Borderline ovarian tumors (BOTs) were first described by Taylor in 1929 and have been a challenge for both pathologists and oncologists. For the group of patients with advanced stage disease, particularly those with invasive implants, there is no consensus regarding standard therapy.[1][2]
Some oncologists would agree that adjuvant treatment is warranted for these patients, based on their worse prognosis and the tendency of these tumors to recur, not only as BOT but also as a low-grad ovarian neoplasm. However, the response to platinum-based adjuvant treatment in these tumors remains mostly suboptimal. Two recent large meta-analysis one looking into a broad spectrum of BOT patients and the other focusing on BOT presenting with invasive implants at primary diagnosis, found no evidence supporting the use of adjuvant treatment in these patients.
Two recent large meta-analysis … found no evidence supporting the use of adjuvant treatment in …patients with Borderline Ovarian Tumors (BOT).
One of the studies reviewed 31 articles including 4965 patients; with the meta-analysis of the 13 studies providing separate mortality data for both treatment groups, including 2206 women, favoring surgical treatment only (OR = 7.44; 95% CI = 3.39? 16.32; p < 0.0005) albeit with moderate heterogeneity of the studies (I2 = 35.0%) but no asymmetry (Egger?s test p = 0.44). Regarding survival data, 4 studies reported no difference between groups. In the adjuvant setting, 4 reported worse outcome and 1 reported a non-significant trend to worse outcome.
Regarding the other study, including 27 articles and 3124 patients, 181 of which with invasive implants, the meta-analysis of the 6 studies providing separate mortality data for both treatment groups favored surgical treatment only, but this difference did not reach statistical significance, with Egger?s regression indicated low asymmetry of the studies (p= 5 .39), and no heterogeneity found (I2 = 0%).
For more information:
[1] Vasconcelos I, Olschewski J, Braicu I, Sehouli J. Limited efficacy of platinum-based adjuvant treatment on the outcome of borderline ovarian tumors. European Journal of Obstetrics and Gynecology (EJOG) Published Online: January 09, 2015 (scheduled in print March 2015 Volume 186, Pages 26?33) [Article]
[2] Vasconcelos I, Olschewski J, Braicu I, Sehouli J. A Meta-Analysis on the Impact of Platinum-Based Adjuvant Treatment on the Outcome of Borderline Ovarian Tumors With Invasive Implants. First Published Online January 19, 2015 doi: 10.1634/theoncologist.2014-0144. The Oncologist January 2015 theoncologist.2014-0144 [Article]
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