title: Ovarian repositioning in pediatric cancer patients: Flexible techniques accommodate pelvic radiation fields.
abstract: Treatments for childhood cancer and consequent long-term survival rates continue to improve. As the success of these therapies advances, premature ovarian failure and sterility have become an increasingly evident long-term morbidity. Abdominal and pelvic radiation have been specifically shown to induce early menopause and decreased fertility. In order to minimize radiation injury, we utilized novel techniques to reposition ovaries in two girls with pelvic tumors prior to initiation of pelvic radiation. One girl with a sacral Ewing sarcoma underwent laparoscopic anterior suspension of the ovaries, using a simple and easily reversible technique. The second patient, who underwent hysterectomy for a recurrent uterine rhabdomyosarcoma, underwent widely lateral and cephalad repositioning of the ovaries. Both procedures were well tolerated, with no significant morbidity. In both cases the ovaries were moved well beyond the planned radiation field. We propose that open or laparoscopic ovarian repositioning in children is a simple, flexible, and reversible option to reduce radiation injury to the ovaries in pediatric cancer patients.
authors.affiliation: Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University College of Physicians and Surgeons, New York, NY 10023, USA. rc2114@columbia.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cowles
authors.forename: Richard M
authors.initials: RM
authors.lastname: Gewanter
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Kandel
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D019060:Minimally Invasive Surgical Procedures; D010049:Ovarian Diseases / Q000209:etiology / Q000517:prevention & control*; D010053:Ovary / Q000601:surgery*; D010386:Pelvic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control*; D012208:Rhabdomyosarcoma / Q000532:radiotherapy; D012447:Sacrum; D012512:Sarcoma, Ewing / Q000532:radiotherapy; D013125:Spinal Neoplasms / Q000532:radiotherapy; D014625:Vaginal Neoplasms / Q000532:radiotherapy