Significance of ovarian transposition in the preservation of ovarian function for young cervical cancer patients undergoing postoperative volumetric modulated radiotherapy

Xu, Hanzi; Guo, Chang; Zhang, Xiuming; Wu, Yaqin; Zhu, Biqing; Lu, Emei; Sun, Zhihua; He, Dalin; Fei, Deng; Lv, Juan; Gong, Zhen

doi:10.21037/atm-21-2909

Cited by 2 publications

(3 citation statements)

References 33 publications

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Section: Methodsmentioning

confidence: 99%

“…Through Monaco 5.1 Treatment Planning System (Elekta), Volumetric Modulated Arc Therapy was administered using Versa HD linear accelerator (Elekta) to the patient with the prescription dose DT 4500-4550cGy/24-25fractions. 22,23 Preparation Before Radiotherapy. All the patients were trained with the purpose to obtain a reasonably full, but comfortable, bladder volume that they felt they could consistently reproduce during the whole period of their radiotherapy.…”

Section: Treatmentmentioning

confidence: 99%

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3D-US and CBCT Dual-guided Radiotherapy for Postoperative Uterine Malignancy: A Primary Workflow Set-up

Li,

Gong,

Liu

et al. 2023

Technol Cancer Res Treat

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Introduction: The consistency of clinical target volume is essential to guiding radiotherapy with precision for postoperative uterine malignancy patients. By introducing a three-dimensional ultrasound system (3D-US) into image-guided radiation therapy (IGRT), this study was designed to investigate the initial workflow set-up, the therapeutic potential, and the adverse events of 3D-US and cone-beam computed tomography (CBCT) dual-guided radiotherapy in postoperative uterine malignancy treatment. Methods: From April 2021 to December 2021, postoperative uterine malignancy patients were instructed to follow the previously standard protocol of daily radiation treatment, particularly a 3D-US (Clarity system) guiding was involved before CBCT. Soft-tissue-based displacements resulting from the additional US-IGRT were acquired in the LT (left)/RT (right), ANT (anterior)/POST (posterior), and SUP (superior)/INF(inferior) directions of the patient before fractional treatment. Displacement distributions before and after treatment either from 3D-US or from CBCT were also estimated and compared subsequently, and the urinary and rectal toxicity was further evaluated. Results: All the patients completed radiation treatment as planned. The assessment of 170 scans resulted in a mean displacement of (0.17 ± 0.24) cm, (0.19 ± 0.23) cm, (0.22 ± 0.26) cm for bladder in LT/RT, ANT/POST, and SUP/INF directions. A mean deviation of (0.26 ± 0.22) cm, (0.58 ± 0.5) cm, and (0.3 ± 0.23) cm was also observed for the bladder centroid between the CBCT and computed tomography -simulation images in three directions. Paired comparison between these two guidance shows that the variations from 3D-US are much smaller than those from CBCT in three directions, especially in ANT/POST and SUP/INF directions with significance ( P = 0.000, 0.001, respectively). During treatment, and 0, 3, 6, 9, and 12 months after treatment, there was no severe urinary and rectal toxicity happened. Conclusion: A primary workflow of 3D-US and CBCT dual-guided radiotherapy has been established, which showed great therapeutic potential with mild to moderate urinary and rectal toxicity for postoperative uterine malignancy patients. But the clinical outcomes of this non-invasive technique need to be investigated further.

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Section: Methodsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

3D-US and CBCT Dual-guided Radiotherapy for Postoperative Uterine Malignancy: A Primary Workflow Set-up

Li,

Gong,

Liu

et al. 2023

Technol Cancer Res Treat

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“…Current research on the location of the transposed ovary is mainly based on statistical methods (8)(9)(10). By analyzing data from 150 patients who had undergone ovarian transposition and received postoperative radiotherapy, LV et al (8) plotted the operating characteristic curve (ROC) of ovarian position versus the dose received and concluded that moving the ovaries above 1.12 cm in the iliac crest plane enabled the dose to be controlled below the safety limit.…”

Section: Introductionmentioning

confidence: 99%

PRT-Net: a progressive refinement transformer for dose prediction to guide ovarian transposition

Luan,

Ding,

Wei

et al. 2024

Front. Oncol.

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IntroductionYoung cervical cancer patients who require ovarian transposition usually have their ovaries moved away from the pelvic radiotherapy (RT) field before radiotherapy. The dose of ovaries during radiotherapy is closely related to the location of the ovaries. To protect ovarian function and avoid ovarian dose exceeding the limits, a safe location of transposed ovary must be determined prior to surgery.MethodsFor this purpose, we input the patient's preoperative CT into a neural network model to predict the dose distribution. Surgeons were able to quickly locate low-dose regions based on the dose distribution before surgery, thus determining the safe location of the transposed ovary. In this work, we proposed a new progressive refinement transformer model PRT-Net that can generate dose prediction at multiple scale resolutions in one forward propagation, and refine the dose prediction using prediction details from low to high resolution based on a deep supervision strategy. A multi-loss function fusion algorithm was also built to fit the prediction results under different loss dimensions. The clinical feasibility of the method was verified through an actual cases.Results and discussionTherefore, using PRT-Net to predict the dose distribution by preoperative CT in cervical cancer patients can assist clinicians to perform ovarian transposition surgery and prevent patients' ovaries from exceeding the prescribed dose limit in postoperative radiotherapy.

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Significance of ovarian transposition in the preservation of ovarian function for young cervical cancer patients undergoing postoperative volumetric modulated radiotherapy

Cited by 2 publications

References 33 publications

3D-US and CBCT Dual-guided Radiotherapy for Postoperative Uterine Malignancy: A Primary Workflow Set-up

3D-US and CBCT Dual-guided Radiotherapy for Postoperative Uterine Malignancy: A Primary Workflow Set-up

PRT-Net: a progressive refinement transformer for dose prediction to guide ovarian transposition

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