Sequelae of lateral ovarian transposition in irradiated cervical cancer patients.
Lateral ovarian transposition (LOT) is a useful technique for preserving ovarian function in "high-risk" premenopausal Stage I cervix cancer patients who undergo hysterectomy and subsequent postoperative whole pelvic radiation therapy. From 1978 to 1988, 38 FIGO Stage I cervical cancer patients underwent LOT as part of their initial operative procedure and 14 of these patients (37%) subsequently received pelvic radiation therapy (LOT + RT) because of pathological findings such as metastatic pelvic lymph node involvement or positive surgical margins (13 patients) or recurrent disease (1 patient). Ten (71%) of the 14 (LOT + RT) patients have maintained ovarian function with a median follow-up of 35 months. Preservation of ovarian function was directly related to the estimated scatter dose to the ovaries. For patients whose estimated ovarian dose was 300 cGy or less, only 1 of 9 patients (11%) underwent menopause, whereas 3 of 5 patients (60%) became menopausal if the ovarian dose was more than 300 cGy. The placement of the ovaries was also crucial for preservation of ovarian function, with 100% of the patients developing menopause if the ovaries were placed below the iliac crest. A major side effect of LOT was the development of symptomatic ovarian cysts in 7 (18%) of the 38 Stage I patients who underwent LOT. In the 24 patients who underwent LOT alone without RT, the incidence of symptomatic ovarian cysts was 25% compared to only 7% of the patients who underwent LOT + RT, although this difference was not statistically significant (p = .18).
Chambers
S K
SK
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510.
Chambers
J T
JT
Kier
R
R
Peschel
R E
RE
D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D010048:Ovarian Cysts / Q000453:epidemiology; D010053:Ovary / Q000601:surgery*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery