Preserving Fertility Does Not Decrease

Survival In Epithelial Ovarian Cancer

SAN DIEGO, CA -- February 9, 2000 -- A study released at the Society of Gynecologic Oncologists annual meeting challenges the traditional management of ovarian cancer in young women by suggesting that conservative surgery (which often allows future childbearing) does not decrease survival rates. The objective of this research was to determine the role and safety of fertility-sparing surgery in early stage invasive epithelial ovarian cancer (EOC). The study was conducted by Carol L. Brown M.D.; Bhaskaran Dharmendra M.D.; and Richard R. Barakat M.D. of the Gynecology Service, Department of Surgery, at Memorial Sloan-Kettering Cancer Center in New York.

"The standard management of early ovarian cancer includes hysterectomy and complete removal of the fallopian tubes and ovaries (TAH/BSO), abruptly causing menopause and leaving no options for future childbearing," said the study's lead author, Carol L. Brown, M.D. "By using conservative surgery that preserves functioning ovarian tissue and the uterus, we found survival rates comparable to the standard surgery of TAH/BSO in this study."

Study subjects came from a retrospective review of 127 Memorial Sloan-Kettering patients who underwent surgery for stage I epithelial ovarian cancer between November 1982 and June 1999. Two groups of patients were identified; one group underwent conservative surgery that preserved the uterus and at least one ovary, the other group had surgery that removed the uterus and all functioning ovarian tissue. Patients in both groups had complete surgical staging for ovarian cancer that included multiple biopsies of the peritoneum, removal of the omentum, and biopsies from lymph nodes. Sixteen patients, or 57 percent of those younger than 40, had surgery that preserved the uterus and opposite ovary. Ninety-two patients, aged 28-87, had TAH/BSO. Patient characteristics, stage, grade of cancer, and tumor type were recorded, and patients in the two groups were compared with respect to recurrence of cancer and survival.

-- In the conservative surgery group, 88 percent of patients are alive with no evidence of cancer at a median of seven years after being diagnosed, compared to 77 percent of the patients having the standard TAH/BSO.

-- 12 percent of women who had ovarian preservation experienced recurrence of cancer compared to 15 percent of women who had both ovaries removed.

-- 93 percent of the conservative surgery group survivors in this study either resumed normal menstrual function or had a successful pregnancy after completing treatment, including the 30 percent who received chemotherapy after their staging surgery.

Dr. Brown and her co-authors concluded that based on their results, preserving the uterus and one ovary in selected patients with ovarian cancer after comprehensive staging is feasible, and does not decrease survival compared to patients undergoing standard surgery. In addition, conservative surgery for ovarian cancer will preserve normal hormonal function and fertility in young women with early stage disease.

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Euro J Cancer Prevention, 12/04

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