BACKGROUND: This is a prospective long-term extension study of a randomized controlled trial aimed to assess the risk-benefit ratio of an ultra-conservative fertility-sparing approach in patients with bilateral borderline ovarian tumours (BOTs). METHODS: The experimental group (n = 15) was treated with an ultra-conservative surgical approach consisting of bilateral cystectomy, whereas the control group (n = 17) received a less conservative surgery consisting of oophorectomy plus controlateral cystectomy alone. All patients received a complete laparoscopic staging followed by a fertility enhancement programme. Patients who completed childbearing were treated with a non-conservative standard treatment at the first recurrence. RESULTS: After a follow-up period of 128 (9 interquartile range (IQR); 115-150 range) and 132 (7 IQR; 117-152 range) months for the experimental and control groups, respectively (P = 0.25), the time to first baby-in-arm (P < 0.02) and the relative rate (RR) of baby-in-arm (8.05 [95% confidence interval (CI), 1.20-9.66; P < 0.01]) were significantly lower and higher, respectively, for the experimental compared with the control group. Although the time to first recurrence was significently (P < 0.01) shorter for the experimental group, in the regression analysis the difference did not reach the statistic significance (P = 0.14), and the RR of recurrence (1.23 [95% CI, 0.62-3.17; P = 0.41]) was not significant. Finally the number needed to treat for pregnancy was three, the number needed to harm for radical surgery was only two. CONCLUSIONS: The ultra-conservative fertility-sparing approach is more effective than the standard approach in terms of reproductive outcomes, but presents a higher oncological risk.
RCT Entities:
BACKGROUND: This is a prospective long-term extension study of a randomized controlled trial aimed to assess the risk-benefit ratio of an ultra-conservative fertility-sparing approach in patients with bilateral borderline ovarian tumours (BOTs). METHODS: The experimental group (n = 15) was treated with an ultra-conservative surgical approach consisting of bilateral cystectomy, whereas the control group (n = 17) received a less conservative surgery consisting of oophorectomy plus controlateral cystectomy alone. All patients received a complete laparoscopic staging followed by a fertility enhancement programme. Patients who completed childbearing were treated with a non-conservative standard treatment at the first recurrence. RESULTS: After a follow-up period of 128 (9 interquartile range (IQR); 115-150 range) and 132 (7 IQR; 117-152 range) months for the experimental and control groups, respectively (P = 0.25), the time to first baby-in-arm (P < 0.02) and the relative rate (RR) of baby-in-arm (8.05 [95% confidence interval (CI), 1.20-9.66; P < 0.01]) were significantly lower and higher, respectively, for the experimental compared with the control group. Although the time to first recurrence was significently (P < 0.01) shorter for the experimental group, in the regression analysis the difference did not reach the statistic significance (P = 0.14), and the RR of recurrence (1.23 [95% CI, 0.62-3.17; P = 0.41]) was not significant. Finally the number needed to treat for pregnancy was three, the number needed to harm for radical surgery was only two. CONCLUSIONS: The ultra-conservative fertility-sparing approach is more effective than the standard approach in terms of reproductive outcomes, but presents a higher oncological risk.
Authors: Sinead H McEvoy; Stephanie Nougaret; Nadeem R Abu-Rustum; Hebert Alberto Vargas; Elizabeth A Sadowski; Christine O Menias; Fuki Shitano; Shinya Fujii; Ramon E Sosa; Joanna G Escalon; Evis Sala; Yulia Lakhman Journal: Abdom Radiol (NY) Date: 2017-10
Authors: Frederico S Falcetta; Theresa A Lawrie; Lídia Rf Medeiros; Maria Ines da Rosa; Maria I Edelweiss; Airton T Stein; Alice Zelmanowicz; Anaelena B Moraes; Roselaine R Zanini; Daniela D Rosa Journal: Cochrane Database Syst Rev Date: 2016-10-13
Authors: F Trillsch; S Mahner; E Vettorazzi; L Woelber; A Reuss; K Baumann; M-D Keyver-Paik; U Canzler; K Wollschlaeger; D Forner; J Pfisterer; W Schroeder; K Muenstedt; B Richter; C Fotopoulou; B Schmalfeldt; A Burges; N Ewald-Riegler; N de Gregorio; F Hilpert; T Fehm; W Meier; P Hillemanns; L Hanker; A Hasenburg; H-G Strauss; M Hellriegel; P Wimberger; S Kommoss; F Kommoss; S Hauptmann; A du Bois Journal: Br J Cancer Date: 2015-01-06 Impact factor: 7.640