Abstract
The aim of this survey was to analyse the standard of care in diagnostic, surgery, chemotherapy and aftercare management for patients with borderline tumours of the ovary (BOTs) in Germany. A structured questionnaire comprising different dimensions was sent to all 1114 gynaecological departments. The questionnaire could be returned anonymously. The overall response rate was 29.0% (323 departments). Most departments were on secondary care (71.8%), tertiary care (23.2%) or university hospital (5.0%) level. Most clinicians performed not more than five BOT operations (89.2%) per year. Most departments (93.2%) used in addition to classical bimanual examination and vaginal ultrasound, tumour marker CA-125 detection, CT scan, MRI or PET-CT techniques. Departments in university and tertiary care hospitals performed more often a fresh frozen section (87 vs 64%). In young women, clinicians performed much seldom unilateral salpingo-oophorectomy (92%) and only in 53% biopsies of the contralateral ovary. Generally, biopsies of the contralateral ovary were performed in 4–53% of the patients. Chemotherapy was mostly favoured in ‘high-risk’ patients with tumour residual, microinvasion or invasive implants. Thus, a high grade of insecurity in diagnostic and therapy of BOT exists in some gynaecological departments and underlines the need for more educational and study activities.
Highlights
Kurman et al, 2008)
Borderline tumours of the ovary (BOTs) are a specific tumour entity that represents some characteristics of malignant ovarian tumours, but which does not show any destructive stromal invasion
This focused on statistical data, such as clinical structure and clinical size of the institutions, number of clinics that were performing surgical and adjuvant treatment for ovarian and borderline tumours, with the special focus on diagnosis, therapy, prognosis and follow-up aspects of borderline tumours of the ovary (BOTs)
Summary
According to Denkert and Dietel (2005), G1 ovarian carcinomas originate step by step from a cystadenoma or a borderline tumour. Kurman et al (2008) differ between type I tumours presenting slow growing, confined to the ovary and most originating from borderline tumours. The detection of extraovarian invasive implants determines to a great extent the prognosis of borderline ovarian tumours (Denkert and Dietel, 2005; Sehouli et al, 2005a, b). In most patients with BOT, non-invasive implants are common, whereas 6% of the women present invasive implants, which are strongly associated with a poorer prognosis (Longacre et al, 2005). 1732 In contrast to ovarian cancer (du Bois et al, 2001, 2005), no surveys have yet been carried out in regard to the clinical management of BOT in Germany. A structured survey about the current clinical management of BOTs is deemed absolutely necessary to gain new approaches in the conception of prospective trials and to identify the demand for further education and research activities concerning the topic of BOT
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