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Fertilitätserhalt bei Borderline-Tumoren des Ovars

  • Vera K. Kreuzer
  • Tanja N. Fehm
Leitthema

Zusammenfassung

Die leitliniengerechte operative Therapie beim Borderline-Tumor des Ovars beinhaltet u. a. die Salpingo-Oophorektomie beidseits und führt somit zum Verlust der Fertilität. Kohortenstudien und Einzelfallberichte zeigen, dass fertilitätserhaltendes Vorgehen (Belassen des kontralateralen Ovars oder alleinige Zystenexstirpation) möglich ist. Hinzu kommen moderne Techniken zum Fertilitätserhalt, wie die kontrollierte ovarielle Stimulation mit Kryokonservierung von Eizellen, aber auch die Kryokonservierung von Ovargewebe. Eine ergebnisoffene Aufklärung über die möglichen Techniken des Fertilitätserhalts mit ausführlicher Risikoaufklärung muss bei jeder fertilen Patientin mit (prospektivem) Kinderwunsch präoperativ erfolgen. Nach abgeschlossener Familienplanung ist eine nachträgliche Komplettierungsoperation zur Reduktion des Rezidivrisikos zu diskutieren.

Schlüsselwörter

Salpingo-Oophorektomie Kryokonservierung Ovulationsinduktion Leitlinien Beratung 

Fertility preservation in patients with borderline ovarian tumors

Abstract

According to the German guidelines, patients with borderline ovarian tumors require bilateral salpingo-oophorectomy, which leads to loss of fertility. Cohort studies and case reports demonstrate that fertility-sparing surgery (unilateral salpingo-oophorectomy or cystectomy) is an option in these patients. In addition, modern fertility-preservation measures could be offered to these patients, including controlled ovarian stimulation with cryopreservation of oocytes as well as cryopreservation of ovarian tissue. All patients with a (prospective) desire to have children must be provided with detailed information on the possible options for fertility preservation as well as on the possible risks. After completion of family planning, subsequent removal of the remnant ovarian tissue to minimize the risk of recurrence should be discussed.

Keywords

Salpingo-oophorectomy Cryopreservation Ovulation Induction Guidelines Counselling 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

V.K. Kreuzer und T.N. Fehm geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Fehm TN (2017) Borderline-Tumoren des Ovars. In: Fehm TN, Fleisch MKJ (Hrsg) Fertilitätserhalt in der Gynäkoonkologie, 1. Aufl. De Gruyter, Berlin, S 146–154CrossRefGoogle Scholar
  2. 2.
    Sherman ME, Mink PJ, Curtis R et al (2004) Survival among women with borderline ovarian tumors and ovarian carcinoma: a population-based analysis. Cancer 100:1045–1052.  https://doi.org/10.1002/cncr.20080 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    du Bois A, Ewald-Riegler N, de Gregorio N et al (2013) Borderline tumours of the ovary: a cohort study of the Arbeitsgmeinschaft Gynäkologische Onkologie (AGO) study group. Eur J Cancer 49:1905–1914.  https://doi.org/10.1016/j.ejca.2013.01.035 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren, Langversion 2.0 2016Google Scholar
  5. 5.
    (2017) Fertility preservation for patients with malignant disease. Guideline of the DGGG, DGU, DGRM (S2k-Level, AWMF Registry No. 015/082, November 2017). http://www.awmf.org/leitlinien/detail/II/015-082.html
  6. 6.
    Morice P, Camatte S, El Hassan J et al (2001) Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors. Fertil Steril 75:92–96.  https://doi.org/10.1016/S0015-0282(00)01633-2 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Vasconcelos I, de Sousa Mendes M (2015) Conservative surgery in ovarian borderline tumours: a meta-analysis with emphasis on recurrence risk. Eur J Cancer 51:620–631.  https://doi.org/10.1016/j.ejca.2015.01.004 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Zanetta G, Rota S, Chiari S et al (2001) Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study. J Clin Oncol 19:2658–2664.  https://doi.org/10.1200/JCO.2001.19.10.2658 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Longacre TA, McKenney JK, Tazelaar HD et al (2005) Ovarian serous tumors of low malignant potential (borderline tumors): outcome-based study of 276 patients with long-term (≥5-year) follow-up. Am J Surg Pathol 29:707–723.  https://doi.org/10.1097/01.pas.0000164030.82810.db CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Uzan C, Muller E, Kane A et al (2013) Fertility sparing treatment of recurrent stage I serous borderline ovarian tumours. Hum Reprod 28:3222–3226.  https://doi.org/10.1093/humrep/det371 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Uzan C, Muller E, Kane A et al (2014) Prognostic factors for recurrence after conservative treatment in a series of 119 patients with stage I serous borderline tumors of the ovary. Ann Oncol 25:166–171.  https://doi.org/10.1093/annonc/mdt430 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Trillsch F, Mahner S, Woelber L et al (2014) Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome: results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study. Ann Oncol 25:1320–1327.  https://doi.org/10.1093/annonc/mdu119 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Helpman L, Beiner ME, Aviel-Ronen S et al (2015) Safety of ovarian conservation and fertility preservation in advanced borderline ovarian tumors. Fertil Steril 104:138–144.  https://doi.org/10.1016/j.fertnstert.2015.03.038 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Park J‑Y, Kim D‑Y, Suh D‑S et al (2008) Outcomes of fertility-sparing surgery for invasive epithelial ovarian cancer: oncologic safety and reproductive outcomes. Gynecol Oncol 110:345–353.  https://doi.org/10.1016/j.ygyno.2008.04.040 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Strowitzki T (2013) Infertilität bei Frauen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:1628–1632.  https://doi.org/10.1007/s00103-013-1851-x CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Vayena E, Rowe PJ, Griffin PD (2002) Current practices and controversies in assisted reproduction. Report of a WHO meeting on “Medical, Ethical and Social Aspects of Assisted Reproduction”Google Scholar
  17. 17.
    Committee of the American Society for Reproductive Medicine P (2013) Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril 99:63.  https://doi.org/10.1016/j.fertnstert.2012.09.023 CrossRefGoogle Scholar
  18. 18.
    von Wolff M, Thaler CJ, Frambach T et al (2009) Ovarian stimulation to cryopreserve fertilized oocytes in cancer patients can be started in the luteal phase. Fertil Steril 92:1360–1365.  https://doi.org/10.1016/j.fertnstert.2008.08.011 CrossRefGoogle Scholar
  19. 19.
    Cakmak H, Rosen MP (2015) Random-start ovarian stimulation in patients with cancer. Curr Opin Obstet Gynecol 27:215–221CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Findeklee S, Lotz L, Heusinger K et al (2015) Fertility protection in female oncology patients: how should patients be counseled? Geburtshilfe Frauenheilkd 75:1243–1249.  https://doi.org/10.1055/s-0035-1558184 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Gadducci A, Guerrieri ME, Genazzani AR (2013) Fertility drug use and risk of ovarian tumors: a debated clinical challenge. Gynecol Endocrinol 29:30–35CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Denschlag D, von Wolff M, Amant F et al (2010) Clinical recommendation on fertility preservation in borderline ovarian neoplasm: ovarian stimulation and oocyte retrieval after conservative surgery. Gynecol Obstet Invest 70:160–165.  https://doi.org/10.1159/000316264 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Beiner ME, Gotlieb WH, Davidson B et al (2001) Infertility treatment after conservative management of borderline ovarian tumors. Cancer 92:320–325CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Fortin A, Morice P, Thoury A et al (2007) Impact of infertility drugs after treatment of borderline ovarian tumors: results of a retrospective multicenter study. Fertil Steril 87:591–596.  https://doi.org/10.1016/j.fertnstert.2006.07.1503 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Fasouliotis SJ, Davis O, Schattman G et al (2004) Safety and efficacy of infertility treatment after conservative management of borderline ovarian tumors: A preliminary report. Fertil Steril 82:568–572.  https://doi.org/10.1016/j.fertnstert.2004.02.114 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    von Wolff M, Montag M, Dittrich R et al (2011) Fertility preservation in women—a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin’s lymphoma and borderline ovarian tumours by the fertility preservation network FertiPROTEKT. Arch Gynecol Obstet 284:427–435.  https://doi.org/10.1007/s00404-011-1874-1 CrossRefGoogle Scholar
  27. 27.
    von Wolff M, Donnez J, Hovatta O et al (2009) Cryopreservation and autotransplantation of human ovarian tissue prior to cytotoxic therapy—A technique in its infancy but already successful in fertility preservation. Eur J Cancer 45:1547–1553.  https://doi.org/10.1016/j.ejca.2009.01.029 CrossRefGoogle Scholar
  28. 28.
    Jensen AK, Macklon KT, Fedder J et al (2017) 86 successful births and 9 ongoing pregnancies worldwide in women transplanted with frozen-thawed ovarian tissue: focus on birth and perinatal outcome in 40 of these children. J Assist Reprod Genet 34:325–336.  https://doi.org/10.1007/s10815-016-0843-9 CrossRefGoogle Scholar
  29. 29.
    Van der Ven H, Liebenthron J, Beckmann M et al (2016) Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: tissue activity, pregnancy and delivery rates. Hum Reprod 31:2031–2041.  https://doi.org/10.1093/humrep/dew165 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Masciangelo R, Bosisio C, Donnez J et al (2018) Safety of ovarian tissue transplantation in patients with borderline ovarian tumors. Hum Reprod 33:212–219.  https://doi.org/10.1093/humrep/dex352 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Fain-Kahn V, Poirot C, Uzan C et al (2009) Feasibility of ovarian cryopreservation in borderline ovarian tumours. Hum Reprod 24:850–855.  https://doi.org/10.1093/humrep/den459 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Daraï E, Fauvet R, Uzan C et al (2013) Fertility and borderline ovarian tumor: a systematic review of conservative management, risk of recurrence and alternative options. Hum Reprod Update 19:151–166.  https://doi.org/10.1093/humupd/dms047 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Dieleman SJ, Hendriksen PJM, Viuff D et al (2002) Effects of in vivo prematuration and in vivo final maturation on developmental capacity and quality of pre-implantation embryos. Theriogenology 57(1):5–20CrossRefPubMedCentralGoogle Scholar
  34. 34.
    Prasath EB, Chan MLH, Wong WHW et al (2014) First pregnancy and live birth resulting from cryopreserved embryos obtained from in vitro matured oocytes after oophorectomy in an ovarian cancer patient. Hum Reprod 29:276–278.  https://doi.org/10.1093/humrep/det420 CrossRefGoogle Scholar
  35. 35.
    Soleimani R, Heytens E, Van den Broecke R et al (2010) Xenotransplantation of cryopreserved human ovarian tissue into murine back muscle. Hum Reprod 25:1458–1470.  https://doi.org/10.1093/humrep/deq055 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Atsma F, Bartelink M‑LEL, Grobbee DE, van der Schouw YT (2006) Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 13:265–279.  https://doi.org/10.1097/01.gme.0000218683.97338.ea CrossRefGoogle Scholar
  37. 37.
    Sarrel PM, Sullivan SD, Nelson LM (2016) Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertil Steril 106:1580–1587.  https://doi.org/10.1016/j.fertnstert.2016.09.018 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Rocca WA, Grossardt BR, de Andrade M et al (2006) Survival patterns after oophorectomy in premenopausal women: a population-based cohort study. Lancet Oncol 7:821–828.  https://doi.org/10.1016/S1470-2045(06)70869-5 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Frauenheilkunde und Geburtshilfe, UniKiD – Universitäres Kinderwunschzentrum DüsseldorfUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  2. 2.Klinik für Frauenheilkunde und GeburtshilfeUniversitätsklinikum DüsseldorfDüsseldorfDeutschland

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