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Effect of radiotherapy on ovarian function in patients undergoing radical surgery for cervical cancer
An Jusheng1, Du Xiaomeng1, Zhang Feng1, Chen Jiayun2, Dai Jianrong2, Huang Manni1, Wu Lingying1
1Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021,China; 2Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021,China
AbstractObjective 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 ≥V5Gy (P=0.025). V8 Gy and Dmean were positively correlated with FSH after treatment (P=0.011, 0.020). The larger the volume of V8Gy and the large Dmean, the higher the FSH, the worse the ovarian function. In two-dimensional technology, the ovarian dose ≥V5Gy 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, V8Gy 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.
An Jusheng,Du Xiaomeng,Zhang Feng et al. Effect of radiotherapy on ovarian function in patients undergoing radical surgery for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2019, 28(10): 753-757.
An Jusheng,Du Xiaomeng,Zhang Feng et al. Effect of radiotherapy on ovarian function in patients undergoing radical surgery for cervical cancer[J]. Chinese Journal of Radiation Oncology, 2019, 28(10): 753-757.
[1] 赵焕章. 子宫颈癌的卵巢保留问题. 卵巢移植保留[J]. 国外医学妇产科学分册,1985,17(4):220. Zhao HZ. Ovarian retention in cervical cancer. Ovarian transplantation retention[J]. Fore Med Obstet Gynecol Fasci,1985,17(4):220. [2] Buekers TE,Anderson B,Sorosky JI,et al. Ovarian function after surgical treatment for cervical cancer[J]. Gynecol Oncol,2001,80(1):85-88. DOI:10.1006/gyno.2000.6039. [3] Anderson B,LaPolla J,Turner D,et al. Ovarian transposition in cervical cancer[J]. Gynecol Oncol,1993,49(2):206-114. [4] Chen J,Chen X,Huang M,et al. A fixed-jaw method to protect critical organs during intensity-modulated radiotherapy[J]. Med Dosim,2014,39(4):325-329. DOI:10.1016/j.meddos.2014.05.006. [5] Koh WJ,Abu-Rustum NR,Bean S,et al. Cervcial cancer. NCCN clinical practice guideline in oncology,version 1.2018[DB][2018-08-28].http//:www.nccn.org. [6] Morice P,Juncker L,Rey A,et al. Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination[J]. Fertil Steril,2000,74(4):743-748. [7] Winarto H,Febia E,Purwoto G,et al. The need for laparoscopic ovarian transposition in young patients with cervical cancer undergoing radiotherapy[J]. Int J Reprod Med,2013,2013:173568. DOI:10.1155/2013/173568. [8] Du Z,Qu H. The relationship between ovarian function and ovarian limited dose in radiotherapy postoperation of ovarian transposition in young patients with cervical cancer[J]. Cancer Med,2017,6(3):508-515. DOI:10.1002/cam4.924. [9] Dursun P,Ayhan A,Yanik FB,et al. Ovarian transposition for the preservation of ovarian function in young patients with cervical carcinoma[J]. Eur J Gynaecol Oncol,2009,30(1):13-15. [10] Yoshihiro U,Shingo O,Masaru I,et al. Strategies for reducing ovarian dose in volumetric modulated arc therapy (VMAT) for postoperative uterine cervical cancer[J]. Br J Radiol,2018,91(1081):20160777. DOI:10.1259/bjr.20160777. [11] Koh WJ,Greer BE,Abu-Rustum NR,et al. Cervical cancer,version 2.2015[J]. J Natl Compr Canc Netw,2015,13(4):395-404. [12] Kase KR,SGK,Chen DTS. Radial distribution of scattered and leakage radiation dose for radiotherapeutic equipment[R]. Geneva:IAEA,1982:111-124.
2019, Vol. 28 
