Luqman Dad MD, Presenter: Nothing to Disclose

PURPOSE/OBJECTIVE(S): Premenopausal women receiving pelvic irradiation will loose ovarian function and therefore develop early menopause. In patients desiring to preserve ovarian function, an oophoropexy, followed by ovarian shielding during RT is preferred. There are few reports correlating dose delivered to the ovaries and ovarian function. We report our experience with ovarian shielding during pelvic radiation. MATERIALS/METHODS: All patients undergoing pelvic RT following oophoropexy were included in this retrospective review. Shielding of the ovaries was achieved using mounted blocks, MLCs, and primary jaws. We assessed ovarian function through a physician-administered survey, at the time of last follow-up, to determine if the patient was experiencing any symptoms of menopause, such as hot flashes, night sweats, irritability, sleep changes, change in energy levels, weight gain, loss of interest in sex, fractured bones, and yeast or urinary tract infections. RESULTS: 6 patients were identified who underwent oophoropexy at the time definitive surgery. The median age at time of oophoropexy was 33 years. The median follow-up time was 24 months. All patients received at least 45 Gy to the whole pelvis. 5 patients had invasive carcinoma of the cervix, while one patient had vulvar cancer. One patient died after 19 months without any documentation of menopausal symptoms. Of the remaining 5 patients, 2 had no menopausal symptoms, and 3 had menopausal symptoms. Of the 3 patients with menopausal symptoms, the doses to left ovary were 200, 310, and 430 cGy, and the right ovarian doses were 180 cGy, 5040 cGy, with the third patient having had the right ovary removed. Of the two patients who did not develop menopausal symptoms, one was four months post-treatment, with dose to the ovaries of 210 cGy and 190 cGy. The second patient was 19 months post-treatment, with doses to the ovaries of 110 cGy and 160 cGy. CONCLUSION: Our series documents that the strategy of oophoropexy with subsequent ovarian shielding during pelvic radiation may preserve ovarian function, thus possibly preventing early menopause. Though we are limited by our sample size, our data does suggest that limiting dose to the ovaries to less than 200 cGy may preserve ovarian function. Larger sample size, longer follow-up, and laboratory monitoring of hormone levels would aide in making more definitive conclusions on the relationship between radiation dose and ovarian function.

Dad, L, Preservation of Ovarian Function Following Oophoropexy with Subsequent Ovarian Shielding during Pelvic Irradiation for the Treatment of Gynecologic Cancer.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8502118.html