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Fertility-sparing uterine displacement for pelvic malignancies: surgical options and radiotherapy dosimetry on a human cadaver.
Pavone, Matteo; Waeldin, Laure; Seeliger, Barbara; Bizzarri, Nicolò; Mutter, Didier; Jarnet, Delphine; Forgione, Antonello; Georges, Noel; Akladios, Cherif; Scambia, Giovanni; Marescaux, Jacques; Lecointre, Lise; Querleu, Denis.
Afiliación
  • Pavone M; Institute of Image-Guided Surgery, IHU Strasbourg, 1 place de l'Hôpital, Strasbourg, 67091, France. matteopavone.21@gmail.com.
  • Waeldin L; Research Institute against Digestive Cancer, IRCAD, Strasbourg, France. matteopavone.21@gmail.com.
  • Seeliger B; UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. matteopavone.21@gmail.com.
  • Bizzarri N; Radiation Therapy University Department, Institut de Cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, Strasbourg, 67200, France.
  • Mutter D; Institute of Image-Guided Surgery, IHU Strasbourg, 1 place de l'Hôpital, Strasbourg, 67091, France.
  • Jarnet D; Research Institute against Digestive Cancer, IRCAD, Strasbourg, France.
  • Forgione A; ICube UMR 7357-Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie, CNRS, University of Strasbourg, Strasbourg, 67000, France.
  • Georges N; Department of Digestive and Endocrine Surgery, University Hospitals of Strasbourg, Strasbourg, 67000, France.
  • Akladios C; UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
  • Scambia G; Institute of Image-Guided Surgery, IHU Strasbourg, 1 place de l'Hôpital, Strasbourg, 67091, France.
  • Marescaux J; Medical Physics Unit, Institut de Cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, Strasbourg, 67200, France.
  • Lecointre L; Research Institute against Digestive Cancer, IRCAD, Strasbourg, France.
  • Querleu D; Radiation Therapy University Department, Institut de Cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, Strasbourg, 67200, France.
World J Surg Oncol ; 22(1): 147, 2024 Jun 03.
Article en En | MEDLINE | ID: mdl-38831328
ABSTRACT

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. 

METHODS:

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 dosimetric CT scans in a hybrid operating room. Two treatment plans (anal and rectal cancer) were simulated on each of the four dosimetric 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 volume receiving 14 Gy (V14Gy) were collected.

RESULTS:

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

CONCLUSIONS:

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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Pélvicas / Dosificación Radioterapéutica / Útero / Planificación de la Radioterapia Asistida por Computador / Cadáver / Radioterapia de Intensidad Modulada / Preservación de la Fertilidad Límite: Female / Humans Idioma: En Revista: World J Surg Oncol Año: 2024 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Pélvicas / Dosificación Radioterapéutica / Útero / Planificación de la Radioterapia Asistida por Computador / Cadáver / Radioterapia de Intensidad Modulada / Preservación de la Fertilidad Límite: Female / Humans Idioma: En Revista: World J Surg Oncol Año: 2024 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido