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Review
Ovarian transposition in patients with cervical cancer prior to pelvic radiotherapy: a systematic review
  1. Barbara Buonomo1,
  2. Francesco Multinu2,3,
  3. Jvan Casarin4,
  4. Ilaria Betella2,
  5. Vanna Zanagnolo2,
  6. Giovanni Aletti2,5 and
  7. Fedro Peccatori1
  1. 1 Fertility and Procreation Unit, Division of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
  2. 2 Division of Gynecologic Surgery, IEO, European Institute of Oncology IRCSS, Milan, Italy
  3. 3 Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
  4. 4 Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
  5. 5 Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
  1. Correspondence to Dr Francesco Multinu, Division of Gynecologic Surgery, IEO, European Institute of Oncology IRCSS, 20141 Milan, Italy; Francesco.Multinu{at}ieo.it

Abstract

Ovarian transposition aims to minimize ovarian exposure and damage during pelvic radiotherapy. One or both ovaries are separated from the uterus and mobilized away from the area where the radiation will be administered. A review of the available literature was conducted to evaluate the efficacy and safety of ovarian transposition among pre-menopausal women diagnosed with cervical cancer and eligible for pelvic radiotherapy. Outcomes evaluated were ovarian function preservation and complication rates. We also searched for information on pregnancy/live birth rates after ovarian transposition. Our search yielded a total of 635 manuscripts, of which 33 were considered eligible. A total of 28 full texts were selected for the current review, including 1377 patients who underwent ovarian transposition. The median or mean follow-up ranged between 7 and 87 months. Ovarian function preservation after ovarian transposition and pelvic radiotherapy, with or without chemotherapy, was 61.7% (431/699 patients), ranging from 16.6% to 100%. A total of 12 studies reported on 117 complications, accounting for 8.5%. Ovarian metastases were described in 5 (0.4%). Data about fertility preservation after ovarian transposition are scarce and definitive conclusions cannot be drawn. Based on the available data, ovarian transposition could be performed on young patients with tumors smaller than 4 cm, and it should be avoided in those with bulky tumors. A risk/benefit assessment should be carefully evaluated by a multidisciplinary team, and the decision regarding ovarian transposition should be always guided by the values and informed preferences of the patient.

  • cervical cancer
  • radiotherapy

https://doi.org/10.1136/ijgc-2020-001774

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    Footnotes

    • FM and FP are joint senior authors.

    • Twitter @Fmultinu, @fedrophd

    • Contributors BB and FM conducted primary research and drafted the original manuscript, all authors contributed to reviewing, editing, and approving the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.