Christine Rousset-Jablonski1, Fréderic Selle2, Elodie Adda-Herzog3, François Planchamp4, Lise Selleret5, Christophe Pomel6, Emile Daraï5, Nathalie Chabbert-Buffet5, 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, de la Motte Rouge Thibault14, Gwenael Ferron15, Mojgan Devouassoux16, Jean-Emmanuel Kurtz17, Magali Provansal18, Moise Namer19, Florence Joly20, Eric Pujade-Lauraine21, Michael Grynberg22, Denis Querleu9, Philippe Morice7, Anne Gompel23, Isabelle Ray-Coquard24. 1. Leon Berard Cancer Center, 28 Rue Laënnec, 69008, Lyon, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, 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. Bergonié Institute Cancer Center, 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. Jean Perrin Cancer Center, 58 Rue Montalembert BP 392, 63011, Clermont-Ferrand Cedex 1, France. 7. Gustave Roussy Cancer Center, 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. Curie Institute Cancer Center, 26 Rue D'Ulm, 75005, Paris, France. 10. Leon Berard Cancer Center, 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 Bd Alexandre Fleming, 25030, Besancon, cedex, France. 14. Eugene Marquis Cancer Center, Avenue de La Bataille Flandres-Dunkerque, 35000, Rennes, France. 15. Claudius Regaud Cancer Center, IUCT Oncopole, 1 Av. 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. Paoli-Calmette Institute, 232 Sainte-Marguerite Boulevard, 13009, Marseille, France. 19. Recommandations pour La Pratique Clinique, Nice-Saint-Paul, 06000, France. 20. François Baclesse Cancer Center, 3 Avenue Du Général Harris, 14076, Caen Cedex 5, France. 21. CHU Paris Centre - Hôpital Hôtel-Dieu, 1 Place Du Parvis Notre-Dame, 75004, Paris, France. 22. Hôpital Jean Verdier, Avenue Du 14 Juillet, 93140, Bondy, France. 23. Université Paris-Descartes, 12 Rue de L'école de Médecine, 75006, Paris, France. 24. Leon Berard Cancer Center, 28 Rue Laënnec, 69008, Lyon, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France; Groupe GINECO, France.
Abstract
INTRODUCTION: Rare ovarian tumours include complex borderline ovarian tumours, sex-cord tumours, germ cell tumours and rare epithelial tumours. Indications and modalities of fertility preservation (FP), infertility management, 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 experts in reproductive medicine and gynaecology have built guidelines on FP, contraception and menopause hormone therapy in women treated for ovarian rare tumours. MATERIAL AND METHODS: A panel of 35 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 identified, concerning indications for FP, contraindications for ovarian stimulation, contraceptive options and menopause hormone therapy for each tumour type. DISCUSSION: Overall, caution has been recommended in the case of potentially hormone-sensitive tumours such as sex-cord tumours, serous and endometrioid low-grade adenocarcinomas, as well as for high-risk serous borderline ovarian tumours. CONCLUSION: 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 tumours include complex borderline ovarian tumours, sex-cord tumours, germ cell tumours and rare epithelial tumours. Indications and modalities of fertility preservation (FP), infertility management, 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 experts in reproductive medicine and gynaecology have built guidelines on FP, contraception and menopause hormone therapy in women treated for ovarian rare tumours. MATERIAL AND METHODS: A panel of 35 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 identified, concerning indications for FP, contraindications for ovarian stimulation, contraceptive options and menopause hormone therapy for each tumour type. DISCUSSION: Overall, caution has been recommended in the case of potentially hormone-sensitive tumours such as sex-cord tumours, serous and endometrioid low-grade adenocarcinomas, as well as for high-risk serous borderline ovarian tumours. CONCLUSION: 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.