Association between the location of transposed ovary and ovarian dose in patients with cervical cancer treated with postoperative pelvic radiotherapy

Abstract

Background and purposeHow to protect the ovarian function during radiotherapy is uncertain. The purpose of this study was to explore the association between the location of the transposed ovary and the ovarian dose in patients with cervical cancer received radical hysterectomy, ovarian transposition, and postoperative pelvic radiotherapy.MethodsA retrospective analysis was conducted of 150 young patients with cervical cancer who received radical hysterectomy, intraoperative ovarian transposition, and postoperative adjuvant radiotherapy in Zhejiang Cancer Hospital. Association between location of the transposed ovaries and ovarian dose was evaluated. The transposed position of ovaries with a satisfactory dose was explored using a receiver operator characteristic curve (ROC) analysis. Patients’ ovarian function was followed up 3 months and 1 year after radiotherapy.ResultsA total of 32/214 (15%) transposed ovaries were higher than the upper boundary of the planning target volume (PTV). The optimum cutoff value of > 1.12 cm above the iliac crest plane was significantly associated with ovaries above the upper PTV boundary. When the ovaries were below the upper boundary of PTV, the optimum cutoff value of transverse distance > 3.265 cm between the ovary and PTV was significantly associated with ovarian max dose (Dmax) ≤ 4Gy, and the optimum cutoff value of transverse distance > 2.391 cm was significantly associated with ovarian Dmax≤5Gy. A total of 77 patients had received complete follow-up, and 56 patients (72.7%) showed preserved ovarian function 1 year after radiotherapy, which was significantly increased compared with 3 months (44.2%) after radiotherapy.ConclusionsThe location of transposed ovaries in patients with cervical cancer is significantly correlated with ovarian dose in adjuvant radiotherapy. We recommend transposition of ovaries > 1.12 cm higher than the iliac crest plane to obtain ovarian location above PTV. When the transposed ovary is below the upper boundary of PTV, ovarian Dmax ≤4Gy may be obtained when the transverse distance between the ovary and PTV was > 3.265 cm, and the ovarian Dmax≤5Gy may be obtained when the transverse distance was > 2.391 cm.

Significance of ovarian transposition in the preservation of ovarian function for young cervical cancer patients undergoing postoperative volumetric modulated radiotherapy

“…Over the past 30 years, ovarian insufficiency after OT has varied from 33% to 100% in different comparisons (20). Consistent with the previous study results (20), our current study found that 68.8% (22/32) of OT patients retained ovarian function almost 1 year after radiation therapy, which is slightly higher than the results (41/105, 39.0%) of Yin et al (14), but slightly lower than the results (56/77, 72.7%) of Lv et al (15). No ovarian metastasis or recurrence was observed in any of the 51 cases.…”

“…For example, Pahisa et al (23) and Han et al (12) investigated the application of OT in patients with cervical cancer undergoing radiation therapy (4 fields, whole pelvis radiation) and found no cases of ovarian metastasis. Yin et al and Lv et al (14,15) also reported no ovarian metastasis in any OT cases during the follow-up period after postoperative IMRT radiation. Soda et al noted that the actual rate of these OT ovarian recurrences is rare after patients undergo postoperative radiation (24).…”

“…This method, which is performed either by laparotomy or laparoscopy, has been widely used with the transposed ovary standard of "4 cm outside the radiation target, or at least 1.5 cm above the iliac crest" (10,12,13). However, these recommendations were designed with reference to the results of 2D box-technique irradiation (10,12,13) or intensitymodulated radiotherapy (IMRT) (14,15). Recent studies have reported that volumetric modulated arc therapy (VMAT), a special kind of IMRT, is superior to the usual irradiation due to its potential to reduce the dose of radiation delivered to the ovaries (16).…”

Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers

“…25 Transposition 1.1-1.5cm above the iliac crest is associated with increased likelihood of normal ovarian function after EBRT. 26,27 Ongoing clinical studies…”

A challenge of fertility preservation in the setting of cervical cancer - a clinical case

“…Транспозиция яичников представляет собой хирургическое изменение положения яичников таким образом, чтобы они находились вне поля облучения во время лучевой терапии. Впервые данная операция была предложена в 1958 г. именно для больных раком шейки матки перед планируемой лучевой терапией [11]. Для осуществления транспозиции пересекается собственная связка яичника (почти всегда еще и маточная труба), после чего яичник на сосудисто-нервной ножке, находящейся в воронко-тазовой связке, фиксируется в латеральном канале брюшной полости, перед большой поясничной мышцей, или высоко спереди и латерально [12].…”