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

Autor: Hoekman EJ; Department of gynecology, Leiden University Medical Center, P/O Box 9600, 2300RC, Leiden, The Netherlands. e.j.hoekman@lumc.nl., Knoester D; Department of gynecology, Leiden University Medical Center, P/O Box 9600, 2300RC, Leiden, The Netherlands., Peters AAW; Department of gynecology, Leiden University Medical Center, P/O Box 9600, 2300RC, Leiden, The Netherlands., Jansen FW; Department of gynecology, Leiden University Medical Center, P/O Box 9600, 2300RC, Leiden, The Netherlands., de Kroon CD; Department of gynecology, Leiden University Medical Center, P/O Box 9600, 2300RC, Leiden, The Netherlands., Hilders CGJM; Department of Gynecology, Reinier de Graaf Gasthuis Delft, Delft, The Netherlands.
Jazyk: angličtina
Zdroj: Archives of gynecology and obstetrics [Arch Gynecol Obstet] 2018 Nov; Vol. 298 (5), pp. 1001-1007. Date of Electronic Publication: 2018 Sep 14.
DOI: 10.1007/s00404-018-4883-5
Abstrakt: Purpose: To 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.
Methods: We 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.
Results: Twenty-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.
Conclusions: Our 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.
Databáze: MEDLINE
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