Borderline ovarian tumors: New insights and old challenge

Objective: Borderline ovarian tumors (BOTs) are a subset of epithielial ovanian tumors that have a very favorable prognosis. The accepted initial treatment is surgical removal of the tumor and biopsies. However, the postoperative management protocol is for from clear. To date, no medical therapy has been shown to clearly improve outcomes. Methods: Authors reviewed the most recently published articles on BOTs, from tumor biology to surgical management, and summarized the state of research in this area. Results: It is still debated in the literature if BOTs can be considered as intermediate precursors in the progression to high grade ovarian tumors. Evidences now propose that high-grade serous carcinomas are not associated with a defined precursor lesion. Currently the management of BOTs is changed with an excellent prognosis also after conservative management, by the use of minimally invasive approach. The 5-year survival rate for such patients after surgical approach is 100% and the 10-year survival rate, depending on histologic features, is about 90%-95%. Conclusions: Women with BOTs have an excellent overall prognosis; the endoscopic management of BOTs reduces complications and could increase fertility results, but, on the contrary, the postoperative treatment for any stage is controversial. Recent trials have confirmed that conservative laparoscopic management of BOT is a safe and effective therapeutic tool in experienced hands. Currently, an important area of research is postoperative chemotherapy: few advantages have been reported after postoperative chemotherapy, even if the number of patients studied is small and the chemotherapeutic regimens used were varied.