Ovarian transposition before radiotherapy in cervical cancer patients: functional outcome and the adequate dose constraint

Lina Yin,Guihao Ke,Saiquan Lu,Weiling Zhang,Jun Zhu

doi:10.1186/s13014-019-1312-2

Abstract

BackgroundThe data regarding a transposed ovary in intensity-modulated radiotherapy (IMRT) are not sufficient. Here we aim to investigate the adequate dose constraint of ovarian transposition before radiotherapy in cervical cancer patients.MethodsThis was a retrospective analysis of 118 patients with cervical cancer who received a radical hysterectomy and ovarian transposition before pelvic irradiation from April 2012 to July 2017. A total of 105 patients underwent IMRT with a limited radiation dose to the ovaries; 48 of these patients received unilateral ovary limitation, while 57 received bilateral ovary limitations. Patient follow up regarding sex hormone levels (estrogen [E2], follicle stimulating hormone [FSH]) and menopausal symptoms was completed one year after their radiation therapy.ResultsA total of 41 out of 105 patients (39.0%) who underwent IMRT with a limited radiation dose to the ovaries preserved their normal ovarian function. The cutoff dose of comparatively lower side ovarian maximum dose was 9.985Gy and the cutoff of mean dose was 5.32Gy. The optimal dose–volume constrains to ovaries was V5.5 < 29.65%. Age ≤ 38 (P = 0.001) was an independent predictors of ovarian function, while limited ovarian side numbers were excluded.ConclusionUsing IMRT, preservation of ovarian function was possible when the limited dose was as low as possible to the ovaries regardless of bilateral or unilateral limitation to the ovaries. The ovarian maximum dose of less than 9.985Gy, the mean dose less than 5.32Gy and V5.5 < 29.65% could be better at preventing ovarian dysfunction. Patients younger than 38 years old were more likely to keep normal ovarian function while limited ovarian side numbers did not appear to exert an obvious effect.

Highlights

Ovarian transposition may decrease the likelihood of ovarian dysfunction after treatment in young patients scheduled to undergo chemotherapy and pelvic irradiation
The data regarding a transposed ovary in intensity-modulated radiotherapy (IMRT) are not sufficient
The purpose of this study was to analyze transposed ovarian dose limitation in IMRT. This was a retrospective analysis of 118 patients with cervical cancer who received radical hysterectomy and ovarian transposition before pelvic irradiation from April 2012 to December 2017 at the Fudan University Shanghai Cancer Center

Summary

Introduction

The data regarding a transposed ovary in intensity-modulated radiotherapy (IMRT) are not sufficient. We aim to investigate the adequate dose constraint of ovarian transposition before radiotherapy in cervical cancer patients. There were significant, increasing trends in cervical cancer mortality rates among young Japanese women below the age of 50 from 1975 to 2012 [1]. Cervical cancer incidence among women 20–24 years old increased significantly for New Zealand women(1985–2013) [2]. In Korea, the incidence and mortality rates of cervical cancer among young women (< 30 years old) increased. Yin et al Radiation Oncology (2019) 14:100 disease, and genitourinary atrophy. Because of these adverse events, some premenopausal patients with cervical cancer are recommended to undergo ovarian transposition [7,8,9]. In the era of 2D opposite-field radiotherapy, the standard recommended ovarian position during radiotherapy is 4 cm outside of the radiation field or more than 1.5 cm above the iliac crest [11]

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