Ovarian metastasis in women with cervical carcinoma in stages IA to IIB

Fan, Yu; Wang, Mengyao; Mu, Yi; Mo, Si-ping; Zheng, Ai; Li, Jinke

doi:10.1097/md.0000000000021146

Cited by 13 publications

(26 citation statements)

References 29 publications

(60 reference statements)

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“…Tumor histology has been identified as an important factor in predicting rate of ovarian metastasis, with many studies supporting lower rates with squamous cell carcinomas compared with adenocarcinomas 4–9. Yamamoto and colleagues reviewed the surgical specimens of a large cohort of 255 patients with cervical cancer and reported a 0.4% risk of ovarian metastasis with squamous cell carcinomas compared with an 8.2% risk in non-squamous tumors 4.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Recently, Fan and colleagues conducted a meta-analysis that included 12 studies of patients with IA-IIB disease and reported on ovarian metastasis rates. They found that while adenocarcinoma recurrence risk was significantly higher (OR 3.89, 95% CI 2.62 to 5.78), overall rates were low for both adenocarcinomas (3.61%) and squamous carcinoma histologies (1.46%) 7. Transposition may therefore be approached with caution and other risk factors in early-stage squamous cell carcinomas and adenocarcinomas of the cervix should be considered 7 11…”

Section: Patient Selectionmentioning

confidence: 99%

“…Patients with bulky cervical tumors may also be at increased risk of ovarian metastasis 6–8 10 12 13. Many studies have assessed the risk of ovarian metastasis based on tumor size greater than or less than 4 cm.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Landoni and colleagues reported on 270 patients who underwent ovarian preservation for cervical cancer and found that tumors greater than 4 cm had a significantly increased risk of ovarian metastasis (RR 5.8, 95% CI 1.5 to 22.0) 8. Fan and colleagues also calculated a pooled rate of 1.93% compared with 0.74% in patients with tumors greater than or less than 4 cm, respectively (OR 2.65) 7. However, Matsuo and colleagues reported very low rates of ovarian metastasis regardless of size, at 2.1% for even those tumors greater than 4 cm 5…”

Section: Patient Selectionmentioning

confidence: 99%

“…Matsuo and colleagues reported an ovarian metastasis rate of 5.7% in patients with cervical cancer and uterine corpus involvement, which was significantly greater than patients with no local extension (0.5%) 5. Fan and colleagues identified three studies (n=9253 patients) examining corpus uterine involvement in cervical cancer, and found an increased risk of ovarian metastasis with OR 7.64 95% CI 2.51 to 23.24) 7. Parametrial involvement was not significantly predictive of ovarian metastasis in a number of independent studies,4 5 however Fan and colleagues found a significant association when pooling the results of four studies (OR 7.87, 95% CI 5.01 to 12.36) and an overall ovarian metastasis rate of 5.0%.…”

Section: Patient Selectionmentioning

confidence: 99%

See 4 more Smart Citations

The role of oophoropexy in patients with gynecological cancer who need radiation therapy

Donovan

Covens

Kupets

et al. 2022

Int J Gynecol Cancer

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Pelvic radiotherapy is an essential component of cancer therapy for patients with cervical and other gynecological malignancies. The ovaries are particularly radiosensitive, and even low radiotherapy doses may result in impaired or complete loss of ovarian function, causing hormonal disturbances and infertility. Recent advances in both surgery and radiotherapy have facilitated the ability of some patients to maintain ovarian function through ovarian transposition and careful radiotherapy planning. Multidisciplinary discussions should be undertaken to consider which candidates are appropriate for transposition. Generally, patients under age 35 should be considered due to ovarian reserve, likelihood of oophoropexy success, and radioresistance of ovaries. Those patients with small squamous cell tumors, minimal extra-uterine extension, and no lymphovascular invasion or lymph node involvement are ideal candidates to minimize risk of ovarian metastasis. Patients should be assessed and counseled about the risks of ovarian metastasis and the likelihood of successful ovarian preservation before undergoing oophoropexy and starting treatment. Oophoropexy should be bilateral if possible, and ovaries should be placed superior and lateral to the radiotherapy field. Studies limiting the mean ovarian dose to less than 2–3 Gray have demonstrated excellent preservation of ovarian function. Intensity modulated radiotherapy and volumetric modulated arc therapy techniques have the potential to further minimize the dose to the ovary with excellent outcomes. The addition of brachytherapy to the treatment regimen will probably cause minimal risk to transposed ovaries. Oophoropexy before radiotherapy may preserve the hormonal function of ovaries for a duration, and fertility might be possible through surrogate pregnancy. Successful ovarian transposition has the potential to improve the overall health and wellbeing, reproductive options, and potentially quality of life in patients with cervical and other gynecological cancers.

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Section: Patient Selectionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%