Abstract
In this study, the relationship between ovarian function and ovarian limited dose in radiotherapy was evaluated in young patients with cervical cancer who underwent ovarian transposition (Fig1B). Moreover, the novel ovarian dose limit for a better preservation of ovarian function in intensity‐modulated radiation therapy (IMRT) was determined. We retrospectively analyzed data from 86 patients with cervical cancer who received radical hysterectomy and ovarian transposition from January 2013 to June 2015. In agreement with the National Comprehensive Cancer Network Guidelines (NCCN) for Cervical Cancer Version 2.2015, 65 patients with pathological high‐risk factors were administered adjuvant radiotherapy—20 of them received three‐dimensional conformal radiotherapy (Observation Group A), 24 patients received IMRT with no limitation on radiation dose to ovaries (Observation Group B), and 21 patients underwent IMRT with limited radiation dose(V10<20%) to ovaries (Observation Group C). Twenty‐one patients without any predetermined high‐risk factors did not received radiation therapy (Control Group D). Patients from all four groups were followed up, and sex hormone levels (E2, P, follicle‐stimulating hormone [FSH], LH) before radiation, postradiation, 3 month, and 6 month after the radiation therapy were measured by electrochemiluminescence immunoassay. Subsequently, changes in sex hormone levels in all four groups of patients at various time points were analyzed. The levels of sexual hormones (E2, P, FSH, LH) before radiation, postradiation, 3 month, and 6 month after the radiation therapy in patients from all three observation groups were significantly lower than those in patients of the control group (P < 0.05). There was no statistically significant difference in the levels of sex hormones in patients of the control group at different time points (P > 0.05). Within each observation group, there was a statistically significant difference in the sex hormone levels in patients before the radiation and after the radiation (P < 0.05); however, when data from all three observation groups were compared, only the difference in the levels of FSH and LH between the patients from Group A and Group C was statistically significant (P < 0.05). The results of receiver‐operating characteristic (ROC) curve analysis suggested that limiting ovarian radiation dose to V7.5 < 26% in IMRT prevents the disruption of ovarian function (area under ROC curve was 0.740, confidence interval [CI] = 0.606–0.874). In young patients with cervical cancer who underwent radical hysterectomy and ovarian transposition without receiving adjuvant radiotherapy, ovarian endocrine function was well preserved. In patients who received any type of postoperative radiotherapy, ovarian function was affected, suggesting that the standard ovarian limited dose used in IMRT disrupted ovarian function. The results of the ROC curve analysis suggested that the new optimal dose limit of V7.5 < 26% should be used in IMRT to preserve ovarian function (P = 0.003).
Highlights
Cervical cancer is one of the most common gynecologic malignancies in China and is the second common female malignant tumor worldwide
In order to determine the optimal dose limit to preserve ovarian function in intensity-m odulated radiation therapy (IMRT), we focused on the relationship between ovarian limited dose given to young patients with cervical cancer after ovarian transposition and ovarian function
receiver-operating characteristic (ROC) curve method applied for further analysis yielded optimal ovarian dose limit of V7.5 < 26%(P = 0.003), with the area under curve 0.740 and 95% CI = 0.606–0.874
Summary
Cervical cancer is one of the most common gynecologic malignancies in China and is the second common female malignant tumor worldwide. The cure rates of patients with the early stages of cervical carcinoma are high, and preserving ovarian function is a vital quality of life factor for those young patients. Patients with the early stages of cervical cancer undergo radical hysterectomy and ovarian transposition to preserve ovarian function. We performed clinical studies to determine the radiation dose limit that can preserve ovarian function. 86 young patients with stages Ib or IIa cervical cancer, who underwent radical hysterectomy and ovarian transposition, were divided into four groups (A, B, C, and control group D) depending on the presence and the type of radiation therapy. Serum level of sex hormones (E2, P, follicle-stimulating hormone [FSH], LH) was used to evaluate the relationship between ovarian function and ovarian radiation dose in young patients with cervical cancer who underwent ovarian transposition. We attempted to find the optimal radiation dose limit to preserve ovarian function in IMRT
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