Ovarian survival after pelvic radiation: transposition until the age of 35 years

Abstract

PurposeTo evaluate the effectiveness of ovarian transposition (OT) prior to radiation therapy (RT) and to evaluate the effect of age on ovarian survival (OS) after OT.MethodsWe performed a retrospective control study, with women (aged < 45 years) who underwent OT prior to pelvic radiation, versus women diagnosed with cervical cancer and treated with hysterectomy/trachelectomy and radiation therapy. All women were treated between 1989 and 2010. The 5 years OS rate was calculated, with a sub-analysis for age (25–30; 31–35 and 36–40 years). Ovarian failure was defined as climacteric complaints (with or without starting hormone replacement therapy) and/or laboratory measurements (FSH > 40 IU/L and/or estradiol < 100 pmol/L), or bilateral salpingo oophorectomy. Women were censored at recurrence.ResultsTwenty-seven women after OT and 29 controls were included. The radiation dose was 44.8 Gy (25.0–63.0 Gy) and 46.3 Gy (45.0–50.0 Gy), respectively. The 5-year ovarian survival rate was 60.3% versus controls 0% (p < 0.001 95% CI 3.48–11.50). Despite the decrease in ovarian survival after OT with increasing age, in all age groups (25–30, 30–35 and 35–40) ovarian survival after OT was significantly better compared to women without OT (p = 0.001; p = 0.004 and p = 0.000, respectively). Neither intra-vaginal radiation therapy of concomitant chemotherapy in addition to pelvic radiation significantly altered ovarian survival.ConclusionsOur data shows that ovarian transposition prior to pelvic radiation is effective in women until the age of 35 years and needs to be discussed in patients aged 36–40 years.

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

“…OT is a surgery to transpose the ovaries out of the eld of radiation to protect them from radiation damage [12]. Hoekman et al [11] noted that the 5-year ovarian survival rate was 60.3% in patients who underwent OT before RT, whereas all patients who received RT without OT had ovarian failure, which is similar to our study. The degree of ovarian damage and ovarian failure is affected by the radiation dose of ovaries [13,14].…”

“…Ovarian transposition (OT) before pelvic irradiation is used to minimize ovarian follicle exposure to radiation and to preserve ovarian function by transposing the ovaries outside the irradiation eld [9][10][11].…”

Ovarian transposition

“…In a cohort of older patients (mean age at transposition, 33.4 years) the positive effect of OT on ovarian survival was shown in all age groups (25-30, 30-35 and 35-40) compared to women without OT. However, ovarian survival rates decreased with increasing age of patients at time of OT [16].…”

Advances in fertility-preservation surgery: navigating new frontiers

“…A recent retrospective case-control study compared women age 45 years or younger with cervical cancer who underwent ovarian transposition before pelvic radiation versus women treated with hysterectomy/ trachelectomy and radiation therapy. The 5-year ovarian survival rate was 60.3% in the transposition group versus 0% in controls (P< .001) (19). A 2019 systematic review evaluated 38 cohort studies or case series involving ovarian transposition in 765 patients.…”