[Adjuvant therapy of malignant ovarian tumors after organ preserving surgery]

During the last years it has become more evident that performing operations with preservation of fertility in young women with malignant ovarian tumors is not associated with higher risks when regarding certain conditions. Basic aspects are the histogenetic origin and tumor spread reflecting the malignant potential of the tumor. Considering the different biological behavior of invasive epithelial carcinomas and malignant germ cell tumors is mandatory. The latter tumors can be cured by effective chemotherapeutic regimen as i.e. VBP or BEP, which should be administered as an adjuvant therapy for all ovarian germ cell malignancies except in cases of pure dysgerminoma or malignant teratoma (Grade 1) Stage Ia. Well differentiated (G1) invasive epithelial carcinomas in Stage Ia do not require adjuvant treatment, too, whereas platinum-based chemotherapy should be administered in patients with poorly differentiated tumors (G3) or in Stage Ic. Fertility sparing operations in patients with more advanced epithelial ovarian cancers should be restricted to single cases. Based upon current results the prognosis of ovarian tumors with low-malignant potential (Borderline-Tumors) seems not to be improved by adjuvant therapy.