Factors associated with premature ovarian insufficiency in young women with locally advanced rectal cancer treated with pelvic radiation therapy Journal Article


Authors: Hilal, L.; Cercek, A.; Navilio, J.; Hsu, M.; Zhang, Z.; Brady, P.; Wu, A. J.; Reyngold, M.; Cuaron, J. J.; Romesser, P. B.; Zinovoy, M.; Nusrat, M.; Pappou, E.; LaGratta, M.; Garcia-Aguilar, J.; Paty, P.; Abu-Rustum, N.; Leitao, M. M.; Crane, C. H.; Hajj, C.
Article Title: Factors associated with premature ovarian insufficiency in young women with locally advanced rectal cancer treated with pelvic radiation therapy
Abstract: Purpose: Pelvic radiation therapy (RT) is standard of care for patients with locally advanced rectal cancer (LARC). Premature ovarian insufficiency (POI) in premenopausal women is a possible side effect. The purpose of our study was to evaluate factors associated with POI in women younger than 50 years, treated with pelvic RT for LARC, including those who underwent ovarian transposition (OT). Methods and Materials: We retrospectively reviewed the records of women younger than 50 years treated with pelvic RT for LARC at our institution between 2001 and 2019. Clinical and hormonal data were used to determine ovarian function. The ovaries and uterus were contoured and dose volume histograms were generated. Association of clinical and dosimetric factors with POI within 12 months of RT was evaluated using Wilcoxon-rank sum test and Fisher's exact test. Results: We identified 76 premenopausal women at time of RT with median age of 43 years (range, 20-49). Twenty-six women (34%) underwent OT. Neoadjuvant, concurrent, and adjuvant chemotherapy was administered in 56 (74%), 69 (91%), and 26 (34%) women, respectively. Median RT dose was 50 Gy/25 fractions. Among 75 women with 12 months of follow-up, 25% had preservation of ovarian function, all in the OT group. Ovarian function was preserved in 19 (76%) women who underwent OT. The median of ovarian mean dose was 1.7 Gy in the OT group versus 44.8 Gy in the non-OT group (P <.001). OT and age at RT were significantly associated with POI (P <.001). No patient with ovarian mean dose less than 1.36 Gy developed POI. Conclusions: OT was significantly associated with reduced risk of POI by enabling lower radiation doses to the ovaries. OT should be considered in young patients undergoing pelvic RT. Although there appears to be a significant association between ovarian mean dose and POI, larger studies are needed to find a dosimetric threshold. Our results suggest keeping the dose to the ovaries as low as reasonably achievable in patients who undergo OT and pelvic RT. © 2021 The Author(s)
Journal Title: Advances in Radiation Oncology
Volume: 7
Issue: 1
ISSN: 2452-1094
Publisher: Elsevier Inc.  
Date Published: 2022-01-01
Start Page: 100801
Language: English
DOI: 10.1016/j.adro.2021.100801
PROVIDER: scopus
PMCID: PMC8767259
PUBMED: 35071829
DOI/URL:
Notes: Article -- Export Date: 1 December 2021 -- Source: Scopus
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MSK Authors
  1. Melissa Remis Zinovoy
    20 Zinovoy
  2. Zhigang Zhang
    335 Zhang
  3. Meier Hsu
    152 Hsu
  4. Philip B Paty
    430 Paty
  5. Mario Leitao
    444 Leitao
  6. Abraham Jing-Ching Wu
    312 Wu
  7. Carla Hajj
    65 Hajj
  8. Paul Bernard Romesser
    109 Romesser
  9. John Jacob Cuaron
    79 Cuaron
  10. Paul James Brady
    12 Brady
  11. Christopher   Crane
    121 Crane
  12. Emmanouil Pappou
    36 Pappou
  13. Lara Hilal
    9 Hilal
  14. Maliha Nusrat
    8 Nusrat