Oophoropexy: A Means of Preserving Ovarian Function Following Pelvic Megavoltage Radiotherapy for Hodgkin's Disease

Ray, Gordon R.; Trueblood, H. Ward; Enright, Lee P.; Kaplan, Henry S.; Nelsen, Thomas S.

doi:10.1148/96.1.175

Cited by 155 publications

(36 citation statements)

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“…In an analysis of multiple values including age, ovarian dose, dose per fraction and total treatment time, RAY et al (1970) found neither a threshold dose for ovarian failure nor a single predictive factor for radiation sterilization. It is generally believed, however, that ovarian failure after radiotherapy is both dose-and age-dependent, with no reliable prediction of outcome for the dose range of 3-10 Gy (CHAPMAN and SUTCLIFFE 1986).…”

Section: Irradiation Effects On Ovarian Functionmentioning

confidence: 87%

Gonadal Dysfunction After Radiotherapy

Riepl¹,

Reitz

1995

Late Sequelae in Oncology

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Section: Irradiation Effects On Ovarian Functionmentioning

confidence: 87%

Gonadal Dysfunction After Radiotherapy

Riepl¹,

Reitz

1995

Late Sequelae in Oncology

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“…This problem may be approached in 2 ways. Firstly, an operative procedure could be employed which would move the ovaries further from the treatment field, either by suturing them to the anterior or posterior surface of the uterus rather than to its fundus (Ray et al, 1970), or by displacing them laterally (Nahas et al, 1971). Secondly, it might be possible to reduce the dose of irradiation to the transposed ovary if shaped lead blocks were prepared individually for each patient to ensure maximum shielding.…”

Section: Methodsmentioning

confidence: 99%

“…The results of treatment by radiotherapy for pathologically staged (PS) nodal disease (Carbone et al, 1971) at the Royal Marsden Hospital show that approximately 80% of patients remain disease free, although more time is needed to assess the long-term prospects for these patients (Peckham et al, 1975 In an attempt to preserve ovarian function in young women receiving pelvic node irradiation, we have employed a technique of mid-line ovarian transposition (oophoropexy). The subsequent menstrual history of women who have had this procedure followed by pelvic node irradiation has been described in publications from the Stanford University Medical Center (Ray et al, 1970;Kaplan, 1972) and in a previous report from the Royal Marsden Hospital (Baker et al, 1972). The purpose of the present study was to compare reproductive and endocrine function in patients having bilateral oophoropexies with those having this operation followed by infradiaphragmatic irradiation.…”

mentioning

confidence: 88%

Reproductive and endocrine function in patients with Hodgkin's disease: effects of oophoropexy and irradiation

Thomas¹,

Winstanly²,

Peckham³

et al. 1976

Br J Cancer

113

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Summary.-Reproductive and endocrine function was investigated in 22 women with Hodgkin's disease who had bilateral mid-line oophoropexies performed at staging laparotomy. The operation was followed in 12 cases by " inverted Y " pelvic lymph node irradiation and in 4 cases by para-aortic lymph node irradiation.Pregnancies occurred after the operation in 4 of the 6 patients subsequently found not to require irradiation below the diaphragm. In the other 2 patients in this group the menstrual history was unaffected and normal gonadotrophin concentrations indicated intact ovarian function. In the group receiving para-aortic irradiation, in whom the ovarian irradiation dose was small (about 150 rad to each ovary) menstrual function and gonadotrophin concentrations were normal at the time of review and one patient has subsequently become pregnant. In the group receiving inverted Y irradiation, in whom the ovaries were shielded from the radiation beam by a rectangular lead block, the ovarian dose was much higher (lowest dose 600 rad, highest dose 3500 rad). Nine of the 12 have persisting amenorrhoea with elevated levels of both gonadotrophins. One patient has since become pregnant and one patient has resumed menstrual cycles and has normal basal gonadotrophin concentrations. One patient who has resumed menstrual cycles has a monotrophic elevation of basal serum FSH concentrations.We conclude that bilateral mid-line oophoropexy does not impair ovarian function or gamete transport and should be performed at diagnostic laparotomy in women of child bearing age with Hodgkin's disease, even when it is uncertain whether pelvic node irradiation will be necessary. The results in the patients who received inverted Y irradiation indicate that the technique of pelvic shielding and ovarian transposition used were only partially successful in preserving fertility. Alternative techniques for preserving ovarian function are discussed.

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“…Different surgical techniques have been proposed for ovarian transposition (e.g. fixation of the ovary in the pouch of Douglas, 24 lateral subcutaneous fixation, intraperitoneal or retroperitoneal fixation to the muscles psoas, and fixation in the paracolic gutter). [25][26][27] In cases of gynaecological cancer, the most adapted technique is, in our experience, ovarian fixation to the paracolic gutter.…”

Section: Ovarian Transposition In Cervical Cancermentioning

confidence: 99%