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Abstract & Commentary
Synopsis: Ovulation induction may be considered after the diagnosis of borderline ovarian tumor.
Source: Beiner M, et al. Cancer. 2001;92:320-325.
Beiner and colleagues analyzed the outcome of a group of patients who received infertility treatment after the conservative management of borderline ovarian tumors. They reviewed the medical records of 104 patients with a borderline tumor of the ovary who were treated and followed over a 20-year period (1979-1999). Forty-three patients who underwent conservative management were the subjects of the current study. Follow-up was available for 95% of the patients, giving a total of 270 women-years of follow-up. Nine of the 43 patients developed a local recurrence, 8 of which occurred in patients with serous tumors. Five of these 9 patients underwent ovarian cystectomy only at the time of recurrence, and all were without evidence of disease at a mean follow-up of 75 months (range, 25-93 months). Nineteen patients delivered a total of 25 healthy children after diagnosis of a borderline ovarian tumor; 7 of these patients were treated with in vitro fertilization (IVF) after diagnosis. Four of these patients developed a recurrence, 2 patients before the IVF treatment and 2 patients after the IVF treatment. The latter 2 patients were without evidence of disease at the time of last follow-up (15 months and 26 months, respectively, after the recurrence). Beiner et al concluded that the results of the study suggest that ovulation induction may be considered after the diagnosis of a borderline ovarian tumor. The 2 recurrences in 7 patients were histologically borderline.
Comment by David M. Gershenson, MD
Borderline ovarian tumors constitute approximately 10-15% of all epithelial ovarian cancers. The average age of patients with borderline tumors is significantly younger than that of patients with invasive ovarian tumors. Therefore, many of these patients are diagnosed during their reproductive years and desire future childbearing. Several studies have documented the relative safety of conservative or fertility-sparing surgery for these patients; typically, either ovarian cystectomy or unilateral salpingo-oophorectomy is acceptable surgical treatment for young patients with borderline tumors confined to the ovary when combined with surgical staging. However, there appears to be a higher risk of infertility in this population compared to the general population, and infertility persisting after diagnosis of a borderline tumor may prompt the use of ovulation induction agents in a subset of these women. The present study findings indicate that ovulation induction after a diagnosis of borderline ovarian tumor is relatively safe, but Beiner et al are correct in emphasizing that "larger clinical trials with longer follow-up are needed." The results of previously reported epidemiological studies are conflicting: some indicate an increased risk of borderline ovarian tumor after ovulation induction, and others do not. Currently, with equivocal available data, women with a history of borderline ovarian tumors who are contemplating the use of ovulation induction agents should be counseled appropriately about the potential risk of recurrence.