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Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination
Objective:
To assess the indications, effectiveness, and complications of ovarian transposition before pelvic irradiation for cervical cancer.
Design:
Prospective study.
Setting:
Gynecologic oncology department at a French cancer center.
Patient(S):
One hundred seven patients treated for cervical cancer.
Intervention(S):
Ovarian transposition to the paracolic gutters with radical hysterectomy and lymphadenectomy.
Main Outcome Measure(S):
Clinical and laboratory follow-up tests for ovarian function.
Result(S):
Bilateral ovarian transposition was achieved in 104 patients (98%). Twelve patients were lost to follow-up or excluded because of evolution of the disease. Preservation of ovarian function was achieved in 83% of the patients having follow-up. The rates of ovarian preservation were 100% for patients treated exclusively by surgery, 90% for patients treated by postoperative vaginal brachytherapy, and 60% for patients treated by postoperative external radiation therapy and vaginal brachytherapy. The main risk for ovarian failure was found in patients treated by external radiation therapy.
Conclusion(S):
Ovarian transposition is a safe and effective procedure for preserving ovarian function in patients treated by a radiosurgical combination. This procedure should be performed in patients <40 years of age with a small invasive cervical carcinoma (<3 cm) treated by initial surgery. In such selected cases, the risk of ovarian metastasis is low.