Impact of ovarian transposition before pelvic irradiation on ovarian function among long‐term survivors of childhood Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort Study

Fernández-Pineda, Israel; Davidoff, Andrew M.; Lu, Lu; Rao, Bhaskar N.; Wilson, Carmen L.; Srivastava, Deo Kumar; Klosky, James L.; Metzger, M; Krasin, Matthew J.; Ness, Kirsten K.; Pui, Ching‐Hon; Robison, Leslie L.; Hudson, Melissa M.; Sklar, Charles A.; Green, Daniel M.; Chemaitilly, Wassim

doi:10.1002/pbc.27232

Cited by 26 publications

(25 citation statements)

References 24 publications

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“…Some studies have shown that oophoropexy can preserve ovarian function despite large-volume IDRT (34)(35)(36). However, in other publications, premature menopause could not be prevented by ovarian transposition (37,38). One reason for this was possibly the scattered radiation, which in the case of paraaortic RT probably resulted in a relevant dose exposure to the ovaries despite oophoropexy.…”

Section: Discussionmentioning

confidence: 99%

Involved Site Radiotherapy Extends Time to Premature Menopause in Infra-Diaphragmatic Female Hodgkin Lymphoma Patients – An Analysis of GHSG HD14- and HD17-Patients

et al. 2021

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IntroductionConsolidation radiotherapy in intermediate stage Hodgkin´s lymphoma (HL) has been the standard of care for many years as involved field radiotherapy (IFRT) after chemotherapy. It included initially involved region(s). Based on randomized studies, radiation volumes could be reduced and involved site radiation therapy (ISRT) became the new standard. ISRT includes the initially affected lymph nodes. In young adults suffering from HL, infertility and hypogonadism are major concerns. With regard to these questions, we analyzed the influence of modern radiotherapy concepts such as consolidating ISRT in infradiaphragmatic involvement of HL after polychemotherapy.Patients and MethodsFive hundred twelve patients treated within German Hodgkin Study Group (GHSG) HD14 and HD17 trials were evaluated. We analyzed log-adjusted follicle-stimulating-hormone (FSH)- and luteinizing-hormone (LH)-levels of HD14-patients with infradiaphragmatic radiotherapy (IDRT) in comparison with HD14-patients, who had a supradiaphragmatic radiotherapy (SDRT). In a second step, we compared IFRT with ISRT of female HD17 patients regarding the effects on ovarian function and premature menopause.ResultsWe analyzed FSH- and LH-levels of 258 female and 241 male patients, all treated with IFRT. Of these 499 patients, 478 patients had SDRT and 21 patients had IDRT. In a multiple regression model, we could show that log-adjusted FSH (p=0.0006) and LH values (p=0.0127) were significantly higher after IDRT than after SDRT. The effect of IDRT on gonadal function was comparable to two cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc). We compared the effect of IFRT with ISRT in thirteen female HD17 patients with infradiaphragmatic (ID) involvement. The mean ovarian dose after ISRT was significantly lower than after IFRT. The calculated proportion of surviving non-growing follicles (NGFs) increased significantly from 11.87% to 24.48% in ISRT compared to IFRT, resulting in a significantly longer calculated time to menopause. The younger the age at therapy, the greater the absolute time gain until menopause.ConclusionInfradiaphragmatic IFRT impairs gonadal function to a similar extent as two cycles of BEACOPPesc. In comparison, the use of ISRT target volume definition significantly reduced radiation dose to the ovaries and significantly extends the time interval from treatment to premature menopause.

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Section: Discussionmentioning

confidence: 99%

Involved Site Radiotherapy Extends Time to Premature Menopause in Infra-Diaphragmatic Female Hodgkin Lymphoma Patients – An Analysis of GHSG HD14- and HD17-Patients

et al. 2021

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“…Three of these six patients showed regular menses after cancer treatment [14]. Furthermore, the effect of OT on ovarian preservation was reviewed in 49 longterm survivors of childhood Hodgkin lymphoma (HL) that underwent OT before radiotherapy and compared to 41 HL patients without OT [15]. The median age at OT was 15 years (range: 4-24 years), and the median age at evaluation was 38 years (range: 25-60 years).…”

Section: A Matter Of Agementioning

confidence: 99%

Ovarian transposition

Reiser

Böttcher

Minasch

et al. 2020

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Summary Cytotoxic chemotherapy regimens and radiotherapy can lead to acute ovarian failure, premature ovarian insufficiency and menopause. Fertility preservation options before radiotherapy include ovarian transposition, where one or both ovaries are placed outside the radiation field. However, the efficacy of ovarian transposition is questioned, as the conservation of ovarian function varies between 17 and 95% in the literature.

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“…6 However, in patients who received pelvic RT for Hodgkin's lymphoma, ovarian transposition did not seem to modify the risk of ovarian insufficiency and further studies are required to assess the long-term benefit of transposition. 35…”

Section: Evidencementioning

confidence: 99%

Local treatment of rhabdomyosarcoma of the female genital tract: Expert consensus from the Children’s Oncology Group (COG), European Soft Tissue Sarcoma Group (EpSSG), and the Cooperative Weichteilsarkom Studiengruppe (CWS)

Lautz

Martelli

Fuchs

et al. 2020

Preprint

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Background The International Soft Tissue Sarcoma Consortium (INSTRuCT) was founded as an international collaboration between different pediatric soft tissue sarcoma cooperative groups (COG, EpSSG, CWS). Besides other tasks, a major goal of the INSTRuCT is to develop consensus expert opinions for best clinical treatment. This consensus paper for patients with rhabdomyosarcoma of the female genital tract (FGU-RMS) provides treatment recommendations for local treatment, long term follow up and fertility preservation. Methods Review of the current literature was combined with recommendations of the treatment protocols of the appropriate clinical trials. Additionally, opinions of international FGU-RMS experts were incorporated into recommendations. Results The prognosis of FGU-RMS is favorable with an excellent response to chemotherapy. Initial complete surgical resection is not indicated, but diagnosis should be established properly. In patients with tumors localized at the vagina or cervix demonstrating incomplete response after induction chemotherapy, local radiotherapy (brachytherapy) should be carried out. In patients with persistent tumors at the corpus uteri, hysterectomy should be performed. Fertility preservation should be considered in all patients. Conclusion For the first time, an international consensus for the treatment of FGU-RMS patients could be achieved, which will help to harmonize the treatment in different study groups.

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Impact of ovarian transposition before pelvic irradiation on ovarian function among long‐term survivors of childhood Hodgkin lymphoma: A report from the St. Jude Lifetime Cohort Study

Cited by 26 publications

References 24 publications

Involved Site Radiotherapy Extends Time to Premature Menopause in Infra-Diaphragmatic Female Hodgkin Lymphoma Patients – An Analysis of GHSG HD14- and HD17-Patients

Involved Site Radiotherapy Extends Time to Premature Menopause in Infra-Diaphragmatic Female Hodgkin Lymphoma Patients – An Analysis of GHSG HD14- and HD17-Patients

Ovarian transposition

Local treatment of rhabdomyosarcoma of the female genital tract: Expert consensus from the Children’s Oncology Group (COG), European Soft Tissue Sarcoma Group (EpSSG), and the Cooperative Weichteilsarkom Studiengruppe (CWS)

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