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Objective:To compare the dosimetric difference between IMRT and VMAT plans for ovarian protection after cervical cancer ovarian transposition surgery.Methods:Thirty-one patients who had received both cervical cancer resection and ovarian transposition were selected for adjuvant radiotherapy. The 9-field evenly divided IMRT and the dual-arc VMAT technology were performed for the treatment planning. The difference of the ovarian mean dose between the two techniques was explored. The relationship between the position of the ovarian-target interval and the ovarian dose was also analyzed.Results:A total of 54 ovaries in 31 patients were effectively transposed and moved out of the target area. Among them, 9 ovaries were located above the upper boundary of the PTV. For these cases, the ovarian mean dose of IMRT and VMAT were (177.8±90.7) and (166.7±70.6) cGy, respectively, which was not statistically different( P>0.05).45 ovaries were located in the same level with PTV. For these cases, the ovarian mean dose of IMRT and VMAT were (459.1±239.9) and (428.3±238.2) cGy, respectively ( z=3.11, P=0.002). The ovarian mean dose has the highest correlation and negative correlation with the closest lateral distance from the ovarian volume center to the PTV surface (IMRT, r=-0.922, P=0.001; VMAT, r=-0.865, P=0.001). To reduce the ovarian mean dose to 500 cGy, the lateral closest distance between the ovarian volume center and the PTV surface should be 3.6 cm and 3.3 cm for IMRT and VMAT respectively. Conclusions:There is no difference between the two planned ovarian doses when the ovaries were located above the upper boundary of the PTV. When the ovaries were located in the same level with PTV, the VMAT plan is better than IMRT in both ovarian dose and treatment efficiency. The ovarian dose could be predicted by the lateral closest distance from the ovarian volume center to the PTV.
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Objective@#The correlation between dosimetric parameters of transposed ovary and different clinical ovarian functional status was assessed in young patients with cervical cancer who needed adjuvant radiotherapy after radical resection of the ⅠB1-ⅡA2 phase of preserved and transposed ovaries.@*Methods@#The function of transposed ovary and relevant clinical symptoms in 86 patients before and 2 years after treatment between 2015 and 2017 were retrospectively analyzed, and the correlation between the dosimetric parameters and functional status of transposed ovaries during radiotherapy was evaluated. Different in vitro measures were adopted to protect the transposed ovaries during postoperative radiotherapy including 68 cases of IMRT or VMAT and 18 cases of two-dimensional and other central radiotherapy.@*Results@#The nearest distance between ovary and PTV was negatively correlated with the ovarian dose ≥V5 Gy (P=0.025). V8 Gy and Dmean were positively correlated with FSH after treatment (P=0.011, 0.020). The larger the volume of V8 Gy and the large Dmean, the higher the FSH, the worse the ovarian function. In two-dimensional technology, the ovarian dose ≥V5 Gy was significantly lower than that in three-dimensional technique. The average age of those with normal ovarian function after treatment was 33.4 years, whereas the average age of women with ovarian failure was 39.6 years (P=0.007). The number of preserved ovaries and whether synchronous chemotherapy was delivered were similar in patients with different ovarian status, which were correlated with the levels of FSH and E2 (Estradiol) before treatment, that is, the higher the level of FSH before treatment, the lower the E2 of ovarian FSH after treatment, and the higher the level of FSH after treatment, the lower the level of ovarian E2. Patients who retained their ovaries before treatment but suffered from ovarian failure received neoadjuvant chemotherapy with a slightly higher age.@*Conclusions@#Age, V8 Gy and Dmean of the transposed ovary, the shortest distance between transposed ovary and PTV, whether neoadjuvant chemotherapy was delivered before surgery and radiotherapy technique affect the protection of the function of transposed ovary.
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Objective The correlation between dosimetric parameters of transposed ovary and different clinical ovarian functional status was assessed in young patients with cervical cancer who needed adjuvant radiotherapy after radical resection of the Ⅰ B1-Ⅱ A2 phase of preserved and transposed ovaries.Methods The function of transposed ovary and relevant clinical symptoms in 86 patients before and 2 years after treatment between 2015 and 2017 were retrospectively analyzed,and the correlation between the dosimetric parameters and functional status of transposed ovaries during radiotherapy was evaluated.Different in vitro measures were adopted to protect the transposed ovaries during postoperative radiotherapy including 68 cases of IMRT or VMAT and 18 cases of two-dimensional and other central radiotherapy.Results The nearest distance between ovary and PTV was negatively correlated with the ovarian dose ≥ V5 Gy (P=0.025).Vs Gy and D were positively correlated with FSH after treatment (P=0.011,0.020).The larger the volume of Vs Gy and the large D the higher the FSH,the worse the ovarian function.In two-dimensional technology,the ovarian dose ≥ V5 Gy was significantly lower than that in three-dimensional technique.The average age of those with normal ovarian function after treatment was 33.4 years,whereas the average age of women with ovarian failure was 39.6 years (P=0.007).The number of preserved ovaries and whether synchronous chemotherapy was delivered were similar in patients with different ovarian status,which were correlated with the levels of FSH and E2 (Estradiol) before treatment,that is,the higher the level of FSH before treatment,the lower the E2 of ovarian FSH after treatment,and the higher the level of FSH after treatment,the lower the level of ovarian E2.Patients who retained their ovaries before treatment but suffered from ovarian failure received neoadjuvant chemotherapy with a slightly higher age.Conclusions Age,V8 Gy and D of the transposed ovary,the shortest distance between transposed ovary and PTV,whether neoadjuvant chemotherapy was delivered before surgery and radiotherapy technique affect the protection of the function of transposed ovary.
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Objective To investigate the changes in ovarian function and the radiotheraputic influence on ovarian function on patients with cervical squamous cell carcinoma.Methods We retrospectively analyzed 53 cases of cervical cancer patients FIGO staging Ⅰ B1-Ⅱ B who had received ovarian transposition surgery at the Maternal and Child Health Hospital of Jiangxi province from January 2009 to June 2012.All the patients included in the study were FIGO staging Ⅰ B1-Ⅱ B and had undergone radiation therapy,including 38 staging Ⅰ B1-Ⅱ A2 cervical cancer patients receiving chemo-therapy after radical radiotherapy due to the presence of risk factors and other 15 patients with stage Ⅱ B to radical concurrent chemoradiotherapy ovarian transposition.Ovarian transposition methods would include laparoscopic ovarian transposition and transabdominal ovarian transposition.15 concurrent patients with stage Ⅱ B who currently receiving chemo-radiotherapy were under laparoscopic ovarian transposition.Among the 38 radical hysterectomy patients,31 were having abdominal ovarian transposition,and the remaining 7 cases were laparoscopic.All the 53 patients had undergone radiotherapy.The levels of serum female hormones FSH,LH,E2 were determined to monitor the ovarian endocrine function.Results According to FIGO staging,18 cases were stage Ⅰ B 1,15 cases Ⅰ B2,3 cases Ⅱ A1,2 cases Ⅱ A2 and 15 cases Ⅱ B.Patients' age range was from 28 to 44 years old,with an average of 37.7 years,median age as 38 years.14 patients (63.6％) were still normal ovarian function after radiotherapy by laparoscopic ovarian transposition,which was 100.0％before radiotherapy.There was a significant difference (P＜0.05) compared with before radiotherapy.After transabdominal ovarian transposition surgery and radiotherapy,normal ovarian function 22 cases (71.0％),and there was a significant difference (P＜0.05) compared with before radiotherapy.No significant difference was found with regard to the proportion of normal ovarian function after radiotherapy between the two groups of patients with laparoscopic and transabdominal ovarian transposition (P＞0.05).Conclusion For the young cervical cancer patients,even with ovarian transposition,ovarian dysfunction was still evident after radiotherapy.There was no significant difference between laparoscopic and transabdominal ovarian transposition.
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A 35-year-old woman underwent laparoscopic radical hysterectomy, pelvic lymphadenectomy and ovarian transposition for stage IB2 cervical adenocarcinoma. She received adjuvant concurrent chemoradiation for poor pathologic risk factors but had tumor recurrence 20 months after the surgery. Transposed ovaries were uninvolved in the recurrence and progression. Salvage chemotherapy and radiotherapy were given. Despite systemic chemotherapy and repeat pelvic radiotherapy, the patient was able to maintain ovarian function. Ovarian transposition in cervical cancer is an easily performed procedure that does not alter the prognosis of the disease in some cases. Present recommendations for its use should be reevaluated so that more premenopausal cancer patients may benefit from this underutilized procedure.
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Female , Humans , Adenocarcinoma , Hysterectomy , Laparoscopy , Lymph Node Excision , Ovary , Prognosis , Quality of Life , Recurrence , Risk Factors , Uterine Cervical NeoplasmsABSTRACT
Objective To investigate the relation of resistant index and function of transposited ovaries following radical hysterectomy in young women with early stage of cervical cancer.Methods A total of 22 young women(aged from 26 to 40 years old)with early stage of cervical cancer(FIGO Ⅰ a or Ⅱ a)were studied from Aug.1997 to Sep.2004 in the Affiliated Hospital of Inner Mongolia Medical Collage.Ovarian transposition was performed at the time of radical hysterectomy and pelvic lymphadenectomy in 12 cases who received postoperative radiotherapy;the rest 10 cases did not receive postoperative radiotherapy.Ovarian function was evaluated by serum FSH,LH,E_2 and B-ultrasonography in all of the cases.Results There was a statistically significant difference between the radiotherapy group and the non-radiotherapy group in serum E_2,FSH,LH levels and RI at the 24th month postoperatively.RI had a negative correlation with E_2 and positive correlation with FSH.Conclusion Ovarian transplantation can preserve the endocrine function of ovary for young women with cervical cancer.RI has a negative correlation with E_2 and positive correlation with FSH.RI is the important index of supervising ovarian function.Postoperative radiotherapy can influence RI and ovarian function.
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Objective To explore the impact of ovarian function in young patients of early cervical cancer after ovarian shift surgery. Methods 6 young patients with cervical cancer were given radical surgery for ovarian transposition at the same time, before and 1 and 6 months after operation, blood FSH, LH, E2 were measured. B-ultrasound was used to monitor ovarian ovarian function. Results 4 patients after 1 month postoperative, 1 case after postoperative 6 months with normal ovarian function, 1 case of pre-operative radiotherapy after 6 months the resumption the ovarian function restoration. Conclusion Young cervical cancer patients with ovarian transposition can maintain good ovarian function.
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In case of young women treated with ovarian preservation in cervical cancer surgery, it is regarded pertinent to reduce the risk of early menopause resulting from adjuvant pelvic irradiation through ovarian transposition. On the other hand, lots of authors have raised questions in regard with the ovary being possibly affected by micrometastasis. Studies have reported appropriate indications of ovarian transposition and risk factors of ovarian metastasis to cope with this problem. We conducted ovarian transposition with cervical cancer patient who had no ovarian metastasis risk factors reported in previous literature and experienced such case that metastasis took place only in the ovary without spreading to other organs. This study is to report that case based on brief literature review.