Ovarian transposition in patients with cervical cancer prior to pelvic radiotherapy: a systematic review

Ovarian transposition aims to minimize ovarian exposure and damage during pelvic radiotherapy. One or both ovaries are separated from the uterus and mobilized away from the area where the radiation will be administered. A review of the available literature was conducted to evaluate the efficacy and safety of ovarian transposition among pre-menopausal women diagnosed with cervical cancer and eligible for pelvic radiotherapy. Outcomes evaluated were ovarian function preservation and complication rates. We also searched for information on pregnancy/live birth rates after ovarian transposition. Our search yielded a total of 635 manuscripts, of which 33 were considered eligible. A total of 28 full texts were selected for the current review, including 1377 patients who underwent ovarian transposition. The median or mean follow-up ranged between 7 and 87 months. Ovarian function preservation after ovarian transposition and pelvic radiotherapy, with or without chemotherapy, was 61.7% (431/699 patients), ranging from 16.6% to 100%. A total of 12 studies reported on 117 complications, accounting for 8.5%. Ovarian metastases were described in 5 (0.4%). Data about fertility preservation after ovarian transposition are scarce and definitive conclusions cannot be drawn. Based on the available data, ovarian transposition could be performed on young patients with tumors smaller than 4 cm, and it should be avoided in those with bulky tumors. A risk/benefit assessment should be carefully evaluated by a multidisciplinary team, and the decision regarding ovarian transposition should be always guided by the values and informed preferences of the patient.

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Laparoscopic ovarian transposition in patients with early cervical cancer

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.01054.x ◽

2008 ◽

Vol 18 (3) ◽

pp. 584-589 ◽

Cited By ~ 40

Author(s):

J. PAHISA ◽

S. MARTÍNEZ-ROMÁN ◽

M. A. MARTÍNEZ-ZAMORA ◽

A. TORNÉ ◽

X. CAPARRÓS ◽

...

Keyword(s):

Cervical Cancer ◽

Ovarian Function ◽

Young Patients ◽

Figo Stage ◽

Pelvic Radiotherapy ◽

Ovarian Transposition ◽

Hormonal Function ◽

Pathologic Evaluation ◽

Minimum Delay ◽

Early Cervical Cancer

The aim of this study was to evaluate the feasibility, efficacy, and morbidity of laparoscopic ovarian transposition on the preservation of hormonal function in patients younger than 45 years operated for early cervical cancer. According to risk factors on pathologic evaluation of the specimen, some of them will receive postoperative pelvic radiotherapy. This subset of patients could benefit from taking the ovaries away from the irradiation field in an effort to preserve their functionality. This prospective study included 28 FIGO stage IB1 cervical cancer patients, 45 years old or younger, maintaining menstrual cycles, who were considered suitable for conservation of the ovaries. The ovarian transposition was performed by laparoscopy as a part of the same celio-Schauta operation. Twelve patients underwent adjuvant pelvic radiotherapy. No intraoperative or postoperative morbidity related to the ovarian transposition was observed, and the procedure only entailed a minimum delay of the operative time. There were no cases of ovarian metastasis. At a mean follow-up of 44 months, 63.6% of patients receiving radiotherapy and 93% of those who nonirradiated maintained normal ovarian function. Two patients developed benign ovarian cysts, requiring oophorectomy, but no other long-term adverse effects of the transposition were identified. To the best of our knowledge, this is the largest series of the laparoscopic procedure reported to date in this setting. According to our results, laparoscopic ovarian transposition is a safe and effective procedure for the preservation of ovarian function in young patients with early cervical cancer undergoing adjuvant radiotherapy after surgery

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The relationship between ovarian function and ovarian limited dose in radiotherapy postoperation of ovarian transposition in young patients with cervical cancer

Cancer Medicine ◽

10.1002/cam4.924 ◽

2017 ◽

Vol 6 (3) ◽

pp. 508-515 ◽

Cited By ~ 4

Author(s):

Zhenhua Du ◽

Hui Qu

Keyword(s):

Cervical Cancer ◽

Ovarian Function ◽

Young Patients ◽

Ovarian Transposition ◽

The Relationship

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Association between the location of transposed ovary and ovarian dose in patients with cervical cancer treated with postoperative pelvic radiotherapy

Radiation Oncology ◽

10.1186/s13014-019-1437-3 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Xiao-juan Lv ◽

Xiao-long Cheng ◽

Ye-qiang Tu ◽

Ding-ding Yan ◽

Qiu Tang

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Adjuvant Radiotherapy ◽

Iliac Crest ◽

Ovarian Function ◽

Pelvic Radiotherapy ◽

Cutoff Value ◽

Ovarian Transposition ◽

Transverse Distance ◽

Upper Boundary

Abstract Background and purpose How to protect the ovarian function during radiotherapy is uncertain. The purpose of this study was to explore the association between the location of the transposed ovary and the ovarian dose in patients with cervical cancer received radical hysterectomy, ovarian transposition, and postoperative pelvic radiotherapy. Methods A retrospective analysis was conducted of 150 young patients with cervical cancer who received radical hysterectomy, intraoperative ovarian transposition, and postoperative adjuvant radiotherapy in Zhejiang Cancer Hospital. Association between location of the transposed ovaries and ovarian dose was evaluated. The transposed position of ovaries with a satisfactory dose was explored using a receiver operator characteristic curve (ROC) analysis. Patients’ ovarian function was followed up 3 months and 1 year after radiotherapy. Results A total of 32/214 (15%) transposed ovaries were higher than the upper boundary of the planning target volume (PTV). The optimum cutoff value of > 1.12 cm above the iliac crest plane was significantly associated with ovaries above the upper PTV boundary. When the ovaries were below the upper boundary of PTV, the optimum cutoff value of transverse distance > 3.265 cm between the ovary and PTV was significantly associated with ovarian max dose (Dmax) ≤ 4Gy, and the optimum cutoff value of transverse distance > 2.391 cm was significantly associated with ovarian Dmax≤5Gy. A total of 77 patients had received complete follow-up, and 56 patients (72.7%) showed preserved ovarian function 1 year after radiotherapy, which was significantly increased compared with 3 months (44.2%) after radiotherapy. Conclusions The location of transposed ovaries in patients with cervical cancer is significantly correlated with ovarian dose in adjuvant radiotherapy. We recommend transposition of ovaries > 1.12 cm higher than the iliac crest plane to obtain ovarian location above PTV. When the transposed ovary is below the upper boundary of PTV, ovarian Dmax ≤4Gy may be obtained when the transverse distance between the ovary and PTV was > 3.265 cm, and the ovarian Dmax≤5Gy may be obtained when the transverse distance was > 2.391 cm.

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Correlation Between Location of Transposed Ovary and Function in Cervical Cancer Patients Who Underwent Radical Hysterectomy

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000404 ◽

2015 ◽

Vol 25 (4) ◽

pp. 688-693 ◽

Cited By ~ 6

Author(s):

Aera Yoon ◽

Yoo-Young Lee ◽

Won Park ◽

Seung Jae Huh ◽

Chel Hun Choi ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Ovarian Function ◽

Medical Center ◽

Young Patients ◽

Surrogate Marker ◽

Ovarian Transposition ◽

Median Serum ◽

Early Cervical Cancer ◽

And Function

ObjectiveThe study investigated the association between the location of transposed ovaries and posttreatment ovarian function in patients with early cervical cancer (IB1-IIA) who underwent radical hysterectomy and ovarian transposition with or without adjuvant therapies.MethodsRetrospective medical records were reviewed to enroll the patients with early cervical cancer who underwent ovarian transposition during radical hysterectomy at Samsung Medical Center between July 1995 and July 2012. Serum follicle-stimulating hormone (FSH) level was used as a surrogate marker for ovarian function.ResultsTwenty-one patients were enrolled. The median age and body mass index (BMI) were 31 years (range, 24–39 years) and 21.3 kg/m2 (range, 17.7–31.2 kg/m2), respectively. The median serum FSH level after treatment was 7.9 mIU/mL (range, 2.4–143.4 mIU/mL). The median distance from the iliac crest to transposed ovaries on erect plain abdominal x-ray was 0.5 cm (range, −2.7 to 5.2 cm). In multivariate analysis, posttreatment serum FSH levels were significantly associated with the location of transposed ovaries (β = −8.1, P = 0.032), concurrent chemoradiation (CCRT) as an adjuvant therapy (β = 71.08, P = 0.006), and BMI before treatment (underweight: β = −59.93, P = 0.05; overweight: β = −40.62, P = 0.041).ConclusionsLocation of transposed ovaries, adjuvant CCRT, and BMI before treatment may be associated with ovarian function after treatment. We suggest that ovaries should be transposed as highly as possible during radical hysterectomy to preserve ovarian function in young patients with early cervical cancer who might be a candidate for adjuvant CCRT and who have low BMI before treatment.

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Ovarian Function Preservation in Patients With Cervical Cancer Undergoing Hysterectomy and Ovarian Transposition Before Pelvic Radiotherapy

Technology in Cancer Research & Treatment ◽

10.1177/15330338211042140 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110421

Author(s):

Wonguen Jung ◽

Yun H. Kim ◽

Kyung S. Kim

Keyword(s):

Cervical Cancer ◽

Ovarian Function ◽

External Beam Radiotherapy ◽

Intraepithelial Neoplasia ◽

Ovarian Failure ◽

P Value ◽

Ovarian Transposition ◽

Group 4 ◽

Function Preservation ◽

Group 2

To examine the factors associated with ovarian failure (OF) and assess the effectiveness of ovarian transposition (OT) before pelvic irradiation for preserving ovarian function in patients with cervical cancer (CC) undergoing hysterectomy. During 2003 to 2017, patients who underwent hysterectomy with preservation of one or both ovaries were retrospectively enrolled. Patients were divided into 4 groups, depending on whether radiotherapy (RT) and OT were performed: group 1, RT(+) and OT(+); group 2, RT(+) and OT(−); group 3, RT(−) and OT(+); group 4, RT(−) and OT(−). OF was defined as serum follicle-stimulating hormone levels of ≥30 mIU/mL. Sixty-six patients (59 [89.4%] invasive CC and 7 [10.6%] cervical intraepithelial neoplasia) were included. The 2-year OF-free survival rate was 61.4% (95% confidence interval [CI] 37.8-86.0), 0%, 91.7% (95% CI 76.0-100), and 75.8% (95% CI 58.2-93.4) for groups 1, 2, 3, and 4, respectively. In groups 1 and 2 receiving RT, OT, and combination of external beam radiotherapy and vaginal brachytherapy were associated with OF on multivariate analysis (MVA) ( P-value = .002 and .046, respectively). In groups 3 and 4 without RT, older age (40 years old) and OT did not affect OF; however, the number of remaining ovaries was independently associated with OF in MVA ( P = .035). OT could effectively preserve ovarian function in patients treated with adjuvant RT, while OT procedure itself did not affect ovarian failure. OT should be considered in the management of premenopausal cervical cancer patients.

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Ovarian Function Preservation in Patients With Cervical Cancer Undergoing Hysterectomy and Ovarian Transposition Before Pelvic Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.2577 ◽

2020 ◽

Vol 108 (3) ◽

pp. e460

Author(s):

W. Jung ◽

Y.H. Kim ◽

K.S. Kim

Keyword(s):

Cervical Cancer ◽

Radiation Therapy ◽

Ovarian Function ◽

Pelvic Radiation ◽

Ovarian Transposition ◽

Function Preservation

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

International Journal of Gynecological Cancer ◽

10.1046/j.1525-1438.1994.04010061.x ◽

1994 ◽

Vol 4 (1) ◽

pp. 61-65 ◽

Cited By ~ 23

Author(s):

N. Husseinzadeh ◽

M. L. Van Aken ◽

B. Aron

Keyword(s):

Cervical Cancer ◽

Radiation Therapy ◽

Ovarian Function ◽

Invasive Cervical Cancer ◽

Young Patients ◽

Average Dose ◽

External Radiation ◽

Adequate Treatment ◽

Ovarian Transposition ◽

Postmenopausal Symptoms

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.

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Ovarian Function Preservation in Patients With Cervical Cancer Undergoing Hysterectomy and Ovarian Transposition Before Pelvic Radiotherapy

10.21203/rs.3.rs-45986/v1 ◽

2020 ◽

Author(s):

Wonguen Jung ◽

Yun Hwan Kim ◽

Kyung Su Kim

Keyword(s):

Cervical Cancer ◽

Ovarian Function ◽

External Beam Radiotherapy ◽

Intraepithelial Neoplasia ◽

Ovarian Failure ◽

P Value ◽

Ovarian Transposition ◽

Group 4 ◽

Function Preservation ◽

Group 2

Abstract Background: To examine the factors associated with ovarian failure (OF) and assess the effectiveness of ovarian transposition (OT) before pelvic irradiation for preserving ovarian function in patients with cervical cancer (CC) undergoing hysterectomy.Methods: During 2003-2017, patients who underwent hysterectomy with preservation of one or both ovaries were retrospectively enrolled. Patients were divided into 4 groups, depending on whether radiotherapy (RT) and OT were performed: group 1, RT(+) and OT(+); group 2, RT(+) and OT(-); group 3, RT(-) and OT(+); group 4, RT(-) and OT(-). OF was defined as serum follicle-stimulating hormone levels of ≥30 mIU/mL.Results: Sixty-six patients (59 [89.4%] invasive CC and 7 [10.6%] cervical intraepithelial neoplasia) were included. The 2-year ovarian failure-free survival (OFFS) rate was 61.4% (95% confidence interval (CI) 37.8–86.0), 0%, 91.7% (95% CI 76.0–100), and 75.8% (95% CI 58.2–93.4) for groups 1, 2, 3, and 4, respectively. In groups 1 and 2 receiving RT, OT and combination of external beam radiotherapy and vaginal brachytherapy (VB) were associated with OF on multivariate analysis (MVA) (p-value=0.002 and 0.046, respectively). In groups 3 and 4 without RT, older age (40 years) and OT did not affect OF; however, the number of remaining ovaries was independently associated with OF in MVA (p=0.035).Conclusions: OT could effectively preserve ovarian function in adjuvant RT-treated patients. Lower location of transposed ovary with VB boost was significantly associated with early OF.

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