Fertility-sparing treatment for epithelial ovarian cancer: a literature review

Epithelial ovarian cancer is more common in postmenopausal women, with a mean age at diagnosis of 65 years; however, it has been documented that 3% to 17% of epithelial ovarian cancer cases are diagnosed in women younger than 40 years, with an overall survival of up to 90% when diagnosed in early-stage disease. The development of fertility-sparing approaches represents one of the most significant advances in the gynecologic oncology field. These approaches can have satisfactory outcomes on fertility with excellent oncological results in premenopausal women with early-stage epithelial ovarian cancer and the desire to preserve fertility. Because of the low occurrence of this specific population, randomized trials have not been performed. However, several retrospective series suggest that in certain cases, fertility-sparing surgery is safe, with low rates of recurrence and favorable reproductive outcomes in accordance to the new techniques in reproductive biology; therefore, fertility-sparing approaches must be discussed with young female patients with epithelial ovarian cancer or in patients that desire to preserve fertility or to maintain ovarian function and to improve quality of life in this particular group of individuals. In this review, we present the published evidence, including oncologic and reproductive results, as well as fertility-sparing surgical options, in the field in the last 10 years.