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  • #282 Uterine transposition versus uterine ventrofixation before radiotherapy as a fertility sparing option in young women with pelvic malignancies: systematic review of the literature and dose simulation

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Poster/ePoster Sessions
04. Fertility/Pregnancy
#282 Uterine transposition versus uterine ventrofixation before radiotherapy as a fertility sparing option in young women with pelvic malignancies: systematic review of the literature and dose simulation
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  1. Matteo Pavone1,2,3,
  2. Rosa Autorino4,
  3. Nicolò Bizzarri3,
  4. Giuditta Chiloiro4,
  5. Vincenzo Valentini4,5,
  6. Giacomo Corrado3,
  7. Gabriella Ferrandina3,5,
  8. Gabriella Macchia6,
  9. Maria Antonietta Gambacorta4,5,
  10. Giovanni Scambia3,5 and
  11. Denis Querleu3
  1. 1Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
  2. 2IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, strasbourg, France
  3. 3UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  4. 4UOC Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  5. 5Università cattolica del Sacro Cuore, Rome, Italy
  6. 6Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy

Abstract

Introduction/Background Neoadjuvant (chemo)radiation may be required treatment of pelvic malignancies in female patients of reproductive age. Irradiation may result in a damage to ovarian and uterine function, compromising the ability of those patients to conceive. While ovarian transposition is an established method to move the ovaries away from the irradiation field, similar surgical procedures regarding the uterus remain investigational. The aim of this study was to carry out a systematic review of the literature on uterine displacement techniques (ventrofixation/transposition) and to simulate the radiation dose received by the uterus in different heights place after the procedures.

Methodology The systematic review was conducted in accordance with the PRISMA guidelines. The study protocol was registered on PROSPERO (CRD42023391278). Retrospectively, a dosimetric study was performed to assess the dose received by the uterus according to hypothetical different displacement positions taking the case of irradiation for rectal or anal cancer as model.

Results A total of 187 studies were included in the initial research, after the screening 9 studies were selected for qualitative synthesis. Data from the dose simulation revealed that in the anatomical position the maximum and median doses were for the rectal cancer 46.5 and 25.2 Gy and for the anal cancer 58.4 and 34.5 Gy respectivetly.

The transposition approach was the most protective with a maximum dose of about 3 and 8 Gy for anal and rectal cancer. None of the simulated US ventrofixation positions, in both cases, received a Dmean surpassing 14 Gy, and the US volumes receiving 14 or 20 Gy for all simulated ventrofixation positions were remarkably small.

Conclusion According to the literature review and the simulation results of the present study we may conclude that simple elevation of the uterus by ventrofixation of the fundus could be considered as a fertility sparing approach in young rectal/anal cancer patients.

Abstract #282 Figure 1
Abstract #282 Figure 1

Uterine dose simulation and Uterine displacement procedures

Disclosures none

https://doi.org/10.1136/ijgc-2023-ESGO.421

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