Skip to main content
SpringerLink
Log in

Fertility preservation treatment of gynecological cancer patients in Spain: a national survey (GOFER study)

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To analyze the current management and use of fertility preservation (FP) treatments among different gynecologic oncology centers in Spain

Methods

From March to April 2019, a transversal study was conducted using a national online survey to consultants registered in the section of Gynecologic Oncology of the Spanish Society of Obstetrics and Gynecology. The survey contained 30 questions that assessed the perceptions and attitudes towards fertility-sparing strategies as well as its management in each participating center.

Results

A total of 51 responders from 12 out of 17 geographical regions of Spain answered the survey. According to 35 responders (68.63%), the age limit for offering FP was 40 years. In most of the centers, an ovarian reserve study is carried out prior to a FP procedure (34 responders, 66.67%). In cervical cancer size, limit for offering trachelectomy is 2 cm (40 responders, 78.43%), with LVSI as an exclusion factor for 26 (51%). Twenty-four (48.98%) responders reported that FP only in ovarian cancer stages IA, 12 (24.49%) also in stages IB, and an additional 13 (26.53%) up to stages IC. Most responders perform FP only in the absence of myometrial infiltration (30, 58.82%) in patients with g1–g2 endometrial cancer.

Conclusions

The performance of professionals at the national level is uneven, demonstrating the need for referral centers to ensure optimal management. International guidelines should be more widely extended throughout Spain to homogenize the treatment of young oncology patients who wish to have children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ayhan A, Reed N, Gultekin M, Dursun P (eds) (2017) Textbook of gynaecological oncology, 4th edn. ESGO (European Society of Gynaecological Oncology).

  2. Cancer Statistics Review. 1975–2015—SEER Statistics. https://seer.cancer.gov/archive/csr/1975_2015/. Accessed Sept 2019

  3. Bentivegna E, Gouy S, Maulard A, Chargari C, Leary A, Morice P (2016) Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review. Lancet Oncol 17(6):e240–e253

    Article  PubMed  Google Scholar 

  4. Zapardiel I, Diestro MD, Aletti G (2014) Conservative treatment of early stage ovarian cancer: oncological and fertility outcomes. Eur J Surg Oncol 40(4):387–393

    Article  CAS  PubMed  Google Scholar 

  5. Simpson AN, Feigenberg T, Clarke BA, Gien LT, Ismiil N, Laframboise S et al (2014) Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin. Gynecol Oncol 133(2):229–233

    Article  CAS  PubMed  Google Scholar 

  6. Robova H, Halaska MJ, Pluta M, Skapa P, Matecha J, Lisy J et al (2014) Oncological and pregnancy outcomes after high-dose density neoadjuvant chemotherapy and fertility-sparing surgery in cervical cancer. Gynecol Oncol 135(2):213–216

    Article  PubMed  Google Scholar 

  7. Instituto Nacional de Estadística. https://www.ine.es/dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736177007&menu=resultados&idp=1254735573002. Accessed Sept 2019

  8. Oncoguía SEGO (2018) Cáncer de cuello uterino. Guías de práctica clínica en cáncer ginecológico y mamario. Publicaciones SEGO

  9. Cibula D, Pötter R, Planchamp F, Avall-Lundqvist E, Fischerova D, Haie Meder C et al (2018) The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Int J Gynecol Cancer 28(4):641–655

    Article  PubMed  Google Scholar 

  10. Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R et al (2018) Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379(20):1895–1904

    Article  PubMed  Google Scholar 

  11. Willows K, Lennox G, Covens A (2016) Fertility-sparing management in cervical cancer: balancing oncologic outcomes with reproductive success. Gynecol Oncol Res Pract 3(1):9

    Article  PubMed  PubMed Central  Google Scholar 

  12. Helpman L, Grisaru D, Covens A (2011) Early adenocarcinoma of the cervix: Is radical vaginal trachelectomy safe? Gynecol Oncol 123(1):95–98

    Article  CAS  PubMed  Google Scholar 

  13. Zusterzeel PLM, Pol FJM, van Ham M, Zweemer RP, Bekkers RLM, Massuger LFAG et al (2016) Vaginal radical trachelectomy for early-stage cervical cancer: increased recurrence risk for adenocarcinoma. Int J Gynecol Cancer 26(7):1293–1299

    Article  PubMed  Google Scholar 

  14. Agarwal S, Schmeler KM, Ramirez PT, Sun CC, Nick A, Dos Reis R et al (2011) Outcomes of patients undergoing radical hysterectomy for cervical cancer of high-risk histological subtypes. Int J Gynecol Cancer 21(1):123–127

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ditto A, Martinelli F, Lorusso D, Haeusler E, Carcangiu M, Raspagliesi F (2014) Fertility sparing surgery in early stage epithelial ovarian cancer. J Gynecol Oncol 25(4):320

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Thomakos N, Malakasis A, Machairiotis N, Zarogoulidis P, Rodolakis A (2018) Fertility sparing management in non-epithelial ovarian cancer. Which patients, what procedure and what outcome? J Cancer 9(24):4659–4664

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gershenson DM (2017) Management of borderline ovarian tumours. Best Pract Res Clin Obstet Gynaecol 41:49–59

    Article  PubMed  Google Scholar 

  18. Bentivegna E, Gouy S, Maulard A, Pautier P, Leary A, Colombo N et al (2016) Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues. Ann Oncol 27(11):1994–2004

    Article  CAS  PubMed  Google Scholar 

  19. Uzan C, Courbiere B, Chabbert-Buffet N (2019) Tumeurs épithéliales de l’ovaire : préservation de la fertilité. Article rédigé sur la base de la recommandation nationale de bonnes pratiques cliniques en cancérologie intitulée « Conduites à tenir initiales devant des patientes atteintes d’un cancer épithélial de l’ovaire » élaborée par FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY sous l’égide du CNGOF et labellisée par l’INCa. Gynécol Obs Fertil Sénol 47(2):180–186

    Article  CAS  Google Scholar 

  20. Kajiyama H, Shibata K, Mizuno M, Hosono S, Kawai M, Nagasaka T et al (2011) Fertility-sparing surgery in patients with clear-cell carcinoma of the ovary: is it possible? Hum Reprod 26(12):3297–3302

    Article  PubMed  Google Scholar 

  21. Park J-Y, Suh D-S, Kim J-H, Kim Y-M, Kim Y-T, Nam J-H (2016) Outcomes of fertility-sparing surgery among young women with FIGO stage I clear cell carcinoma of the ovary. Int J Gynaecol Obstet 134(1):49–52

    Article  PubMed  Google Scholar 

  22. Chiva L, Lapuente F, González-Cortijo L, Carballo N, García JF, Rojo A et al (2008) Sparing fertility in young patients with endometrial cancer. Gynecol Oncol 111(2):S101–S104

    Article  PubMed  Google Scholar 

  23. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J et al (2016) ESMO-ESGO-ESTRO consensus conference on endometrial cancer. Int J Gynecol Cancer 26(1):2–30

    Article  PubMed  Google Scholar 

  24. Koskas M, Uzan J, Luton D, Rouzier R, Daraï E (2014) Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertil Steril 101(3):785.e3–794.e3

    Article  Google Scholar 

  25. Kesic V, Rodolakis A, Denschlag D, Schneider A, Morice P, Amant F et al (2010) Fertility preserving management in gynecologic cancer patients: the need for centralization. Int J Gynecol Cancer 20(9):1613–1619

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gynecologic Oncology Unit, Donostia University Hospital, San Sebastián, Spain

    Mikel Gorostidi

  2. Gynecologic Oncology Unit, Hospital Clinic, Barcelona, Spain

    Blanca Gil-Ibañez & Aureli Torné

  3. Gynecologic Oncology Unit, MD Anderson Cancer Center International, Madrid, Spain

    Sonsoles Alonso

  4. Gynecologic Oncology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Antonio Gil-Moreno

  5. Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Madrid, Spain

    Antonio Gil-Moreno

  6. Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain

    Alicia Hernandez & Ignacio Zapardiel

Authors
  1. Mikel Gorostidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Blanca Gil-Ibañez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sonsoles Alonso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Gil-Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alicia Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aureli Torné
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ignacio Zapardiel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MG: review of the literature, data collection, data analysis and interpretation, manuscript preparation, and approval of the final draft. AT, AG-M: data analysis and interpretation, manuscript preparation, and approval of the final draft. SA and AH: manuscript preparation and approval of the final draft. BG-I and IZ: conception and design of the study, data interpretation, review of the literature, critical review, and approval of the final draft.

Corresponding author

Correspondence to Blanca Gil-Ibañez.

Ethics declarations

Conflict of interest

The authors have neither commercial, proprietary, not financial interests in the products and companies described in this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gorostidi, M., Gil-Ibañez, B., Alonso, S. et al. Fertility preservation treatment of gynecological cancer patients in Spain: a national survey (GOFER study). Arch Gynecol Obstet 301, 793–800 (2020). https://doi.org/10.1007/s00404-020-05468-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05468-8

Keywords

Search

Navigation