Rousset-Jablonski Christine, Selle Fréderic, Adda-Herzog Elodie, Planchamp François, Selleret Lise, Pomel Christophe, Chabbert-Buffet Nathalie, Daraï Emile, Pautier Patricia, Trémollières Florence, Guyon Frederic, Rouzier Roman, Laurence Valérie, Chopin Nicolas, Faure-Conter Cécile, Bentivegna Enrica, Vacher-Lavenu Marie-Cécile, Lhomme Catherine, Floquet Anne, Treilleux Isabelle, Lecuru Fabrice, Gouy Sébastien, Kalbacher Elsa, Genestie Catherine, de la Motte Rouge Thibault, Ferron Gwenael, Devouassoux-Shisheboran Mojgan, Kurtz Jean-Emmanuel, Namer Moise, Joly Florence, Pujade-Lauraine Eric, Grynberg Michael, Querleu Denis, Morice Philippe, Gompel Anne, Ray-Coquard Isabelle
Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France; Hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du grand-Revoyet, 69495 Pierre-Bénite cedex, France.
Groupe hospitalier Diaconesses Croix-Saint-Simon, 12-18, rue du Sergent-Bauchat, 75012 Paris, France.
Bull Cancer. 2018 Mar;105(3):299-314. doi: 10.1016/j.bulcan.2017.10.032.
Rare ovarian tumors include complex borderline ovarian tumors, sex-cord tumors, germ cell tumors, and rare epithelial tumors. Indications and modalities of fertility preservation, infertility management and 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 of experts in reproductive medicine and gynaecology have worked on guidelines about fertility preservation, contraception and menopause hormone therapy in women treated for ovarian rare tumors.
A panel of 39 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.
Thirty-five recommendations were selected, and concerned indications for fertility preservation, contraindications for ovarian stimulation (in the context of fertility preservation or for infertility management), contraceptive options (especially hormonal ones), and menopause hormone therapy for each tumor type. Overall, prudence has been recommended in the case of potentially hormone-sensitive tumors such as sex cord tumors, serous and endometrioid low-grade adenocarcinomas, as well as for high-risk serous borderline ovarian tumors.
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.
罕见卵巢肿瘤包括复杂交界性卵巢肿瘤、性索肿瘤、生殖细胞肿瘤和罕见上皮性肿瘤。生育力保存的指征和方式、不孕症管理以及激素避孕或绝经激素治疗的禁忌证是临床实践中常见的问题。来自法国国家罕见妇科癌症网络的一组专家以及生殖医学和妇科专家共同制定了关于卵巢罕见肿瘤患者生育力保存、避孕和绝经激素治疗的指南。
一个由39名不同专业的专家组成的小组采用德尔菲法（正式共识方法）参与了指南的制定。在系统的文献综述后起草声明，然后通过连续两轮进行评分。
共选出35条建议，涉及生育力保存的指征、卵巢刺激的禁忌证（在生育力保存或不孕症管理的背景下）、避孕选择（尤其是激素避孕）以及每种肿瘤类型的绝经激素治疗。总体而言，对于性索肿瘤、浆液性和子宫内膜样低级别腺癌等潜在激素敏感肿瘤以及高危浆液性交界性卵巢肿瘤，建议谨慎处理。
在文献稀缺的情况下，一种正式的共识方法使得指南得以制定，这将有助于临床医生管理这些患者。
