Abstract
A considerable number of patients with a cancer diagnosis are of childbearing age and have not satisfied their desire for a family. Despite ovarian cancer (OC) usually occurring in older patients, 3%–14% are diagnosed at a fertile age with the overall 5-year survival rate being 91.2% in women ≤44 years of age when it is found at 1A–B stage. In this scenario, testing the safety and the efficacy of fertility sparing strategies in OC patients is very important overall in terms of quality of life.Unfortunately, the lack of randomised trials to validate conservative approaches does not guarantee the safety of fertility preservation strategies. However, evidence-based data from descriptive series suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. This conservative surgery helps to maintain organ function, giving patients of childbearing age the possibility to preserve their fertility.We hereby analysed the main evidence from the international literature on this topic in order to highlight the selected criteria for conservative management of OC patients, including healthy BRCA mutations carriers.
Highlights
Gynaecological cancers are relatively frequent in the female population, with a global estimated incidence of 222,700 new cases in Europe [1]
In a retrospective study, unlike Wright JD, in a 240 patients with malignant early stage/epithelial OC (EOC) treated with fertility-sparing surgery, confirmed that grade of nuclear differentiation G3 was the only predictor for survival, associated with a significant higher rate of distant recurrence (RFS: Hazard ratio [HR]: 4.2, 95% confidence interval [CI]: 1.5–11.7, P = 0.0067; OS: HR: 7.6, 95% CI: 2.0–29.3, P = 0.0032) [51]
– Two severe rejections caused by bilateral thrombotic arterial occlusions
Summary
Gynaecological cancers are relatively frequent in the female population, with a global estimated incidence of 222,700 new cases in Europe [1]. Ovarian tissue preservation is not an option for women with OC or at high risk of developing OC (BRCA1-2 carriers patients). Recent data show the impact of this strategy in breast cancer patients [28, 29] with a significant reduction in the risk of treatment-induced premature ovarian failure and higher pregnancy rates in patients receiving GnRHa during chemotherapy [30,31,32].
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