Abstract
Epithelial ovarian cancer (EOC) continues to represent one of the most lethal conditions in women in the western countries. With the shifting of childbearing towards higher age, EOC increasingly affects women with active childbearing wish, resulting in major impacts on treatment management. Next to the optimal therapeutic treatment strategies, gynecologic oncologists are being asked to incorporate into their decision-making processes the patients' wish for fertility preserving alternatives ideally without compromising oncologic safety. Nowadays, fertility-sparing surgery represents an effective alternative to conventional radical cytoreduction in younger women with early stages of the disease. As such, this paper considers indications for fertility sparing surgery in EOC, reflects on outcomes from the oncologic and reproductive data of the largest and most relevant series outcomes data, reporting on fertility sparing techniques in EOC, reviews medicamentous efforts to prevent chemotherapy induced gonadotoxicity, and discusses future aspects in the gynecologic cancer management.
Highlights
Epithelial ovarian cancer (EOC) continues to represent a lethal condition which commonly affects women in a multifocal and peritoneal metastasized fashion
After thorough insight of the current literature, fertility-sparing surgery (FSS) in earlystage EOC appears an absolutely viable and safe option for women younger than 40 years who wish to preserve their childbearing potential after careful consideration of histologic subtypes
The optimal indication is referring to stage Ia G1/G2 disease, as well as stage Ic with favorable, that is, nonclear-cell histology
Summary
Epithelial ovarian cancer (EOC) continues to represent a lethal condition which commonly affects women in a multifocal and peritoneal metastasized fashion. With the constant shifting of childbearing age towards higher ages, the increasing incidence of EOC in women with active childbearing potential constitutes a therapeutic dilemma [2]. Both patients and treating physicians are being encountered with the abrupt loss of childbearing potential due to the malignant disease, while alternatives are being sought that try to preserve a last hope of fertility within the antitumor treatment [3]. Equivalent to the nowadays established organ-preserving techniques in borderline ovarian tumors, in early EOC, strategies like preservation of the contralateral ovary and uterus or even in highly specialized cases peritonectomy of the pelvis and uterus serosa to avoid the need of hysterectomy are being recruited [5, 6]. The aim of this paper is to provide an overview of the most significant hitherto reports and discuss future perspectives
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