scholarly journals Ovarian Transposition Strategy in Patients with Cervical Cancer Who Undergo Pelvic Radiation: Proposal of Ovarian Placement Based on Virtual Simulations

2021 ◽  
Author(s):  
Gabriel Oliveira Bernardes Gil ◽  
Cassiano Asano ◽  
Maria Luísa Braga Vieira Gil ◽  
Warne Andrade ◽  
Eduardo Batista Cândido ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Conformal Radiotherapy ◽  
Ovarian Failure ◽  
Sacral Promontory ◽  
Childbearing Age ◽  
Pelvic Radiation ◽  
Ovarian Transposition ◽  
Virtual Simulations ◽  
Volumetric Modulated Arc Radiotherapy

Objective: To establish a proposal for the location for ovarian transposition, considering different irradiation techniques and time to ovarian failure. Methods: Patients with cervical cancer in childbearing age submitted to adjuvant radiotherapy were selected. Delineation of simulated positions of the ovaries and pelvic radiation planning was done in CT, with three techniques: 3D conformal radiotherapy, intensity-modulated radiotherapy, and volumetric modulated arc radiotherapy. In order to correlate the ovaries maximal doses with the time to ovarian failure, the authors have used the one adaptation of Wallace model that predicts oocytes survival rates after radiation exposure. Results: Thirteen patients who were being treated between 2008 and 2017 were studied. When the ovaries were positioned 10 cm cranially from the sacral promontory, the pelvic radiation entails a decrease of 20% in the time to ovarian failure compared with that expected for a female at the same age without irradiation exposition. The placement of the ovaries <5 cm cranially from the sacral promontory results in a decrease >90%. There was no difference in time to ovarian failure between the radiation treatment techniques tested: 3D conformal radiotherapy, intensity-modulated radiotherapy, and volumetric modulated arc radiotherapy (p=0.197). Conclusions: The present study, based on virtual simulations, is the first to use the sacral promontory as a reference for a proposal of ovarian location with transposition. The authors have correlated the position of the ovaries and percentage of decrease in time to ovarian failure. These findings can potentially improve the management and counselling of patients with cervical cancer in childbearing age and deserve clinical validation.

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.

scholarly journals Adjuvant pelvic intensity-modulated radiotherapy and concurrent docetaxel and cisplatin chemotherapy for postoperative cervical cancer with adverse risk factors: a retrospective report on toxicity and outcome in a single institution

2020 ◽  
Author(s):  
Guangyu Zhang ◽  
Fangfang He ◽  
Youzhong Zhang ◽  
Haijian Wu ◽  
Qingwei Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Endocrine Function ◽  
Hematologic Toxicity ◽  
Ovarian Transposition ◽  
Intensity Modulated ◽  
Grade 3 ◽  
Docetaxel Chemotherapy

Abstract Background: To retrospectively assess the toxicity of delivering postoperative intensity-modulated radiotherapy (IMRT) and concurrent cisplatin and docetaxel chemotherapy to patients with cervical cancer and adverse risk factors.Methods: Every patient received postoperative IMRT and concurrent cisplatin and docetaxel chemotherapy. The clinical target volume (CTV) included the regional lymph node regions (obturator, common, internal, and external iliacs and presacral and para-aortic regions); the upper 2.0 cm of the vagina; and paravaginal soft tissue lateral to the vagina. Acute and late toxicities were scored using the Common Terminology Criteria for Adverse Events (CTCAE) and the Radiation Therapy Oncology Group (RTOG) late radiation morbidity scoring criteria, respectively.Results: Seventy-six patients were treated with postoperative IMRT and concurrent cisplatin and docetaxel chemotherapy. The median follow-up was 32 months. Eight patients (10.5%) had recurrence—loco-regional recurrence in four patients (5.3%) and distant metastasis in four (5.2%). Acute grade ≥3 gastrointestinal and hematologic toxicity occurred in one and five patients, respectively. One patient (1.3%) suffered from late grade 3 toxicities. Seventeen patients experienced ovarian transposition, 14 (82%) of whom maintained ovarian function. Seventy-four patients (97.4%) were alive at the last follow-up.Conclusions: Concurrent cisplatin and docetaxel chemotherapy with postoperative IMRT was safe and well tolerated, with acceptable acute and late toxicities. Moreover, the distant metastases control rates were encouraging, although loco-regional failure continued to be the primary mode of failure. Postoperative IMRT provides an opportunity to preserve endocrine function for patients with ovarian transposition.

Extended-Field Intensity-Modulated Radiotherapy and Concurrent Cisplatin-Based Chemotherapy for Postoperative Cervical Cancer With Common Iliac or Para-Aortic Lymph Node Metastases: A Retrospective Review in a Single Institution

2012 ◽  
Vol 22 (7) ◽  
pp. 1220-1225 ◽  
Author(s):  
Guangyu Zhang ◽  
Chunli Fu ◽  
Youzhong Zhang ◽  
Jianbo Wang ◽  
Naian Qiao ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Field Intensity ◽  
Intensity Modulated Radiotherapy ◽  
Endocrine Function ◽  
Ovarian Transposition ◽  
Intensity Modulated ◽  
Extended Field ◽  
Grade 3

ObjectiveRetrospectively, to assess the toxicity of delivering postoperative extended-field intensity-modulated radiotherapy (EF-IMRT) and concurrent cisplatin chemotherapy for patients with cervical cancer with a pathologically confirmed positive common iliac node and/or a para-aortic node.MethodsEach patient received postoperative EF-IMRT and concurrent cisplatin chemotherapy. The clinical target volume included regional lymph node regions (obturator; common, internal, and external iliac nodal regions; presacral region; and para-aortic regions) and the upper 2.0 cm of the vagina and paravaginal soft tissue lateral to the vagina. The acute and late toxicity were scored using the Common Terminology Criteria for Adverse Events (CTCAE) and the Radiation Therapy Oncology Group late radiation morbidity scoring criteria, respectively.ResultsFifty-eight patients were treated with postoperative EF-IMRT and concurrent cisplatin chemotherapy. The median follow-up was 34 months. Eighteen patients (31%) had recurrence. The region of recurrence was in-field in 2 patients (3.4%) and out-field in 16 patients (27.6%). Acute grade 3 or higher gastrointestinal, genitourinary, and hematologic toxicity occurred in 2, 1, and 11patients, respectively. Three patients (5.1%) had late grade 3 toxicities. Thirteen patients experienced ovarian transposition; of these, 10 patients (77%) maintained ovarian function. Forty-one patients (71%) were alive at the last follow-up.ConclusionsConcurrent cisplatin chemotherapy with postoperative EF-IMRT was safe and well tolerated. The acute and late toxicities are acceptable. The locoregional control rates are hopeful, although distant metastases continue to be the primary mode of failure. Postoperative EF-IMRT provides an opportunity to preserve endocrine function for patients with ovarian transposition.

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