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Ovarian preservation techniques for female pelvic radiotherapy techniques: a critical review

Published online by Cambridge University Press:  18 October 2016

A Durrant  and
P Bridge
A Durrant
Affiliation:
Directorate of Medical Imaging and Radiotherapy, University of Liverpool, Liverpool, UK
P Bridge*
Affiliation:
Directorate of Medical Imaging and Radiotherapy, University of Liverpool, Liverpool, UK
*
Correspondence to: Pete Bridge, Directorate of Medical Imaging and Radiotherapy, University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK. Tel: 0151 7958366; E-mail: pete.bridge@liverpool.ac.uk
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Abstract

Introduction

Advances in treatment over recent years have increased the long-term survival of young, female cancer patients; unfortunately these treatments bring a significant risk of ovarian failure and infertility. This literature review aimed to determine the optimal technique for ovarian preservation in pre-menopausal women receiving pelvic radiotherapy (IMRT). The traditional method comprises surgical transposition; IMRT and other emerging techniques may offer alternative non-invasive means of sparing ovaries and minimising dose.

Methods

A critical review of the evidence pertaining to pelvic radiotherapy and ovarian sparing was performed. Evidence was subjected to critical appraisal using the Critical Appraisal Skills Programme tool and thematic analysis of the findings identified key issues.

Results

Surgical transposition appears to be a successful method of preserving ovarian function depending on the position of the ovaries outside of the radiation field, the age of the patient and the total dose received by the ovaries. There is limited modern evidence concerning its usage in relation to emerging techniques and technology. The use of IMRT is certainly widespread in the treatment of female pelvic cancers, however, there is no evidence supporting its use for reduction of ovarian dose. Several other studies have attempted to demonstrate new techniques to preserve ovarian function, but no functional outcome measures have reinforced their results.

Conclusions

Ovarian transposition has a proven track record for preservation of ovarian function, but the potential value of IMRT as a viable alternative to date remains unexplored. New work should be encouraged to determine the potential value of IMRT as a non-surgical alternative.

Keywords

intensity-modulated radiotherapyovaryradiotherapysurgical transposition
Type
Literature Reviews
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 1 , March 2017 , pp. 73 - 78
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Copyright
© Cambridge University Press 2016 

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References

1. Dickman, P, Adami, H. Interpreting trends in cancer patient survival. J Intern Med 2006; 260 (2): 103–117.Google Scholar
2. Mundt, A, Lujan, A, Rotmensch, J et al. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2002; 52 (5): 1330–1337.Google Scholar
3. Dryden, A, Ussher, J, Perz, J. Young women’s construction of their post-cancer fertility. Psychol Health 2014; 9 (11): 1341–1360.Google Scholar
4. Greil, A, Slauson-Blevins, K, McQuillan, J. The experience of infertility: a review of recent literature. Sociol Health Illn 2010; 32 (1): 140–162.Google Scholar
5. Chambers, S, Chambers, J, Kier, R, Peschel, R. Sequelae of lateral ovarian transposition in irradiated cervical cancer patients. Int J Radiat Oncol Biol Phys 1991; 20 (6): 1305–1308.Google Scholar
6. Wallace, W, Thomson, A, Saran, F, Kelsley, T. Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys 2005; 62 (3): 738–744.Google Scholar
7. Mazonakis, M, Damilakis, J, Varveris, H, Gourtsoyiannis, N. Radiation dose to laterally transposed ovaries during external beam radiotherapy for cervical cancer. Acta Oncol 2006; 45 (6): 702–707.Google Scholar
8. Haie-Meder, C, Mlika-Cabanne, N, Michel, G et al. Radiotherapy after ovarian transposition: ovarian function and fertility preservation. Int J Radiat Oncol Biol Phys 1993; 25 (3): 419–424.Google Scholar
9. Morice, P, Juncker, L, Rey, A, El-Hassan, J, Haie-Meder, C, Castaigne, D. Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination. Fertil Steril 2000; 74 (4): 743–748.Google Scholar
10. Anderson, B, LaPolla, J, Turner, D, Chapman, G, Buller, R. Ovarian transposition in cervical cancer. Gynecol Oncol 1993; 49 (2): 206–214.Google Scholar
11. Farber, L, Ames, J, Rush, S, Gal, D. Laparoscopic ovarian transposition to preserve ovarian function before pelvic radiation and chemotherapy in a young patient with rectal cancer. MedGenMed 2005; 7 (1): 66.Google Scholar
12. Yarali, H, Demirol, A, Bukulmez, O, Coskun, F, Gurgan, T. Laparoscopic high lateral transposition of both ovaries before pelvic irradiation. J Am Assoc Gynecol Laprosc 2000; 7 (2): 237–239.CrossRefGoogle ScholarPubMed
13. Schulz-Lobmeyr, I, Schratter-Sehn, A, Huber, J, Wenzl, R. Laparoscopic lateral ovarian transposition before pelvic irradiation for a Non Hodgkin Lymphoma. Acta Obstet Gyn Scan 1999; 78 (4): 350–352.Google Scholar
14. Falcone, T, Attaran, M, Bedaiwy, M, Goldburg, J. Ovarian function preservation in the cancer patient. Fertil Steril 2004; 81 (2): 243–257.Google Scholar
15. D’Souza, D, Rumble, R, Fyles, A et al. Intensity-modulated radiotherapy in the treatment of gynaecological cancers. Clin Oncol 2012; 24 (7): 499–507.Google Scholar
16. Fiorino, C, Valdagni, R, Rancati, T, Sanguineti, G. Dose-volume effects for normal tissues in external radiotherapy: pelvis. Radiother Oncol 2009; 93 (2): 153–167.Google Scholar
17. Roeske, J, Lujan, A, Rotmensch, J, Waggoner, S, Yamada, D, Mundt, A. Intensity-modulated whole pelvic radiation therapy in patients with gynecologic malignancies. Int J Radiat Oncol Biol Phys 2000; 48 (5): 1613–1621.Google Scholar
18. Peters, N, Petterson, A, Horan, G, Gregory, D, Sala, E. Assessment of ovarian movement on consecutive pelvic MRI examinations in patients with gynaecological malignancies: what is the planning organ-at-risk volume for radiotherapy? Br J Radiol 2012; 85: 1407–1414.Google Scholar
19. Soda, I, Ishiyama, H, Ono, S et al. Assessment of transposed ovarian movement: how much of a safety margin should be added during pelvic radiotherapy? J Radiat Res 2015; 56 (2): 1–6.Google Scholar
20. Hong, L, Alektiar, K, Chui, C et al. IMRT of large fields: whole-abdomen irradiation. Int J Radiat Oncol Biol Phys 2002; 54 (1): 278–289.CrossRefGoogle ScholarPubMed
21. Lujan, A, Mundt, A, Yamada, D, Rotmensch, J, Roeske, J. Intensity-modulated radiotherapy as a means of reducing dose to bone marrow in gynecologic patients receiving whole pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2003; 57 (2): 516–521.Google Scholar
22. Oktay, K, Bedoschi, G. Oocyte cryopreservation for fertility preservation in postpubertal female children at risk for premature ovarian failure due to accelerated follicle loss in turner syndrome or cancer treatments. J Pediatr Adolesc Gynecol 2014; 27 (6): 342–346.Google Scholar
23. Lee, C, Bilton, S, Famigliettie, R et al. Treatment planning with protons for pediatric retinoblastoma, medulloblastoma, and pelvic sarcoma: how do protons compare with other conformal techniques? Int J Radiat Oncol Biol Phys 2005; 63 (2): 362–372.Google Scholar
24. The Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2012; 98 (6): 1407–1415.Google Scholar
25. Liu, Y, Shiau, C, Lee, M et al. The role and strategy of IMRT in radiotherapy of pelvic tumors: dose escalation and critical organ sparing in prostate cancer. Int J Radiat Oncol Biol Phys 2007; 67 (4): 1113–1123.CrossRefGoogle ScholarPubMed