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676 Fertility-sparing uterine displacement for pelvic malignancies: surgical options and radiotherapy dosimetry on a human cadaver
  1. Matteo Pavone1,2,3,
  2. Laure Waeldin4,
  3. Lise Lecointre1,5,6,
  4. Nicolò Bizzarri3,
  5. Didier Mutter1,
  6. Delphine Jarnet7,
  7. Antonello Forgione2,
  8. Noel Georges4,
  9. Cherif Akladios6,
  10. Giovanni Scambia3,
  11. Jacques Marescaux2,
  12. Barbara Seeliger1,5,8 and
  13. Denis Querleu1,3
  1. 1Institut Hospitalo-Universitaire (IHU) Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
  2. 2IRCAD, Research Institute Against Digestive Cancer France, Strasbourg, Strasbourg, France
  3. 3Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Rome, Italy
  4. 4Radiation Therapy University Department, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
  5. 5ICube UMR 7357-Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie, CNRS, University of Strasbourg, Strasbourg, France
  6. 6Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
  7. 7Medical Physics Unit, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
  8. 8University Hospitals of Strasbourg, Department of Digestive and Endocrine Surgery, Strasbourg, France

Abstract

Introduction/Background Radio(chemo)therapy is often required in pelvic malignancies (cancer of the anus, rectum, cervix). Direct irradiation adversely affects ovarian and endometrial function, compromising the fertility of women. While ovarian transposition is an established method to move the ovaries away from the radiation field, surgical procedures to displace the uterus are investigational. This study demonstrates the surgical options for uterine displacement in relation to the radiation dose received.

Methodology The uterine displacement techniques were carried out sequentially in a human female cadaver to demonstrate each procedure step by step and assess the uterine positions with dosimetry CT scans in a hybrid operating room. Two treatment plans (anal and rectal cancer) were simulated on each of the four dosimetry scans (1.anatomical position, 2.uterine suspension of the round ligaments to the abdominal wall 3.ventrofixation of the uterine fundus at the umbilical level, 4.uterine transposition).Treatments were planned on Eclipse® System (Varian Medical Systems®,USA) using Volumetric Modulated Arc Therapy. Data about maximum (Dmax) and mean (Dmean) radiation dose received and the uterine volume receiving 14Gy(V14Gy) were collected.

Results All procedures were completed without technical complications. In the rectal cancer simulation with delivery of 50Gy to the tumor, Dmax, Dmean and V14Gy to the uterus were respectively 52,8Gy, 34,3Gy and 30,5cc (1), 31,8Gy, 20,2Gy and 22.0cc (2), 24,4Gy, 6,8Gy and 5.5cc (3), 1,8Gy, 0,6Gy and 0.0cc (4). For anal cancer, delivering 64Gy to the tumor respectively 46,7Gy, 34,8Gy and 31,3cc (1), 34,3Gy, 20.04Gy and 21,5cc (2), 21,8Gy, 5,9Gy and 2,6cc (3), 1,4Gy, 0,7Gy and 0.0cc (4).

Conclusion The feasibility of several uterine displacement procedures was safely demonstrated. Increasing distance to the radiation field requires more complex surgical interventions to minimize radiation exposure. Surgical strategy needs to be tailored to the multidisciplinary treatment plan, and uterine transposition is the most technically complex with the least dose received.

Disclosures None.

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