Significance of ovarian transposition in the preservation of ovarian function for young cervical cancer patients undergoing postoperative volumetric modulated radiotherapy.
Significance of ovarian transposition in the preservation of ovarian function for young cervical cancer patients undergoing postoperative volumetric modulated radiotherapy.
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卵巢转位对年轻宫颈癌术后容积调制放疗患者卵巢功能保存的意义
DOI：
10.21037/atm-21-2909
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发表时间：
2021-12
影响因子：
--
通讯作者：
Gong Z
中科院分区：
文献类型：
--
作者：
Xu H;Guo C;Zhang X;Wu Y;Zhu B;Lu E;Sun Z;He D;Deng F;Lv J;Gong Z
本文旨在评价卵巢移位术（OT）和剂量限制对年轻宫颈癌患者术后接受容积调制式弧形治疗（VMAT）保留卵巢功能的有效性。回顾性分析了2015年9月至2018年9月在南京医科大学附属肿瘤医院接受术后VMAT的年轻宫颈癌患者。比较OT与非OT患者的VMAT计划，并随访患者的卵巢功能。使用受试者工作特征（ROC）曲线进一步探讨卵巢的换位位置和辐射剂量限制。共有51例年轻患者（年龄≤40岁）入选本研究，其中32例接受了OT，19例未接受OT。对于这些OT和非OT患者，同质性指数（HI）、符合性指数（CI）、危及器官（OAR）、平均监测单位（MU）数量和平均治疗时间相似，无统计学显著差异（P≥ 0. 05）。通过随访研究，发现OT和非OT患者中保留卵巢功能的患者分别为22例（32例中）和0例（19例中）。保留卵巢功能的最小距离被确定为2.1 cm之间的一个换位卵巢的中心和计划的目标体积（PTV）的边缘。最大剂量（Dmax）为9.8戈伊，平均剂量（Dmean）为4.6戈伊。OT对剂量分布、靶区符合性、OAR保护或治疗效果无不良影响，因此对于使用VMAT技术接受术后放疗的年轻宫颈癌患者，OT是一种保护卵巢功能的可靠方法。具体地，当易位卵巢的中心与PTV边缘之间的距离大于2.1 cm，并且辐射剂量被限制为小于9.8戈伊的Dmax和小于4.6戈伊的Dmean时，可以保留易位卵巢的功能。
This paper aimed to evaluate the effectiveness of ovarian transposition (OT) and the dose constraint for preserving ovarian function in young cervical cancer patients who underwent postoperative volumetric modulated arc therapy (VMAT). A retrospective analysis was conducted of young cervical cancer patients who accepted postoperative VMAT in the Affiliated Cancer Hospital of Nanjing Medical University from September 2015 to September 2018. VMAT plans for OT and non-OT patients were compared, and the patients’ ovarian function was followed up. The transposed position of the ovaries and the radiation dose constraint were further explored using a receiver operator characteristic (ROC) curve. A total of 51 young patients (age ≤40 years) were included in the study, 32 of whom underwent OT and 19 of whom did not. For these OT and non-OT patients, the homogeneity index (HI), conformity index (CI), organs at risk (OARs), average number of monitor units (MUs), and mean treatment time were similar and showed no statistically significant difference (P≥0.05). Through follow-up studies, the number of patients with preserved ovarian function was found to be 22 (out of 32) and 0 (out of 19) in the OT and non-OT patients, respectively. The minimal distance for preserving ovarian function was determined as 2.1 cm between the center of a transposed ovary and the planning target volume (PTV) margin. The optimal limited radiation doses were estimated as maximum dose (Dmax) 9.8 Gy and mean dose (Dmean) 4.6 Gy, respectively. OT shows no negative effects on dose distribution, target region conformity, protection of OARs, or treatment efficacy and is therefore a reliable method in the preservation of ovarian function for young cervical cancer patients undergoing postoperative radiotherapy using the VMAT technique. Specifically, when the distance between the center of a transposed ovary and the PTV margin is more than 2.1 cm, and the radiation dose is limited to a Dmax of less than 9.8 Gy and a Dmean of less than 4.6 Gy, the function of transposed ovaries may be preserved.
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影响因子：
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作者：
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