Techniques and endocrine-reproductive outcomes of ovarian transposition prior to pelvic radiotherapy in both gynecologic and non-gynecologic cancers: A systematic review and meta-analysis.

BACKGROUND: Premature ovarian failure may be a consequence of radiotherapy administered for the treatment of various female oncologic diseases. Before radiotherapy, fertility may be preserved through ovarian transposition (OT), which consists of moving the ovaries away from the radiation field. OBJECTIVE: To ascertain all types of surgical techniques employed for OT, outline the endocrine and reproductive outcomes of each one, and discover if one works better than the others. SEARCH STRATEGY: The authors performed a systematic search of the English literature looking for all studies related to OT before radiotherapy published up to June 2023. Nine studies were included. SELECTION CRITERIA: The eligible studies were assessed based on the presence of a description of the surgical technique employed for OT before pelvic radiotherapy and a report of the endocrine and reproductive outcomes. DATA COLLECTION AND ANALYSIS: Odds ratios (OR) with 95% confidence intervals were used to compare endocrine and reproductive outcomes The χ2 test was employed for the statistical analysis and a P value less than 0.05 was considered significant. MAIN RESULTS: A total of 323 female patients aged between 7 and 51 years-198 (61.3%) with non-gynecologic cancer and 125 (38.7%) with gynecologic cancer-underwent OT, either bilateral (221, 68.4%) or unilateral (102, 31.6%), before radiotherapy. Essentially, two types of OT were employed: lateral and medial. A total of 71 (22%) patients underwent medial OT and 252 (78%) patients (127 with non-gynecologic tumors and 125 with gynecologic tumors) had a lateral OT. The latter was used in a similar percentage of cases for gynecologic (50.4%) and non-gynecologic (49.6%) tumors, whereas the medial approach was performed only for non-gynecologic cancers (Hodgkin's lymphoma). The difference between medial OT and lateral OT was not significant regarding the preservation of endocrine function (OR 0.65, P = 0.120). However, midline OT worked better in terms of reproductive outcomes. In fact, the percentage of patients with pregnancy (49.2%) and live births (45%) associated with medial OT was significantly higher than that associated with lateral OT, 6.5% and 13.4%, respectively, and the difference between such data was statistically significant (OR 7.04, P = 0.001 and OR 5.29, P = 0.003, respectively). CONCLUSIONS: Ovarian transposition is an important method to preserve fertility before radiotherapy, considering the worldwide ongoing use of this treatment for various cancers arising in young women. The surgical method depends on the type of disease, but OT-especially medial OT when feasible-is effective in terms of ovarian function preservation and reproductive outcomes.

Management of gynecological cancer in pregnant patients.

INTRODUCTION: Cancer during pregnancy is a rare but challenging condition. More women delay childbearing and consequently the incidence of cancer during pregnancy is constantly increasing. EVIDENCE ACQUISITION: An extensive electronic search was performed in PubMed and Scopus. Only studies written after 1985 were considered eligible for this review. Abstracts, conference papers, book chapters, animal studies, commentaries as well as editorials articles were excluded from this review. EVIDENCE SYNTHESIS: Cancer treatment during pregnancy is possible, but both maternal and fetal conditions need to be preserved. Randomized clinical trials are not feasible and current evidence are mainly based on case-series, small case reports and expert opinion. Cervical and ovarian cancers are the most common gynecological cancers diagnosed during pregnancy. Surgery and chemotherapy after the first trimester seem to be relatively safe for the newborn. Platinum-based chemotherapy administered during the 2nd-3rd trimester showed comparable adverse effects in newborns to those in the general population. Babies exposed to antenatal chemotherapy might be more likely to develop small for gestational age and NICU admission, than babies not exposed. CONCLUSIONS: Management of pregnant women with cancer should be performed in specialized cancer centers and all cases should be discussed with a multidisciplinary approach. In the present review, we discuss the current recommendations for the management of pregnancies complicated by cancer and neonatal outcomes.

Intrafollicular nerve growth factor concentration in patients with polycystic ovary syndrome: a case-control study.

BACKGROUND: To evaluate the concentration of nerve growth factor (NGF) in follicular fluid of women affected by polycystic ovary syndrome (PCOS) undergoing to In Vitro Fertilization cycle. METHODS: In the context of an in-vivo study, a sample of 52 women was considered: 20 were without pathology (male infertility - control group) and 32 were affected by PCOS. All patients received a long stimulation protocol and the oocytes obtained by pick-up were fertilized with standard procedures of intracytoplasmic sperm injection (ICSI). Samples of follicular fluid (FF) were collected at oocyte pick-up. After centrifugation at 560 × g for 3 min, follicular fluid samples were frozen at -80 °C. After thawing the values of NGF in FF were determined by enzyme immunoassay ELISA using commercially available NGF enzyme-linked immunosorbent assay kits. The results of study were analyzed statistically with Student's t-test. RESULTS: The content of NGF was higher in FF of PCOS patients (2023.30±587.09 pg/mL) in comparison with control group (1704.09±326.8 pg/mL; P<0.05). The levels of serum estrogen (E2) were higher in patients with PCOS (1724.24±635.79 pg/mL) than in control group (1305.3±298.12 pg/mL; P<0.05). The number of retrieved oocytes was more in PCOS patients (9.7±4.6) than in control group (8±4.4), but oocytes in metaphase II were similar in two groups (6.2±2.4 vs. 6.09±4). CONCLUSIONS: The present results show that ovaries of PCOS patients produce more NGF than non-PCOS patients; it confirms that an excess of ovarian NGF might be an abnormality contributing to polycistic ovary morphology and PCOS.

Management of uterine fibroids in pregnancy: recent trends.

PURPOSE OF REVIEW: The review analyzes how fibroids may influence pregnancy and how myomas may be modified by pregnancy. The most important clinical aspect concerns the impact of myoma on pregnancy and the possibility of a well tolerated surgical treatment for the mother and her fetus, preserving maternal reproductive capacity. RECENT FINDINGS: Fibroids significantly increase in size during early pregnancy and then decrease in the third trimester. Although most women with uterine fibroids have a regular pregnancy, data from the literature suggest that they may have a higher risk of fertility problems and pregnancy complications. SUMMARY: Myomectomy can increase the rate of pregnancy in women with infertility, attempting to restore a normal anatomy and reduce uterine contractility and local inflammation associated with the presence of fibroids, improving the blood supply. Current evidence does not suggest routine myomectomy during pregnancy or at the cesarean birth, as fibroids-related complications are rare and may be overcome by the risks of surgery. However, in selected cases, myomectomy is a feasible and safe technique and associated to a good outcome.The diagnosis of myomas in pregnancy may require attention for the adequate management to preserve maternal and fetal well-being.