Borderline tumors of the ovary: fertility treatment, conservative management, and pregnancy outcome.
BACKGROUND
Ovarian tumors of borderline malignancy have a less aggressive behavior and tend to occur at a younger age than their invasive counterparts. The role and extent of fertility-sparing conservative treatments is under continuous evaluation.


METHODS
The current study was a retrospective review of 82 patients with confirmed borderline tumors diagnosed over a 25-year period, with special focus on fertility-associated issues.


RESULTS
Follow-up was available for 96% of the patients, for a total of 357 women-years of follow-up. Thirty-nine patients underwent conservative management. Of these, only three patients had a contralateral recurrence. Two of the three again opted for conservative management and were without evidence of disease at last follow-up. Seventeen patients did benefit from contralateral ovarian dissection either by cystectomy or oophorectomy because of contralateral benign or borderline disease. Eleven patients had received or were scheduled to receive ovulation induction. Five patients were diagnosed during the evaluation, and another two were diagnosed so soon after the initiation of ovulation induction that a causative relationship appeared to be unlikely. Six patients were diagnosed during ongoing pregnancies. Twenty-two pregnancies were achieved in 15 patients after conservative treatment. No influence of the disease or its treatment on the pregnancy (or vice versa) was observed during a mean follow-up of 69 months.


CONCLUSIONS
Data are accumulating that indicate conservative fertility-sparing disease management is adequate treatment for patients with borderline tumors. Available data indicate that in these patients fertility, pregnancy outcome, and survival remain excellent.
Gotlieb
W H
WH
Division of Gynecologic Oncology, Tel Aviv University Sackler School of Medicine, Sheba Medical Center, Tel Hashomer, Israel.
Flikker
S
S
Davidson
B
B
Korach
Y
Y
Kopolovic
J
J
Ben-Baruch
G
G
D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002648:Child; D003884:Dermoid Cyst / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D004210:Dissection; D005069:Evaluation Studies as Topic; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010048:Ovarian Cysts / Q000601:surgery; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy; D010062:Ovulation Induction; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000601:surgery; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015996:Survival Rate