Very useful article that nicely summarises the fact that there is no standard management of this frustrating, rare diagnosis!
Some helpful recommendations that can be (should be) used to advocate for PROPER follow-up and monitoring.
There are currently no evidence based criteria for individualised
patient tailored management and equally no
unified international or UK national protocol for the
management of BOTs. Based on the current knowledge
from the literature and results of our survey of current
practice in the UK, we propose the following recommendations.
Surgical management
(1) Fertility sparing surgery is adequate for young women
with early stage disease, with subsequent completion surgery
on family completion; and
(2) Surgical staging is important
to identify the presence and type of extra-ovarian
implants, which can affect prognosis.
Histological assessment
(1) BOTs should be thoroughly sampled, at least 1 block
per centimeter;
(2) Histological reports should include
comments on the presence of micro-invasion, micropapillary
pattern, intramucosal carcinoma, presence and type
of implants and tumor stage; and
(3) Cases should be reported/reviewed
by specialist gynaecological pathologists.
Follow up
(1) Patients should be followed up for at least 5 years;
(2) Conservative surgery, high stage disease and invasive
implants warrant closer and longer term follow up;
(3)
Patients should be followed up by clinical examination
and CA 125 levels. CA19-9 and CEA levels should also
be assessed in patients with mucinous BOTs; and
(4) All women who have undergone fertility sparing should in
addition have annual pelvic ultrasound for 5 years, then
every 2-3 years until they have completion surgery.
MDT discussion
All cases should be referred to and discussed in the specialist
gynaecological oncology MDT meeting.
Management of relapsed disease or patients presenting
with advanced disease
Debulking surgery is the preferred management. Chemotherapy
may be used in the presence of progressive
invasive disease, though the activity of platinum-based
chemotherapy in this group is quite low and patients
should be considered for clinical trials. It is important to
establish the behaviour and natural history of the disease
in individuals, and a period of observation and monitoring
before introducing chemotherapy will permit selection
of those with more rapidly progressive disease, for
whom chemotherapy is more appropriate.
Survey of the management of borderline ovarian tumors in the United Kingdom
Amy Winser, Jonathan A Ledermann, Richard Osborne, Hani Gabra and Mona A El-Bahrawy.
jozi-ovari 
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