Christine Rousset-Jablonski1, Fréderic Selle2, Elodie Adda-Herzog3, François Planchamp4, Lise Selleret5, Christophe Pomel6, Nathalie Chabbert-Buffet5, Emile Daraï5, Patricia Pautier7, Florence Trémollières8, Frederic Guyon4, Roman Rouzier9, Valérie Laurence9, Nicolas Chopin10, Cécile Faure-Conter10, Enrica Bentivegna7, Marie-Cécile Vacher-Lavenu11, Catherine Lhomme7, Anne Floquet4, Isabelle Treilleux10, Fabrice Lecuru12, Sébastien Gouy7, Elsa Kalbacher13, Catherine Genestie7, Thibault de la Motte Rouge14, Gwenael Ferron15, Mojgan Devouassoux-Shisheboran16, Jean-Emmanuel Kurtz17, Moise Namer18, Florence Joly19, Eric Pujade-Lauraine20, Michael Grynberg21, Denis Querleu4, Philippe Morice7, Anne Gompel11, Isabelle Ray-Coquard10. 1. Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France; Hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du grand-Revoyet, 69495 Pierre-Bénite cedex, France. Electronic address: christine.rousset-jablonski@lyon.unicancer.fr. 2. Groupe hospitalier Diaconesses Croix-Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France. 3. Hôpital Foch, service de gynécologie-obstétrique, 40, rue Worth, 92151 Suresnes, France. 4. Institut Bergonié, 229, Cours-de-l'Argonne, 33000 Bordeaux, France. 5. Hôpital Tenon, service de gynécologie-obstétrique et médecine de la reproduction, 4, rue de la Chine, 75020 Paris, France. 6. Centre Jean-Perrin, 58, rue Montalembert BP, 392, 63011 Clermont-Ferrand cedex 1, France. 7. Institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France. 8. Hôpital Paule-de-Viguier, centre de ménopause et de dépistage de l'ostéoporose, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France. 9. Institut Curie, 26, rue d'Ulm, 75005 Paris, France. 10. Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France. 11. Hôpital Cochin-Port Royal, 53, avenue de l'Observatoire, 75014 Paris, France. 12. Hôpital Européen Geroges-Pompidou, 20, rue Leblanc, 75015 Paris, France. 13. CHU Besançon-Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France. 14. Centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France. 15. CLCC, institut Claudius-Regaud, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France. 16. Hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du grand-Revoyet, 69495 Pierre-Bénite cedex, France. 17. CHU de Strasbourg, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France. 18. Recommandations pour la pratique clinique, Nice-Saint-Paul, 06000 Nice, France. 19. Centre François-Baclesse, 3, avenue du Général-Harris, 14076 Caen cedex 5, France. 20. CHU Paris Centre, hôpital Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75004 Paris, France. 21. Hôpital Jean-Verdier, avenue du 14 juillet, 93140 Bondy, France.
Abstract
INTRODUCTION: Rare ovarian tumors include complex borderline ovarian tumors, sex-cord tumors, germ cell tumors, and rare epithelial tumors. Indications and modalities of fertility preservation, infertility management and contraindications for hormonal contraception or menopause hormone therapy are frequent issues in clinical practice. A panel of experts from the French national network dedicated to rare gynaecological cancers, and of experts in reproductive medicine and gynaecology have worked on guidelines about fertility preservation, contraception and menopause hormone therapy in women treated for ovarian rare tumors. METHODS: A panel of 39 experts from different specialties contributed to the preparation of the guidelines, following the DELPHI method (formal consensus method). Statements were drafted after a systematic literature review, and then rated through two successive rounds. RESULTS: Thirty-five recommendations were selected, and concerned indications for fertility preservation, contraindications for ovarian stimulation (in the context of fertility preservation or for infertility management), contraceptive options (especially hormonal ones), and menopause hormone therapy for each tumor type. Overall, prudence has been recommended in the case of potentially hormone-sensitive tumors such as sex cord tumors, serous and endometrioid low-grade adenocarcinomas, as well as for high-risk serous borderline ovarian tumors. DISCUSSION: In the context of a scarce literature, a formal consensus method allowed the elaboration of guidelines, which will help clinicians in the management of these patients.
INTRODUCTION: Rare ovarian tumors include complex borderline ovarian tumors, sex-cord tumors, germ cell tumors, and rare epithelial tumors. Indications and modalities of fertility preservation, infertility management and contraindications for hormonal contraception or menopause hormone therapy are frequent issues in clinical practice. A panel of experts from the French national network dedicated to rare gynaecological cancers, and of experts in reproductive medicine and gynaecology have worked on guidelines about fertility preservation, contraception and menopause hormone therapy in women treated for ovarian rare tumors. METHODS: A panel of 39 experts from different specialties contributed to the preparation of the guidelines, following the DELPHI method (formal consensus method). Statements were drafted after a systematic literature review, and then rated through two successive rounds. RESULTS: Thirty-five recommendations were selected, and concerned indications for fertility preservation, contraindications for ovarian stimulation (in the context of fertility preservation or for infertility management), contraceptive options (especially hormonal ones), and menopause hormone therapy for each tumor type. Overall, prudence has been recommended in the case of potentially hormone-sensitive tumors such as sex cord tumors, serous and endometrioid low-grade adenocarcinomas, as well as for high-risk serous borderline ovarian tumors. DISCUSSION: In the context of a scarce literature, a formal consensus method allowed the elaboration of guidelines, which will help clinicians in the management of these patients.