Ovarian transposition in patients with cervical cancer prior to pelvic radiotherapy: a systematic review

Abstract

Ovarian transposition aims to minimize ovarian exposure and damage during pelvic radiotherapy. One or both ovaries are separated from the uterus and mobilized away from the area where the radiation will be administered. A review of the available literature was conducted to evaluate the efficacy and safety of ovarian transposition among pre-menopausal women diagnosed with cervical cancer and eligible for pelvic radiotherapy. Outcomes evaluated were ovarian function preservation and complication rates. We also searched for information on pregnancy/live birth rates after ovarian transposition. Our search yielded a total of 635 manuscripts, of which 33 were considered eligible. A total of 28 full texts were selected for the current review, including 1377 patients who underwent ovarian transposition. The median or mean follow-up ranged between 7 and 87 months. Ovarian function preservation after ovarian transposition and pelvic radiotherapy, with or without chemotherapy, was 61.7% (431/699 patients), ranging from 16.6% to 100%. A total of 12 studies reported on 117 complications, accounting for 8.5%. Ovarian metastases were described in 5 (0.4%). Data about fertility preservation after ovarian transposition are scarce and definitive conclusions cannot be drawn. Based on the available data, ovarian transposition could be performed on young patients with tumors smaller than 4 cm, and it should be avoided in those with bulky tumors. A risk/benefit assessment should be carefully evaluated by a multidisciplinary team, and the decision regarding ovarian transposition should be always guided by the values and informed preferences of the patient.

Laparoscopic ovarian transposition in teenage and young women with locally advanced rectal cancer: Respite amidst cancer chaos

“…Thus, the most appropriate way to measure is using a time to event variable like ovarian survival. Ovarian preservation is reported to be between 60% to 94% [6,19,[24][25][26][27][28][29][30]. This outcome represents the technical effectiveness of the procedure.…”

“…After pelvic chemoradiation, over 94% of women experience persistent amenorrhoea [5], hence, ovarian transposition (OT) is a well‐established method while performing radical hysterectomy for cervical cancer [6]. However, its practice for nongynaecological cancers requiring pelvic radiation is underutilized.…”

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

“…Many studies reporting ovarian preservation rates after ovarian transposition and radiotherapy were conducted in the era of 3D conformal radiotherapy techniques. A recent systematic review of transposition for cervical cancer noted only three studies reporting on ovarian preservation after transposition used more conformal radiotherapy techniques 37. Yin and colleagues published a series of 118 patients with cervical cancer who received hysterectomy, oophoropexy and pelvic irradiation with intensity modulated radiotherapy 32.…”

“…Tumor size <4 cm Large tumor size (IB3) may increase ovarian metastasis risk, though absolute rates appear low across studies 6 8 10 12 13 Local extension Absence of parametrium or uterine corpus involvement Among the highest risk factors for ovarian metastasis, however absolute rates low across studies 4 5 7 Lymphovascular invasion Absent Lymphovascular invasion may increase risk of ovarian metastasis, however absolute rates low across studies 7 8 13 14 Lymph node involvement Absence of pelvic lymph nodes Absence of para-aortic lymph nodes Among highest risk factor for ovarian metastasis Involvement of multiple pelvic or para-aortic lymph nodes may necessitate extended field radiotherapy, with possible simultaneous boost required, increasing dose to transposed ovaries 7 8 13 14 Age Younger than 35 years Improved outcomes in ovarian survival consistently reported in patients younger than [35][36][37][38][39][40] Baseline ovarian function should be assessed in older patients being considered for ovarian metastasis 1 12 13 15 16 Radiosensitivity of ovaries increased with advancing age 20 Body mass index Normal body mass index High or low body mass index may influence ovarian survival, however evidence is limited 46 Review ovarian reserve, however baseline preoperative assessment of ovarian function should be conducted in patients of any age. 12 17 Turkgeldi and colleagues reported 71.4% of patients aged 30 or older underwent menopause compared with 25.9% of patients younger than 30.…”

Female Oncofertility: Current Understandings, Therapeutic Approaches, Controversies, and Future Perspectives

“…This is usually indicated for patients receiving pelvic radiotherapy for cervical cancer, vaginal, rectal, or anal cancers, pelvic lymphoma or Ewing’s sarcoma [ 215 , 222 ]. In recent meta-analysis, the mean rate of ovarian function recovered in patients who had ovarian transposition before pelvic radiotherapy was 61.7% (431/699) [ 223 ].…”