Radiation dose to laterally transposed ovaries during external beam radiotherapy for cervical cancer

Mazonakis, Michalis; Damilakis, John; Varveris, H.; Gourtsoyiannis, Nicholas

doi:10.1080/02841860600703884

Cited by 10 publications

(12 citation statements)

References 16 publications

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“…Based on derived RIs (Table 3), safety volumes for the 95th and 99th RIs would encompass 11 and 25 cm 3 for the left ovary and 24 and 54 cm 3 for the right ovary, respectively. Figure 4 shows the safety volumes (95% and 99%) superimposed onto the pre-treatment planning CT scan.…”

Section: Resultsmentioning

confidence: 99%

“…If the ovaries are adjacent to irradiation beams but not within the target volume, the dose can be minimised by the use of adequate shielding, by angulation of the treatment head or by a non-divergent border adjacent to the ovary in question. However, the level of scattered irradiation may still be sufficient to destroy function in this ovary and methods of oophoropexy (surgical relocation of the ovary) should be considered [1,3].…”

Section: Discussionmentioning

confidence: 99%

“…The radiation dose required for this to occur depends on patient age and previous exposure to chemotherapy; immediate ovarian failure results from a dose of 16.5 Gy in females younger than 20 years, while 14 Gy is sufficient in 30-year-old females [1,2]. In current clinical practice, this is either accepted as a known complication of the procedure or the ovaries are surgically transposed out of the pelvis to reduce the received dose below the ablation threshold positioning [3]. In both cases, future pregnancies would require either donor ova or in vitro fertilisation.…”

mentioning

confidence: 99%

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Assessment of ovarian movement on consecutive pelvic MRI examinations in patients with gynaecological malignancies: what is the planning organ-at-risk volume for radiotherapy?

Peters

Patterson²,

Horan³

et al. 2012

BJR

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Objectives: The aims of this study are to assess the extent of ovarian movement on consecutive MRI examinations in patients with gynaecological malignancies and to define potential safety volumes around the ovaries that may avoid ovarian ablation during pelvic irradiation. Methods: Patients with cervical, vaginal and endometrial cancer who underwent MRI examinations of the pelvis before and during radiotherapy were included in the study. The position of the ovaries was retrospectively determined on two consecutive axial and sagittal T 2 weighted MRI examinations of the pelvis. Ovarian movement was determined in craniocaudal, anteroposterior and mediolateral directions. Safety volumes were calculated by computing elliptical volumes based on the derived 95% and 99% reference intervals. Results: 30 patients with a gynaecological malignancy were included. Both ovaries could be identified on the MRI examinations in all cases. The safety volumes around the ovaries encompassing 95% and 99% of ovarian movement were 11 and 25 cm 3 (95%), and 24 and 54 cm 3 (99%), for the left and right ovary, respectively. Conclusion: Adding a safety volume around the ovaries may reduce the high radiation dose to the ovaries. This could potentially avoid ovarian ablation, reducing significant fertility morbidity.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Assessment of ovarian movement on consecutive pelvic MRI examinations in patients with gynaecological malignancies: what is the planning organ-at-risk volume for radiotherapy?

Peters

Patterson²,

Horan³

et al. 2012

BJR

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“…Radiation protocols vary in type (external-beam or brachytherapy), dose, degree of scatter, and use of shielding 45 . In cervical cancer, for example, external-beam radiation in conjunction with lead block shielding reduced radiation doses by 96%-98% at each laterally transposed ovary 54 . From a patient standpoint, vascular damage, adjuvant chemotherapy 55 , and patient age greater than 40 years 44,56 can affect success 51 .…”

Section: Ovarian Transposition and Gonadal Shieldingmentioning

confidence: 99%

Oncofertility in Canada: Gonadal Protection and Fertility-Sparing Strategies

Ronn

Holzer

2013

Current Oncology

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Background: Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. Methods: Here, we review the fertility preservation measures currently available. Medical and surgical strategies are both outlined. Results: Fertility-preserving strategies and gonadal protection have demonstrated variable success in a number of approaches. The value of hormone suppression is still in question for women. Progestins for endometrial cancer and alternative chemotherapies are other medical approaches. Gonadal shielding and protective surgical approaches have also been attempted. Conclusions: The techniques discussed here may be selectively considered and integrated into patient care in an attempt to preserve future fertility before initiating cancer treatment.

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“…Transposition can also be combined with gonadal shielding to further reduce the dose effect 148 . Using transposition, preservation of menstrual function have been reported to range from 65% to more than 88% [149][150][151] .…”

Section: Fertility-sparing Surgical Optionsmentioning

confidence: 99%