The relationship between ovarian function and ovarian limited dose in radiotherapy postoperation of ovarian transposition in young patients with cervical cancer.
The relationship between ovarian function and ovarian limited dose in radiotherapy postoperation of ovarian transposition in young patients with cervical cancer.
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作者：
Du Z;Qu H
本研究在接受卵巢移位术的年轻宫颈癌患者中评估了卵巢功能与放疗中卵巢限制剂量的关系（图1B）。此外，确定了在调强放射治疗（IMRT）中更好地保护卵巢功能的新卵巢剂量限值。我们回顾性分析了2013年1月至2015年6月期间接受根治性子宫切除术和卵巢移位术的86例宫颈癌患者的数据。根据美国国家综合癌症网络宫颈癌指南（NCCN）第2.2015版，对65例有病理高危因素的患者进行了辅助放疗-其中20例接受了三维适形放疗A组24例，接受调强放疗，不限制卵巢受照剂量观察组（B）21例，行卵巢限制剂量（V10<20%）调强放疗（C组）21例。21名没有任何预先确定的高风险因素的患者未接受放射治疗（对照组D）。随访4组患者，采用电化学发光免疫分析法测定放疗前、放疗后、放疗后3个月、放疗后6个月的性激素水平（E2、P、促卵泡激素[FSH]、LH）。随后，分析所有四组患者在不同时间点的性激素水平变化。3组患者放疗前、放疗后、放疗后3个月、6个月的性激素（E2、P、FSH、LH）水平均显著低于对照组（P < 0.05）。对照组患者不同时间点的性激素水平差异无统计学意义（P > 0.05）。各观察组内，患者放疗前与放疗后的性激素水平差异有统计学意义（P < 0.05），但将三个观察组的数据进行比较时，只有A组与C组患者的FSH和LH水平差异有统计学意义（P < 0.05）。受试者工作特征（ROC）曲线分析结果表明，IMRT中将卵巢放射剂量限制在V7.5 < 26%可防止卵巢功能破坏（ROC曲线下面积为0.740，可信区间[CI] = 0.606-0.874）。年轻宫颈癌患者行根治性子宫切除术和卵巢移位术，未接受辅助放疗，卵巢内分泌功能保存良好。在接受任何类型的术后放疗的患者中，卵巢功能受到影响，这表明IMRT中使用的标准卵巢限制剂量破坏了卵巢功能。ROC曲线分析结果提示，IMRT应采用V7.5 < 26%的最佳剂量限值，以保护卵巢功能（P = 0.003）。
In this study, the relationship between ovarian function and ovarian limited dose in radiotherapy was evaluated in young patients with cervical cancer who underwent ovarian transposition (Fig1B). Moreover, the novel ovarian dose limit for a better preservation of ovarian function in intensity‐modulated radiation therapy (IMRT) was determined. We retrospectively analyzed data from 86 patients with cervical cancer who received radical hysterectomy and ovarian transposition from January 2013 to June 2015. In agreement with the National Comprehensive Cancer Network Guidelines (NCCN) for Cervical Cancer Version 2.2015, 65 patients with pathological high‐risk factors were administered adjuvant radiotherapy—20 of them received three‐dimensional conformal radiotherapy (Observation Group A), 24 patients received IMRT with no limitation on radiation dose to ovaries (Observation Group B), and 21 patients underwent IMRT with limited radiation dose(V10<20%) to ovaries (Observation Group C). Twenty‐one patients without any predetermined high‐risk factors did not received radiation therapy (Control Group D). Patients from all four groups were followed up, and sex hormone levels (E2, P, follicle‐stimulating hormone [FSH], LH) before radiation, postradiation, 3 month, and 6 month after the radiation therapy were measured by electrochemiluminescence immunoassay. Subsequently, changes in sex hormone levels in all four groups of patients at various time points were analyzed. The levels of sexual hormones (E2, P, FSH, LH) before radiation, postradiation, 3 month, and 6 month after the radiation therapy in patients from all three observation groups were significantly lower than those in patients of the control group (P < 0.05). There was no statistically significant difference in the levels of sex hormones in patients of the control group at different time points (P > 0.05). Within each observation group, there was a statistically significant difference in the sex hormone levels in patients before the radiation and after the radiation (P < 0.05); however, when data from all three observation groups were compared, only the difference in the levels of FSH and LH between the patients from Group A and Group C was statistically significant (P < 0.05). The results of receiver‐operating characteristic (ROC) curve analysis suggested that limiting ovarian radiation dose to V7.5 < 26% in IMRT prevents the disruption of ovarian function (area under ROC curve was 0.740, confidence interval [CI] = 0.606–0.874). In young patients with cervical cancer who underwent radical hysterectomy and ovarian transposition without receiving adjuvant radiotherapy, ovarian endocrine function was well preserved. In patients who received any type of postoperative radiotherapy, ovarian function was affected, suggesting that the standard ovarian limited dose used in IMRT disrupted ovarian function. The results of the ROC curve analysis suggested that the new optimal dose limit of V7.5 < 26% should be used in IMRT to preserve ovarian function (P = 0.003).