Outcomes of ovarian transposition in cervical cancer; an updated meta-analysis.
Cervical cancer
Ovarian cysts
Ovarian metastases
Ovarian preservation
Ovarian transposition
Journal
BMC women's health
ISSN: 1472-6874
Titre abrégé: BMC Womens Health
Pays: England
ID NLM: 101088690
Informations de publication
Date de publication:
22 07 2022
22 07 2022
Historique:
received:
21
01
2022
accepted:
20
06
2022
entrez:
22
7
2022
pubmed:
23
7
2022
medline:
27
7
2022
Statut:
epublish
Résumé
Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early menopause. As women become more knowledgeable about their fertility options, it is still unclear who will benefit from the intervention. We updated our previous meta-analysis of ovarian function preservation, symptomatic ovarian cysts, and metastases to the transposed ovaries following ovarian transposition in cervical cancer patients to further guide current clinical practice. A systematic search of Medline, Embase, Web of Science, and The Cochrane Library databases, dating from January 1980 to July 2021, was conducted. We computed the summary proportions of women who had ovarian function preservation, non-ovarian cyst formation and metastases to the transposed ovaries following ovarian transposition by random-effects meta-analysis and we explored study heterogeneity by type of radiotherapy. There were 29 publications reporting on 1160 women with cervical cancer who underwent ovarian transposition. In the group that underwent surgery alone, 91% of the women had preserved ovarian function (95% CI 83-100), 89% (95% CI 80-99) of women who did not develop ovarian cysts, and 99% (95% CI 1-5) of women who did not suffer metastases to the transposed ovaries. In the surgery ± brachytherapy (BR) group, the proportion of women with the preserved ovarian function was 93% (95% CI 76-113), 84% (95% CI 69-103) of women who did not develop ovarian cysts, and 99% (95% CI 82-120) of women who did not suffer metastases to the transposed ovaries. In the external beam pelvic radiotherapy (EBRT) ± BR ± surgery group, the proportion of women with the preserved ovarian function was 61% (95% CI 55-69), and 95% (95% CI 85-107) of women who developed ovarian cysts. There were no metastases to the transposed ovaries in that group. In women with cervical cancer, ovarian transposition offers a significant preservation of the ovarian function. Despite an expected incidence of ovarian cyst formation, it carries almost no risk for metastases to the transposed ovaries.
Sections du résumé
BACKGROUND
Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early menopause. As women become more knowledgeable about their fertility options, it is still unclear who will benefit from the intervention. We updated our previous meta-analysis of ovarian function preservation, symptomatic ovarian cysts, and metastases to the transposed ovaries following ovarian transposition in cervical cancer patients to further guide current clinical practice.
METHODS
A systematic search of Medline, Embase, Web of Science, and The Cochrane Library databases, dating from January 1980 to July 2021, was conducted. We computed the summary proportions of women who had ovarian function preservation, non-ovarian cyst formation and metastases to the transposed ovaries following ovarian transposition by random-effects meta-analysis and we explored study heterogeneity by type of radiotherapy.
RESULTS
There were 29 publications reporting on 1160 women with cervical cancer who underwent ovarian transposition. In the group that underwent surgery alone, 91% of the women had preserved ovarian function (95% CI 83-100), 89% (95% CI 80-99) of women who did not develop ovarian cysts, and 99% (95% CI 1-5) of women who did not suffer metastases to the transposed ovaries. In the surgery ± brachytherapy (BR) group, the proportion of women with the preserved ovarian function was 93% (95% CI 76-113), 84% (95% CI 69-103) of women who did not develop ovarian cysts, and 99% (95% CI 82-120) of women who did not suffer metastases to the transposed ovaries. In the external beam pelvic radiotherapy (EBRT) ± BR ± surgery group, the proportion of women with the preserved ovarian function was 61% (95% CI 55-69), and 95% (95% CI 85-107) of women who developed ovarian cysts. There were no metastases to the transposed ovaries in that group.
CONCLUSIONS
In women with cervical cancer, ovarian transposition offers a significant preservation of the ovarian function. Despite an expected incidence of ovarian cyst formation, it carries almost no risk for metastases to the transposed ovaries.
Identifiants
pubmed: 35869476
doi: 10.1186/s12905-022-01887-8
pii: 10.1186/s12905-022-01887-8
pmc: PMC9308360
doi:
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
305Informations de copyright
© 2022. The Author(s).
Références
Gynecol Oncol. 1995 Jan;56(1):3-7
pubmed: 7821844
Gynecol Oncol. 1990 Nov;39(2):155-9
pubmed: 2121629
Radiat Res. 2011 Dec;176(6):787-95
pubmed: 21988524
Int J Gynecol Cancer. 2006 Jan-Feb;16(1):121-4
pubmed: 16445621
AJR Am J Roentgenol. 2005 May;184(5):1602-10
pubmed: 15855125
CA Cancer J Clin. 2015 Mar;65(2):87-108
pubmed: 25651787
Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:433-465
pubmed: 33143928
Cancer. 1996 Jun 15;77(12):2638-45
pubmed: 8640716
Cancer. 1999 Nov 15;86(10):2138-42
pubmed: 10570443
Fertil Steril. 2000 Oct;74(4):743-8
pubmed: 11020517
Int J Gynecol Cancer. 2020 Jun;30(6):873-878
pubmed: 32241876
Gynecol Oncol. 2001 Jan;80(1):85-8
pubmed: 11136575
Am J Obstet Gynecol. 1992 Jan;166(1 Pt 1):50-3
pubmed: 1733218
Int J Gynecol Cancer. 2007 May-Jun;17(3):623-8
pubmed: 17309669
Int J Gynecol Cancer. 2021 Mar;31(3):360-370
pubmed: 33649003
BMJ. 1989 Dec 2;299(6712):1363-7
pubmed: 2513964
Lancet. 2003 Jun 28;361(9376):2217-25
pubmed: 12842378
Eur J Gynaecol Oncol. 1993;14 Suppl:77-80
pubmed: 8200379
Gynecol Oncol. 1984 Jul;18(3):373-9
pubmed: 6430756
Int J Gynecol Cancer. 1999 Sep;9(5):396-400
pubmed: 11240800
Cancer Med. 2017 Mar;6(3):508-515
pubmed: 28211638
Am J Obstet Gynecol. 2016 Oct;215(4):460.e1-460.e13
pubmed: 27133009
ANZ J Surg. 2003 Sep;73(9):712-6
pubmed: 12956787
J Obstet Gynaecol Res. 2011 Jul;37(7):825-9
pubmed: 21450024
Eur J Surg Oncol. 2019 Aug;45(8):1328-1340
pubmed: 30857878
Radiat Oncol. 2019 Jun 10;14(1):100
pubmed: 31182114
J Clin Oncol. 2020 Apr 1;38(10):1030-1040
pubmed: 32031867
Am J Obstet Gynecol. 2018 Oct;219(4):415-417
pubmed: 29883577
Int J Gynecol Cancer. 2011 Dec;21(9):1704-7
pubmed: 22080894
J Obstet Gynaecol Res. 2013 Nov;39(11):1533-7
pubmed: 23855765
Arch Gynecol Obstet. 2018 Nov;298(5):1001-1007
pubmed: 30218184
Gynecol Oncol. 1989 Dec;35(3):349-51
pubmed: 2599470
Gynecol Oncol. 1993 May;49(2):206-14
pubmed: 8504989
Fertil Steril. 2012 Jun;97(6):1387-93.e1-2
pubmed: 22464082
Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):738-44
pubmed: 15936554
Gynecol Oncol. 2001 Dec;83(3):605-7
pubmed: 11733981
Eur J Gynaecol Oncol. 2015;36(1):25-9
pubmed: 25872330
Eur J Gynaecol Oncol. 1996;17(3):177-82
pubmed: 8780914
Radiat Oncol. 2019 Dec 16;14(1):230
pubmed: 31842971
Int J Gynecol Cancer. 2010 Aug;20(6):1082-6
pubmed: 20683422
Gynecol Oncol. 1982 Apr;13(2):195-202
pubmed: 6804316
Int J Gynaecol Obstet. 1997 Aug;58(2):223-8
pubmed: 9252259
Radiat Oncol. 2015 Feb 22;10:50
pubmed: 25890342
Gynecol Oncol. 2001 Aug;82(2):312-6
pubmed: 11531285
Best Pract Res Clin Obstet Gynaecol. 2021 Sep;75:2-9
pubmed: 34053867
Eur J Gynaecol Oncol. 2013;34(2):124-7
pubmed: 23781581
Int J Cancer. 2020 Sep 1;147(5):1245-1251
pubmed: 32037528
Int J Gynaecol Obstet. 2007 Oct;99(1):64-5
pubmed: 17445818
Lancet. 2019 Jan 12;393(10167):169-182
pubmed: 30638582
Int J Radiat Oncol Biol Phys. 1991 Jun;20(6):1305-8
pubmed: 2045304
Cancer. 2013 Jan 15;119(2):325-31
pubmed: 22806897
Gynecol Endocrinol. 2001 Feb;15(1):5-13
pubmed: 11293925
Minerva Ginecol. 2017 Jun;69(3):250-258
pubmed: 28271699
Obstet Gynecol. 2013 Apr;121(4):709-716
pubmed: 23635669
Virchows Arch. 2018 Jun;472(6):919-936
pubmed: 29725757
JAMA. 2000 Apr 19;283(15):2008-12
pubmed: 10789670
Eur J Gynaecol Oncol. 1988;9(6):479-84
pubmed: 3234426
J Ovarian Res. 2014 Jun 25;7:69
pubmed: 24995040
Hum Reprod Update. 2001 Nov-Dec;7(6):535-43
pubmed: 11727861
Eur J Surg Oncol. 1990 Apr;16(2):141-6
pubmed: 2323410
Radiat Oncol. 2015 Apr 17;10:91
pubmed: 25896675
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Fertil Steril. 2019 Sep;112(3):438-445
pubmed: 31446903
Gynecol Oncol Rep. 2018 Apr 18;24:78-82
pubmed: 29915802
J Radiat Res. 2015 Mar;56(2):354-9
pubmed: 25589505
Int J Gynecol Cancer. 2015 May;25(4):688-93
pubmed: 25675036
Gynecol Oncol Res Pract. 2016 Oct 21;3:9
pubmed: 27795832
Best Pract Res Clin Obstet Gynaecol. 2021 Sep;75:37-53
pubmed: 33715965
Int J Gynecol Cancer. 2008 May-Jun;18(3):584-9
pubmed: 18476952
J Clin Oncol. 2013 Jul 1;31(19):2500-10
pubmed: 23715580
Abdom Radiol (NY). 2017 Oct;42(10):2488-2512
pubmed: 28528388