Ovarian function following pelvic irradiation in prepubertal and pubertal girls and young adult women.
OBJECTIVE
To analyze the effect of pelvic radiotherapy on ovarian function in prepubertal and pubertal girls and young adult women.


METHODS
In a retrospective monoinstitutional analysis, patients < 30 years of age at diagnosis were included who had been irradiated between 1979 and 1998. The main tumor types were Hodgkin's disease (38%), Ewing's sarcoma (20%) and nephroblastoma (11%). Patients were classified into three groups according to the position of the ovary in relation to the radiation portals. Group 1 was defined by direct irradiation of both ovaries. Group 2 patients were included with both ovaries potentially located in the radiation portals. In group 3, at least one ovary was not directly irradiated. The median follow-up was 128 months.


RESULTS
16 of 55 analyzed patients were categorized in group 1. In ten of these patients, hormone status was evaluable. The ovarian doses were >/= 15 Gy. Except for one patient treated with 15 Gy all developed hormone failure. Eight of 14 patients of group 2 were evaluable. Seven of these patients developed ovarian failure. 19 of 24 patients in group 3 were evaluable. Nine of these patients developed ovarian failure. The observed difference in the rate of ovarian failure between the groups is statistically significant (p = 0.045).


CONCLUSIONS
All patients receiving > 15 Gy to the ovaries developed hormone failure. In one case of a patient receiving an ovarian dose of 15 Gy, hormone failure was not found. In case of pelvic irradiation excluding at least one ovary, approximately half of the patients developed ovarian dysfunction, probably also due to the effects of polychemotherapy.
Schuck
Andreas
A
Department of Radiotherapy, University Hospital, Muenster, Germany. schuck@uni-muenster.de
Hamelmann
Victoria
V
Brämswig
Jürgen H
JH
Könemann
Stefan
S
Rübe
Claudia
C
Hesselmann
Stefan
S
Riesenbeck
Dorothea
D
Horst
Ekkehard
E
Bölling
Tobias
T
Paulussen
Michael
M
Jürgens
Heribert
H
Willich
Normann
N
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001859:Bone Neoplasms / Q000532:radiotherapy; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000532:radiotherapy; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000532:radiotherapy; D008572:Menarche; D009369:Neoplasms / Q000532:radiotherapy*; D010049:Ovarian Diseases / Q000209:etiology*; D010053:Ovary / Q000502:physiology / Q000503:physiopathology / Q000528:radiation effects*; D011247:Pregnancy; D011627:Puberty; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000532:radiotherapy; D011795:Surveys and Questionnaires; D013997:Time Factors; D009396:Wilms Tumor / Q000532:radiotherapy