Abstract
Ovarian stimulation for oocyte and embryo cryopreservation is the standard of care for fertility preservation in young breast cancer patients before gonadotoxic chemotherapy. The procedure should be started as soon as possible to avoid delay of treatment; thus, it is often performed concomitantly with tumor staging assessments. However, questions remain regarding the potential negative impact on oocyte quality that may occur due to exposure to scattered ionizing radiation from imaging techniques when staging assessment is conducted at the same time as ovarian stimulation. We conducted a retrospective study on all breast cancer patients who performed ovarian stimulation for fertility preservation at our center between November 2012 and May 2020. Gynecologic and oncological characteristics were similar between patients exposed (n = 14) or not (n = 60) to ionizing radiation. Exposed patients started the ovarian stimulation sooner after diagnosis than non-exposed patients (11.5 vs 28days, respectively, P < 0.01). Cycle parameters, including the median number of oocytes collected (10.5 vs 7, P = 0.16), maturation rates (92.5% vs 85.7%, P = 0.54), and fertilization rates (62.2% vs 65.4%, P = 0.70), were similar between groups. This study shows that scattered ionizing radiation due to staging assessment appears to be safe without compromising follicular growth and maturation. Larger studies on fertility and obstetrical outcomes are needed to confirm these preliminary data.
Highlights
Breast cancer in young women is of great concern as it is the most common cancer diagnosed in women aged between 20 to 39 years old [1]
Ionizing radiation techniques differed according to the markers used: fluorodeoxyglucose labelled with fluorine 18 (18F-FDG) and a low-dose total body scanner was used for positron emission tomography (PET)-scan, red blood cells labelled with Technetium 99 (99Tc-RBC) was used for multi-gated acquisition (MUGA) scan, and methyl-diphosphonate labelled with scattered pelvic irradiation doses based on the existing literature on conceptus dosage in pregnant women, taking into account the highest estimate as follows: 25 mGy for a thoraco-abdominal CT [18], mGy for a PET scan [18], 5 mGy for a bone scan [19], and 0.5 mGy for a MUGA scan [18]
Surge/premature triggering (n=4), non-compliance to the ovarian stimulation protocol (n=2), fertility preservation for breast cancer relapse (n=1), and expression of formal refusal communicated to the institution to use their clinical data for clinical trials (n=1)
Summary
Breast cancer in young women is of great concern as it is the most common cancer diagnosed in women aged between 20 to 39 years old [1]. A recent study has shown an increasing incidence of breast cancer cases in premenopausal women in countries with a high human development index over the last 15 years [2]. In the last few decades, progress in oncological treatments has led to an improvement in overall survival for these patients which exceeds 80% at 5 years [3]. The first option recommended to preserve fertility in breast cancer patients is the cryopreservation of oocytes and/or embryos after letrozole-associated controlled ovarian stimulation [7, 8]. This approach has been proven to be safe, and as efficient as standard ovarian stimulation protocols [9]
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