Ovarian transposition in young patients with invasive cervical cancer receiving radiation therapy

Abstract

Twenty-two patients with invasive cervical cancer had ovarian transposition. Fifteen patients received whole pelvic external radiation therapy via a teletherapy unit, and nine patients also received one or two intracavitary insertions. Ovarian function was measured by serum gonadotropins, FSH, and LH. We were unable to measure gonadotropin levels in four patients because they were lost to follow-up after completion of radiation therapy. Five patients developed postmenopausal symptoms; in two the ovaries were not shielded and they received radiation by lateral ports with an average dose above 2500 cGY. Therefore, ovarian function was preserved in seven of 11 patients (64%), all of whom received </= 500 cGY with an average dose of 250 cGY to the ovaries via external radiation and intracavitary insertion(s). FSH values ranged from 3.3 to 38.8 mlU ml-1 (mean = 17.7 mlU ml-1). Two patients developed symptomatic ovarian cysts. Ovarian function can be preserved by transposing the ovaries at the time of surgery prior to radiation with adequate treatment planning which limits the radiation dose to the ovaries to </=300 cGY.

Laparoscopic Ovarian Transposition Before Pelvic Irradiation: A Saudi Tertiary Center Experience

“…Ovarian transposition outside the pelvic irradiation field has been shown to reduce the ovarian irradiation dose by 90% to 95% compared with the untransposed ovary. 18,28 Laparoscopic surgery has been one of the important innovations in modern-day surgery, allowing the patient to have a fast recovery. The published laparoscopic experience with ovarian transposition has been limited to few small series.…”

Association between the location of transposed ovary and ovarian function in patients with uterine cervical cancer treated with (postoperative or primary) pelvic radiotherapy

“…Ovarian failure can occur after single dose of 400 cGy or a fractionated regimen of 1,500 cGy during 10 days. The radiation dose inducing ovarian failure after treatment decreases with increasing age (6). A study reported that ovarian function was preserved in 64% of patients with bilateral ovarian transposition who received a radiation dose of <500 cGy (7).…”

Radiation dose to laterally transposed ovaries during external beam radiotherapy for cervical cancer

“…Haie-Meder et al [3] have reported that almost 85% of women undergoing radiotherapy for a wide variety of pelvic malignancies following lateral ovarian transposition will continue to demonstrate gonadal function for ovarian doses of less than 5 Gy. Other studies have suggested that an ovarian dose lower than 5 Gy is required to induce ovarian damage [10,12,14,19]. Ash [19] has reported that a fractionated dose to ovaries of 4 Gy may cause a 30% incidence of sterility in women aged 15 Á40 years.…”

“…Chambers et al [10] and Van Eijkeren et al [14] found a steep dose response effect at 3 Gy for induction of early menopause in women undergoing radiotherapy for cervical cancer after lateral ovarian transposition. Husseinzadeh et al [12] reported that the radiation dose to transposed ovaries should be limited to 3 Gy for ovarian function preservation in young patients irradiated for invasive cervical cancer. To be conservative, a radiation dose of 3 Gy was considered as the threshold value for ovarian damage in this study.…”