
Epidemiology
Treatment
Outcome
Focus on conservative surgery
Focus on assisted reproduction after BOT diagnosis
Conclusions
Epidemiology of borderline ovarian tumors (BOT)
-
Incidence: 4/100.000 new cases year
15-20% of all epithelial ovarian cancer
Median age: 55 years
30% < 40 years of age
Increasing trends in incidence
- Change in histopathological criteria
- Change in reproductive factors
- No protection from oral
contraceptives
- Increased obesity rate and
infertility
Treatment of BOT
- The cornerstone of treatment is surgery
- No role for adjuvant chemotherapy
- No role for radiation therapy
Surgical Treatment of BOT
-
Consider age and childbearing wish
Remove all tumor
Stage thoroughly
No role for hysterectomy
No clear role for lymph node dissection
Laparoscopic approach safe
BE CONSERVATIVE !
Outcome of BOT
Outcome of BOT
% OS
Relapse may occur in 8% of BOT, but most recurrences
(70%) are still BOT with excellent DFS and OS
In case of invasive recurrences, DFS and OS are worse
Why fertility-sparing surgery and assisted
reproduction are important for young
patients with BOT?
- Age at first pregnancy is increasing
- BOT is a curable disease
- Patients with BOT are at risk of infertility for repeated
surgeries (not for chemo!)
- The window of reproductive opportunity may be
shortened
Fertility-sparing surgery of BOT
Fertility sparing surgery of BOT
Fertility sparing surgery of BOT
C= cystectomy
USO= unilateral salpingo-oophorectomy
Fertility sparing surgery of BOT
Cystectomy
25.3%
Unilateral
Salpingo
Ooforectomy
12.5%
Bilateral
Cystectomy
Fertility sparing surgery of BOT
Assisted reproduction after BOT diagnosis
Assisted reproduction after BOT diagnosis
Assisted reproduction after BOT diagnosis
Assisted reproduction after BOT diagnosis
Fertility preservation after BOT diagnosis
WRAP UP
Fertility preservation in young patients with BOT can be
accomplished with a careful conservative surgical
planning, but also with gametes harvesting, when
needed.
Even if fertility preservation procedures may be
associated with a higher risk of relapse, no difference in
survival has been described.
Federica Tomao, Fedro Peccatori, Lino del Pup et al
SPECIAL ISSUES IN FERTILITY PRESERVATION FOR GYNECOLOGIC MALIGNANCIES.
Critical Review Oncology and Haematology; 2015 accepted for publication
Conclusions
Borderline ovarian tumors are rare, but curable diseases
Almost 30% of cases are diagnosed during reproductive
age
If the patient is interested in subsequent pregnancy,
fertility sparing surgery should be always pursued
Cystectomy is associated with higher recurrence rate
compared to unilateral salpingo-oophorectomy, but
overall survival remains excellent
Ovarian stimulation with oocyte freezing/ICSI might be
associated with higher incidence or recurrence rate of
BOT, but overall survival remains excellent
A thorough oncofertility counseling should be offered to
all young patients with BOT