Modern radiation therapy and potential fertility preservation strategies in patients with cervical cancer undergoing chemoradiation

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Abstract

Young patients with cervical cancer who undergo chemoradiation might be interested in fertility preservation, not only dependent upon the use of a gestational carrier as maybe achieved by the use of ovarian transposition and cryo-conservation of oocytes or ovarian tissue, but may prefer to carry pregnancy to term after cancer treatment. The latter approach is a non-established concept needing both modern radiation therapy approaches as well as modifications -if at all possible- in current recommendations for target volume delineation to spare dose to the unaffected uterus. Future strategies to serve selected patients in this respect should only be conducted in prospective clinical evaluations and are critically discussed in this article.

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Most cited references 37

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Livebirth after orthotopic transplantation of cryopreserved ovarian tissue.

J Donnez, M Dolmans, D Demylle … (2004)

The lifesaving treatment endured by cancer patients leads, in many women, to early menopause and subsequent infertility. In clinical situations for which chemotherapy needs to be started, ovarian tissue cryopreservation looks to be a promising option to restore fertility. In 1997, biopsy samples of ovarian cortex were taken from a woman with stage IV Hodgkin's lymphoma and cryopreserved before chemotherapy was initiated. After her cancer treatment, the patient had premature ovarian failure. In 2003, after freeze-thawing, orthotopic autotransplantation of ovarian cortical tissue was done by laparoscopy. 5 months after reimplantation, basal body temperature, menstrual cycles, vaginal ultrasonography, and hormone concentrations indicated recovery of regular ovulatory cycles. Laparoscopy at 5 months confirmed the ultrasonographic data and showed the presence of a follicle at the site of reimplantation, clearly situated outside the ovaries, both of which appeared atrophic. From 5 to 9 months, the patient had menstrual bleeding and development of a follicle or corpus luteum with every cycle. 11 months after reimplantation, human chorionic gonadotrophin concentrations and vaginal echography confirmed a viable intrauterine pregnancy, which has resulted in a livebirth. We have described a livebirth after orthotopic autotransplantation of cryopreserved ovarian tissue. Our findings suggest that cryopreservation of ovarian tissue should be offered to all young women diagnosed with cancer.

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Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients.

Jennifer Wo, Akila N. Viswanathan (2009)

Radiation has many potential long-term effects on cancer survivors. Female cancer patients may experience decreased fertility depending on the site irradiated. Oncologists should be aware of these consequences and discuss options for fertility preservation before initiating therapy. A comprehensive review of the existing literature was conducted. Studies reporting the outcomes for female patients treated with cranio-spinal, abdominal, or pelvic radiation reporting fertility, pregnancy, or neonatal-related outcomes were reviewed. Cranio-spinal irradiation elicited significant hormonal changes in women that affected their ability to become pregnant later in life. Women treated with abdomino-pelvic radiation have an increased rate of uterine dysfunction leading to miscarriage, preterm labor, low birth weight, and placental abnormalities. Early menopause results from low-dose ovarian radiation. Ovarian transposition may decrease the rates of ovarian dysfunction. There is a dose-dependent relationship between ovarian radiation therapy (RT) and premature menopause. Patients treated with RT must be aware of the impact of treatment on fertility and explore appropriate options.

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Acute ovarian failure in the childhood cancer survivor study.

Marilyn Stovall, Annelien Mertens, John Whitton … (2006)

Defined as the loss of ovarian function within 5 yr of diagnosis, acute ovarian failure (AOF) is known to develop in a subset of survivors of pediatric and adolescent cancers. Its precise incidence is unknown, and data concerning its risk factors are limited. Our objective was to determine the incidence of and patient/treatment factors associated with AOF in a large cohort of pediatric cancer survivors. We conducted a retrospective cohort, multicenter study. Female participants from the Childhood Cancer Survivor Study who were greater than 18 yr of age were considered for inclusion. We excluded survivors who received cranial irradiation at doses of more than 3000 cGy, those with hypothalamic/pituitary tumors, and survivors who underwent bilateral oophorectomy. Survivors who reported never menstruating or who had ceased having menses within 5 yr after their cancer diagnosis were considered to have AOF. We assessed incidence and risk factors for AOF. Of a total of 3390 eligible survivors, 215 cases (6.3%) developed AOF. Survivors with AOF were older at diagnosis and more likely to have been diagnosed with Hodgkin's lymphoma or to have received abdominal or pelvic radiotherapy than survivors without AOF. Among survivors with AOF, 116 (54%) had received at least 1000-cGy ovarian irradiation. In a multivariable logistic regression model, increasing doses of ovarian irradiation, exposure to procarbazine, and exposure to cyclophosphamide at ages 13-20 yr were independent risk factors for AOF. AOF develops in a small subset of survivors, especially those treated with at least 1000-cGy ovarian radiation. These results will facilitate patient counseling and selection of candidates for newer fertility preservation techniques.

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Author and article information

Contributors

Pirus Ghadjar: pirus.ghadjar@charite.de

Volker Budach: volker.budach@charite.de

Christhardt Köhler: ch.koehler@asklepios.com

Andreas Jantke: Dr.jantke@fera-berlin.de

Simone Marnitz: simone.marnitz@charite.de

Journal

Journal ID (nlm-ta): Radiat Oncol

Journal ID (iso-abbrev): Radiat Oncol

Title: Radiation Oncology (London, England)

Publisher: BioMed Central (London )

ISSN (Electronic): 1748-717X

Publication date (Electronic): 22 February 2015

Publication date PMC-release: 22 February 2015

Publication date Collection: 2015

Volume: 10

Electronic Location Identifier: 50

Affiliations

[ ]Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

[ ]Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany

Article

Publisher ID: 353

DOI: 10.1186/s13014-015-0353-4

PMC ID: 4341866

PubMed ID: 25890342

SO-VID: 0491e29c-8670-4671-98f1-1be531ed8ee3

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 16 September 2014

Date accepted : 5 February 2015

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cervical cancer,radiation therapy,fertility preservation,chemotherapy

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: cervical cancer, radiation therapy, fertility preservation, chemotherapy

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Modern radiation therapy and potential fertility preservation strategies in patients with cervical cancer undergoing chemoradiation

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Karger: Oncology

Most cited references 37

Livebirth after orthotopic transplantation of cryopreserved ovarian tissue.

Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients.

Acute ovarian failure in the childhood cancer survivor study.

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