Outcomes

Recurrence

The median time to recurrence is 5 to 7 years for borderline tumors, but late recurrences decades later are also reported. Recurrence can be either a borderline or an invasive epithelial cancer; it is not surprising that invasive recurrences are more likely to result in death.6,15,16,38 Traditional management of recurrent tumors is secondary cytoreduction with or without postoperative chemotherapy. One of the largest studies on recurrent ovarian borderline tumors was reported by Crispens and associates15 from the M.D. Anderson experience and showed a 5.6-year median time to recurrence and a further 7.7-year median survival after recurrence. In this study, most women underwent secondary surgery, and optimal cytoreduction was a significant predictor of survival. For all nonsurgical interventions (chemotherapy, hormonal therapy, and radiation therapy), the response rate was only 26%, and 50% of those responses occurred after platinum-based chemotherapy. Similarly, 50% of the patients had stable disease to the nonsurgical options, and again, in order of decreasing efficacy, the therapies were platinum-based chemotherapy (11 of 21 patients), hormonal therapy (8 of 21), other chemotherapy (6 of 21) and radiation therapy (3 of 21). The median duration of stable disease was 12 months.

In summation, women with recurrent borderline tumor should initially be managed surgically (if feasible), and adjuvant treatment may be offered including platinum-based chemotherapy or hormonal treatment.

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