Ovarian tumors of low malignant potential(OTLMP) or borderline tumors for approximately 10%, of all ovarian neoplasms. Borderline tumors have some but not all of the histologic characteristics of malignancy: stratification of epithelial cells,
with
some
degree of nuclear atypia increased mitotic actitity but without stromal invasion. We reviewed 20 published English―written articles from 1978 to 1992 and Korean gynecologic cancer registry of 1990. In this review, we tried to concentrate on
several
debating issues in OTLMP: 1) What kind of surgery is needed of each stages?, 2) Is postoperative adjuvant therapy needed?, 3) If needed, which type?
Following results were obtained from the basis of 1516 patients with OTLMP. Patients with OTLMP are younger than with invasive ovarian cancers: age was in their forties. The majority of patients(74.5%) had stage I disease, and the incidence
dropped
abruptly to 9.4% for stage Ⅱ, 15.7% for stage Ⅲ and 0.4% for stage Ⅳ. The most common histologic subtype was serous(56.7%), followed by mucinous(38.1%). However interestingly in Korea and Japan, the mucinous type was the most common one.
The primary treatment for OTLMP was surgery, and the conservative surgery to preserve fertility in young women was sufficient for stage I disease with careful follow―up. The majority of patients(79.1%) with stage I disease were treated by
surgery
alone. Adjuvant such as chemotherapy (CT) and/or radiotherapy(RT) could prolong the recurrence of disease a little later, but failed to increase diaease―free survival significantly in stage I disease. In stageⅡ disease, the surgery should be a
total
abdominal hysterectomy and bilateral salpingo―oophorectomy with multiple sampling of the peritoneal cavity. About a third of patients with stageⅡ disease received no adjuvant therapy and the others received CT and/or RT, however, there was no
difference in outcome of recurrence and survival. In advanced stage. 15% of patients received no adjuvant therapy after initial debulking surgery, and the rest of patients received CT and/or RT. No differences in recurrence and survival between
each
groups were noticed , too.
The status of second―look laparotomy(SLL) did not depend on the stage of the disease. Positive rate of SLL for stage I diaease was not statistically different from that for the combined stages Ⅱ―Ⅳ. Survival for stage I at 5 years was reported
to
range from 80 to 100%, and even stage Ⅲ had survival ranging from 64 to 96%. Long―term survival at 15∼20 years was also good.
Although it is quite difficult to make conclusions because of the lack of prospective randomized studies from this review, it appears clear that surgical removal of the tumor and careful follow―up of patients are all that are necessary in stage
I
disease and further multi―center prospective study for the effect of adjuvant therapy in advanced disease is definitely needed.
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