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

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.

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

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.

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

2021 ◽  
Vol 31 (3) ◽  
pp. 360-370
Author(s):  
Barbara Buonomo ◽  
Francesco Multinu ◽  
Jvan Casarin ◽  
Ilaria Betella ◽  
Vanna Zanagnolo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Ovarian Function ◽  
Young Patients ◽  
Complication Rates ◽  
Pelvic Radiotherapy ◽  
Ovarian Transposition ◽  
Risk Benefit Assessment ◽  
Menopausal Women ◽  
Informed Preferences ◽  
Function Preservation

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.

Fertile Potential of Freshly Isolated Adipose Tissue Derived Stromal cells and Bone Marrow Mesenchymal Stromal cells Against Premature Ovarian Failure

2021 ◽  
Vol 17 ◽  
Author(s):  
Tahir Maqbool ◽  
Faheem Hadi ◽  
Sehrish Tahir ◽  
Sadia Naz ◽  
Sajida Shahnawaz ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Adipose Tissue ◽  
Mesenchymal Stromal Cells ◽  
Premature Ovarian Failure ◽  
Stromal Cells ◽  
Serum Levels ◽  
Ovarian Failure ◽  
Group 4 ◽  
Group 3 ◽  
Group 2

Background: Failure to attain pregnancy or even miscarriage leads to infertility and premature ovarian failure (POF) is challenging type of infertility, stem cells have the ability to repair ovarian damage adipose tissue derived stromal cells (AT-SCs) and bone marrow mesenchymal stromal cells (BM-MSCs) have demonstrated promising regenerative abilities in several diseases including POF. Methods: Experiments were performed to prove the ability of AT-SCs and BM-MSCs in restoring ovarian functions, a total of 20 rats were randomly assigned to four groups; 5 rats in each group 1st group was untreated, 2nd was cyclophosphamide and busulfan treated group, 3rd was cyclophosphamide and busulfan + AT-SCs, 4th was cyclophosphamide and busulfan + BM-MSCs. Results: Group 3 and group 4 showed restored ovarian functions in the form of increase of weight (including body weight and ovarian weight), and a significant decrease in FSH serum levels (p < 0.05) compared to group 2, and anti-Mullerian hormone (AMH) serum levels increased (p < 0.05) in group 3 and group 4 versus group 2. Increased antioxidant level of glutathione (GSH) and superoxide dismutase (SOD) in group 3 and group 4 compared with group 2, also histochemistry analysis demonstrated normal tissue distribution in 3rd and 4th group compared with 2nd group. Conclusions: We demonstrated the ability of AT-SCs and BM-MSCs to restore ovarian function in female with POF.

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

2019 ◽  
Vol 14 (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.

scholarly journals Hepato curative effects of Silymarin and Cymbopogoncitratus stem infusion: RCT

2021 ◽  
Vol 15 (6) ◽  
pp. 1966-1969
Author(s):  
Sidra Mumal ◽  
Abdul Azeem ◽  
Talal Zafar ◽  
Hina Aslam ◽  
Tasneem Murad ◽  
...  
Keyword(s):  
Synergistic Effects ◽  
Serum Markers ◽  
Control Group ◽  
P Value ◽  
Trial Methodology ◽  
Adult Rats ◽  
Sinusoidal Dilatation ◽  
Group 4 ◽  
Group 3 ◽  
Group 2

People all around the world suffer from liver diseases, which is a serious health problem. Purpose: To observe the synergistic effects of Silymarin and Cymbopogoncitratus stem infusion on liver in acetaminophen induced hepatotoxicity in rats. Study Design: Laboratory-Based Randomized Control Trial. Methodology: Total forty adult rats were divided into four groups (10 each). Group 1 was taken as control group. After initial sampling at day 0, Acetaminophen (300 mg/kg) was injected to 30 rats via intra-peritoneal route. At day 8, rats were further divided into three groups. Group 2 was a disease control group. Group 3 was given Silymarin (100 mg/kg) and group 4 was treated with Silymarin (100 mg/kg) plus Cymbopogoncitratus stem infusion (130 mg/kg) through gavage method for fourteen days. At day 21, rats were sacrificed for histological examination after terminal sampling. Statistical Analysis: Mean± SEM was calculated and analyzed through SPSS 20. P-value less than 0.05 was considered statistically significant. Results: Rats from group 2 showed marked elevation (p<0.05) in serum markers. There was marked sinusoidal dilatation and necrosis present in group 2 rats.Silymarinin group 3 and Silymarin plus Cymbopogoncitratus stem infusion in group 4 significantly lowered the biochemical enzymes as well as considerably reversed the histological changes in comparison to group 2 rats. Conclusion: We concluded in present study that synergism was observed in group 4 rats. There was more reversal of hepatic injury in group 4 rats. Key words: Cymbopogoncitratus, Silymarin and Synergism.

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

2015 ◽  
Vol 25 (4) ◽  
pp. 688-693 ◽  
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.

Vaginal Dilator Use to Promote Sexual Wellbeing After Radiotherapy in Gynaecological Cancer Survivors: A Prospective Observational Study

2021 ◽  
Author(s):  
Dimitra Charatsi ◽  
Polyxeni Vanakara ◽  
Michail Nikolaou ◽  
Aikaterini Evaggelopoulou ◽  
Dimitrios Korfias ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Survivors ◽  
External Beam Radiotherapy ◽  
Sexual Life ◽  
P Value ◽  
Sexual Rehabilitation ◽  
Vaginal Stenosis ◽  
Sexual Symptoms ◽  
Radiation Induced ◽  
Vaginal Dilators

Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.

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