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Lu H, Jia D, Tang Q, Shu S. Primary endodermal sinus tumor originating from the sacral ligament: a case report and review of the literature. BMC Pregnancy Childbirth 2023; 23:528. [PMID: 37474890 PMCID: PMC10357729 DOI: 10.1186/s12884-023-05849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Endodermal sinus tumor (EST) is a malignant tumor originating from the ovary or testis. In most case, ultrasound examination shows ovarian mass. But there is a special kind of extra-gonadal endodermal sinus tumor, which occur in organs other than gonads with insidious onset. Here we reported a case of endodermal sinus tumor, which originated from the sacral ligament presenting as an acute lower abdominal pain. CASE PRESENTATION A 14-year-old girl was admitted to the hospital because of acute lower abdominal pain. The ultrasound showed a mass with 72 mm × 64 mm × 50 mm in Douglas, and there was no abnormality in bilateral ovaries and fallopian tubes. Laparoscopic exploration showed a large amount of blood clots in the pelvic cavity. After removal of the blood, we found rotten fish-like tissue in the left sacral ligament, rapid pathology suggested endodermal sinus tumor. After the operation, we retrospectively examined the value of alpha-fetoprotein (AFP), which was found to be elevated, and post-operative paraffin pathology confirmed the diagnosis. After four cycles of BEP chemotherapy, exploratory laparotomy was performed to remove the visible lesion, but postoperative pathology showed no abnormality. At the one-year follow-up, the patient remained recurrence-free. CONCLUSION Extra-gonadal germ cell tumors are rarely reported. When young teenagers complain of acute lower abdominal pain with elevated AFP, but there was no lesion in bilateral ovaries and fallopian tubes, we must think about the possibility of endodermal sinus tumors. Accurate diagnosis facilitates complete resection of lesions and improves patient's outcomes.
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Affiliation(s)
- Han Lu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University Guangzhou, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Dongsong Jia
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University Guangzhou, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Qionglan Tang
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, People's Republic of China
| | - Shanrong Shu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Jinan University Guangzhou, Guangzhou, 510630, Guangdong, People's Republic of China.
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2
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Ní Dhonnabháin B, Elfaki N, Fraser K, Petrie A, Jones BP, Saso S, Hardiman PJ, Getreu N. A comparison of fertility preservation outcomes in patients who froze oocytes, embryos, or ovarian tissue for medically indicated circumstances: a systematic review and meta-analysis. Fertil Steril 2022; 117:1266-1276. [PMID: 35459522 DOI: 10.1016/j.fertnstert.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare obstetric outcomes in patients cryopreserving reproductive cells or tissues before gonadotoxic therapy. DESIGN A literature search was conducted following PRISMA guidelines on Embase, Medline, and Web of Science. Studies reporting obstetric outcomes in cancer patients who completed cryopreservation of oocyte, embryo, or ovarian tissue were included. SETTING Not applicable. PATIENT(S) Cancer patients attempting pregnancy using cryopreserved cells or tissues frozen before cancer therapy. INTERVENTION(S) Oocyte, embryo, or ovarian tissue cryopreservation for fertility preservation in cancer. MAIN OUTCOME MEASURE(S) The total numbers of clinical pregnancies, live births, and miscarriages in women attempting pregnancy using cryopreserved reproductive cells or tissues were calculated. A meta-analysis determined the effect size of each intervention. RESULT(S) The search returned 4,038 unique entries. Thirty-eight eligible studies were analyzed. The clinical pregnancy rates were 34.9%, 49.0%, and 43.8% for oocyte, embryo, and ovarian tissue cryopreservation, respectively. No significant differences were found among groups. The live birth rates were 25.8%, 35.3%, and 32.3% for oocyte, embryo, and ovarian tissue cryopreservation, respectively, with no significant differences among groups. The miscarriage rates were 9.2%, 16.9%, and 7.5% for oocyte, embryo, and ovarian tissue cryopreservation, respectively. Significantly fewer miscarriages occurred with ovarian tissue cryopreservation than with embryo cryopreservation. CONCLUSION(S) This enquiry is required to counsel cancer patients wishing to preserve fertility. Although the limitations of this study include heterogeneity, lack of quality studies, and low utilization rates, it serves as a starting point for comparison of reproductive and obstetric outcomes in patients returning for family-planning after gonadotoxic therapy.
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Affiliation(s)
- Bríd Ní Dhonnabháin
- Institute for Women's Health, University College London, London, United Kingdom
| | - Nagla Elfaki
- Department of Obstetrics and Gynaecology, University College London Hospital, London, United Kingdom
| | - Kyra Fraser
- Department of Surgery, The Royal Free Hospital, London, United Kingdom
| | - Aviva Petrie
- Biostatistics Unit, Eastman Dental Institute, University College London, London, United Kingdom
| | - Benjamin P Jones
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Srdjan Saso
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Paul J Hardiman
- Department of Gynaecology, The Royal Free Hospital, London, United Kingdom
| | - Natalie Getreu
- Institute for Women's Health, University College London, London, United Kingdom.
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Zheng S, Ma M, Chen Y, Li M. Effects of quercetin on ovarian function and regulation of the ovarian PI3K/Akt/FoxO3a signalling pathway and oxidative stress in a rat model of cyclophosphamide-induced premature ovarian failure. Basic Clin Pharmacol Toxicol 2021; 130:240-253. [PMID: 34841658 DOI: 10.1111/bcpt.13696] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/17/2021] [Accepted: 11/22/2021] [Indexed: 12/28/2022]
Abstract
To investigate the ability of quercetin to improve ovarian function and inhibit ovarian oxidative stress through the PI3K/Akt/FoxO3a signalling pathway in a rat model of premature ovarian failure (POF), we constructed a POF rat model with cyclophosphamide (CTX) and treated it with quercetin. Haematoxylin and eosin staining (H&E staining) was used to observe the morphological changes of the ovaries. The serum levels of AMH, E2, FSH, SOD, GSH-Px and MDA were determined by enzyme-linked immunosorbent assays. The expression of phosphatidylinositol 3-kinase (PI3K), protein kinase B (Akt), forkhead box O3a (FoxO3a) and their phosphorylated forms AMH, FSH and their receptors in the ovary were detected by western blots. The mRNA expression of PI3K, Akt, FOXO3a, AMH, FSH and their receptors was detected by qRT-PCR. Our results showed that quercetin could significantly increase the expression of AMH, E2, SOD and GSH-Px, upregulate the protein expression of AMH, FSH and its receptor and decrease the expression ratio of phosphorylated PI3K, Akt, FOXO3a and the unphosphorylated forms. Moreover, quercetin inhibited the mRNA expression of PI3K, Akt and FOXO3a. These results suggest that quercetin can restore ovarian function and inhibit oxidative stress by regulating the PI3K/Akt/FoxO3a signalling pathway.
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Affiliation(s)
- Shaoyan Zheng
- Pharmacy Department, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Mingying Ma
- Pharmacy Department, Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, China
| | - Yanxia Chen
- Pharmacy Department, The First Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Miaoxia Li
- Comprehensive Laboratory, Guangdong Huiqun Chinese Traditional Medicine Co., Ltd, Shantou, China
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The role of MRI in cervical cancer > 2 cm (FIGO stage IB2-IIA1) conservatively treated with neoadjuvant chemotherapy followed by conization: a pilot study. Radiol Med 2021; 126:1055-1063. [PMID: 34060027 PMCID: PMC8292245 DOI: 10.1007/s11547-021-01377-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/20/2021] [Indexed: 12/28/2022]
Abstract
Introduction MRI is very accurate in selecting young women with cervical cancer for fertility-sparing surgery (FSS), in particular radical hysterectomy (RH). In order to improve obstetrical outcomes, neoadjuvant chemotherapy (NACT) followed by cold knife conization (CKC) has been proposed as alternative technique. Objective To investigate the role of MRI in evaluation of response to treatment after neoadjuvant chemotherapy (NACT), followed by CKC, in patients with cervical cancer FIGO stage IB2-IIA1 with tumor size 2 – 4 cm, desiring to preserve their fertility. Methods 13 young women (23–36 years old) with cervical cancer stage IB2-IIA1 desiring to preserve their fertility were included. Tumor diameter at baseline and after treatment was detected on 1.5 T MRI. Treatment response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and then compared to histopathology result. Results MRI correctly assessed 11 out of 13 cases, according to RECIST 1.1, compared to histopathology. Among these 7 patients with partial response (PR), 2 cases of CR, 1 SD and 1 PD with persistence or enlargement of primary tumor. Conclusion Our pilot study supports the usefulness of MRI in assessment of treatment response after NACT, followed by CKC. Trial registration number ClinicalTrials.gov: NCT02323841
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Cho HW, Lee S, Min KJ, Hong JH, Song JY, Lee JK, Lee NW, Kim T. Advances in the Treatment and Prevention of Chemotherapy-Induced Ovarian Toxicity. Int J Mol Sci 2020; 21:ijms21207792. [PMID: 33096794 PMCID: PMC7589665 DOI: 10.3390/ijms21207792] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
Due to improvements in chemotherapeutic agents, cancer treatment efficacy and cancer patient survival rates have greatly improved, but unfortunately gonadal damage remains a major complication. Gonadotoxic chemotherapy, including alkylating agents during reproductive age, can lead to iatrogenic premature ovarian insufficiency (POI), and loss of fertility. In recent years, the demand for fertility preservation has increased dramatically among female cancer patients. Currently, embryo and oocyte cryopreservation are the only established options for fertility preservation in women. However, there is growing evidence for other experimental techniques including ovarian tissue cryopreservation, oocyte in vitro maturation, artificial ovaries, stem cell technologies, and ovarian suppression. To prevent fertility loss in women with cancer, individualized fertility preservation options including established and experimental techniques that take into consideration the patient’s age, marital status, chemotherapy regimen, and the possibility of treatment delay should be provided. In addition, effective multidisciplinary oncofertility strategies that involve a highly skilled and experienced oncofertility team consisting of medical oncologists, gynecologists, reproductive biologists, surgical oncologists, patient care coordinators, and research scientists are necessary to provide cancer patients with high-quality care.
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Nezhat C, Roman RA, Rambhatla A, Nezhat F. Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review. Fertil Steril 2020; 113:685-703. [DOI: 10.1016/j.fertnstert.2020.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
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Capela D, Louro N, La Fuente de Carvalho J. [Preservation of fertility in transgender people]. Rev Int Androl 2020; 19:137-144. [PMID: 31948868 DOI: 10.1016/j.androl.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/07/2019] [Accepted: 10/27/2019] [Indexed: 10/25/2022]
Abstract
Young transgender people increasingly seek medical help to assist them in their gender transition with hormone therapy and/or sex reassignment surgery. However, these treatments limit fertility and may make them irreversibly infertile. Studies show that the transgender population wishes to have biological children and, to help them achieve this desire for parenthood, there are techniques for preserving fertility, such as cryopreservation of gametes, embryos and ovarian or testicular tissue. However, alongside these techniques, there are ethical issues and several challenges before, during and after these procedures, that may lead young transgender people to reject these methods of preserving fertility. In conclusion, health professionals should be informed about all these dynamics between gender transition therapies and their impact on fertility, in order to better guide these individuals in their decision.
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Affiliation(s)
- Diana Capela
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.
| | - Nuno Louro
- Serviço de Urologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Cai Y, Yin J, Jin Y, Li Y, Wu M, Yang J, Huang H, Leng J, Pan L. Endometriosis-associated ovarian cancer is not a distinct clinical entity among young patients: A 12-year cohort study. Eur J Surg Oncol 2019; 46:876-882. [PMID: 31837932 DOI: 10.1016/j.ejso.2019.11.517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/19/2019] [Accepted: 11/29/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate the clinicopathological features and prognostic value of endometriosis in young patients with ovarian endometrioid carcinoma (OEC) and ovarian clear cell carcinoma (OCCC). METHODS The medical files and clinical follow-up data of patients aged 40 years or younger with OEC or OCCC between January 2006 and December 2017 who had undergone complete surgical staging followed by systemic chemotherapy were retrospectively reviewed. RESULTS A total of 94 women were included in this study. Univariate analysis revealed that the progression-free survival (PFS) and overall survival (OS) rates of patients with endometriosis-associated ovarian carcinoma (EAOC) did not improve compared with those of patients without EAOC (5-year PFS: 80.0% vs. 75.9% and 5-year OS: 85.0% vs. 86.0%, respectively). Multivariate analyses confirmed that FIGO stage (II-IV), cytology-positive ascites or peritoneal washes and residual disease > 1 cm were independent predictors of PFS and that residual disease > 1 cm was the only predictor of OS. CONCLUSIONS Endometriosis is not independently associated with the prognosis of OEC and OCCC among young patients. The intrinsic relationship between endometriosis and ovarian cancer warrants further investigation.
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Affiliation(s)
- Yan Cai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jie Yin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Jin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huifang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Salama M, Anazodo A, Woodruff TK. Preserving fertility in female patients with hematological malignancies: a multidisciplinary oncofertility approach. Ann Oncol 2019; 30:1760-1775. [PMID: 31418765 DOI: 10.1093/annonc/mdz284] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Oncofertility is a new interdisciplinary field at the intersection of oncology and reproductive medicine that expands fertility options for young cancer patients. The most common forms of hematological malignancies that occur in girls and young women and therefore necessitate oncofertility care are acute lymphocytic leukemia, acute myeloid leukemia, non-Hodgkin's lymphoma, and Hodgkin's lymphoma. Aggressive gonadotoxic anticancer regimens including alkylating chemotherapy and total body irradiation are used often in treating girls and young women with hematological malignancies. The risks of gonadotoxicity and subsequent iatrogenic premature ovarian insufficiency and fertility loss depend mainly on the type and stage of the disease, dose of anticancer therapy as well as the age of the patient at the beginning of treatment. To avoid or at least mitigate the devastating complications of anticancer therapy-induced gonadotoxicity, effective and comprehensive strategies that integrate different options for preserving and restoring fertility ranging from established to experimental strategies should be offered before, during, and after chemotherapy or radiotherapy. A multidisciplinary approach that involves strong coordination and collaboration between hemato-oncologists, gynecologists, reproductive biologists, research scientists, and patient navigators is essential to guarantee high standard of care.
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Affiliation(s)
- M Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - T K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine-Northwestern University, Chicago, USA.
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Lee S, Ryu KJ, Kim B, Kang D, Kim YY, Kim T. Comparison between Slow Freezing and Vitrification for Human Ovarian Tissue Cryopreservation and Xenotransplantation. Int J Mol Sci 2019; 20:ijms20133346. [PMID: 31288388 PMCID: PMC6651588 DOI: 10.3390/ijms20133346] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 11/16/2022] Open
Abstract
Two methods for the cryopreservation of human ovarian tissue were compared using a xenotransplantation model to establish a safe and effective cryopreservation method. Ovarian tissues were obtained from women who underwent benign ovarian surgery in the gynecology research unit of a university hospital. The tissues were transplanted into 112 ovariectomized female severe combined immunodeficient mice 4 weeks after slow freezing or vitrification cryopreservation. Tissues were retrieved 4 weeks later. Primordial follicular counts decreased after cryopreservation and xenotransplantation, and were significantly higher in the slow freezing group than in the vitrification group (p < 0.001). Immunohistochemistry and TUNEL assay showed that the Ki-67 and CD31 markers of follicular proliferation and angiogenesis were higher in the slow freezing group (p < 0.001 and p = 0.006, respectively) and DNA damage was greater in the vitrification group (p < 0.001). Western blotting showed that vitrification increased cellular apoptosis. Anti-Müllerian hormone expression was low in transplanted samples subjected to both cryopreservation techniques. Electron microscopy revealed primordial follicle deformation in the vitrification group. Slow freezing for ovarian tissue cryopreservation is superior to vitrification in terms of follicle survival and growth after xenotransplantation. These results will be useful for fertility preservation in female cancer patients.
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Affiliation(s)
- Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Boram Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Dahyeon Kang
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
| | - Yoon Young Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul 03080, Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Korea.
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Ovarian tissue cryopreservation and transplantation in patients with cancer. Obstet Gynecol Sci 2018; 61:431-442. [PMID: 30018897 PMCID: PMC6046360 DOI: 10.5468/ogs.2018.61.4.431] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/11/2017] [Accepted: 10/20/2017] [Indexed: 12/31/2022] Open
Abstract
Chemotherapy and radiotherapy improved survival rates of patients with cancer. However, they can cause ovarian failure and infertility in women of reproductive age. Infertility following cancer treatment is considered a major quality of life issue. Ovarian tissue cryopreservation and transplantation is an important option for fertility preservation in adult patients with cancer who need immediate chemotherapy or do not want to undergo ovarian stimulation. Ovarian tissue freezing is the only option for preserving the fertility of prepubertal patients with cancer. In a recent review, it was reported that frozen-thawed ovarian transplantation has lead to about 90 live births and the conception rate was about 30%. Endocrine function recovery was observed in 92.9% between 3.5 and 6.5 months after transplantation. Based on our review, ovarian tissue cryopreservation and transplantation may be carefully considered before cancer treatment in order to preserve fertility and endocrine function in young cancer survivors.
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Zhang Q, Li W, Kanis MJ, Qi G, Li M, Yang X, Kong B. Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis. Oncotarget 2018; 8:46580-46592. [PMID: 28418849 PMCID: PMC5542294 DOI: 10.18632/oncotarget.16233] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objectives of this study were to evaluate the rates of recurrence, survival and pregnancy, and characterize pregnancy outcomes of early-stage cervical cancer(eCC) treated with fertility-sparing methods such as cervical conization (CON) and radical trachelectomy(RT) with or without pelvic lymphadenectomy. STUDY DESIGN This was a meta-analysis of observational studies analyzed by a random-effects model and a meta-regression to assess heterogeneity. RESULTS Sixty observational studies encompassing 2,854 patients were included; 17 of which evaluated CON and 43 RT. Three hundred and seventy-five patients were included in the CON group: 176(46.9%) stage IA1 and 167(44.5%) stage IB1. In the RT group, 2479 cases were included: 143(6.0%) stage IA1, 299(12.1%) stage IA2, 1987(79.9%) stage IB1. CON was performed in 347(92.5%) cases, resulting in a recurrence rate of 0.4%(95%CI: 0.0%-1.4%), a death rate of 0%(0%-0%), a pregnancy rate of 36.1%(26.4%-46.2%), a spontaneous abortion rate of 14.8%(9.3%-21.2%) and a preterm delivery rate of 6.8%(1.5%-15.5%). For the RT group, 2273(91.7%) underwent successful surgeries with a recurrence rate of 2.3%(1.3%-3.4%),a death rate of 0.7%(0.3%-1.1%), a pregnancy rate of 20.5%(16.8%-24.5%), a spontaneous abortion rate of 24.0%(18.8%-29.6%) and a preterm delivery rate of 26.6%(19.6%-34.2%). From a subgroup analysis, the recurrence rates for stage IA tumors treated with CON and RT were 0.4%(0.0%-1.9%) and 0.7%(0.0%-2.3%), respectively; and for stage IB were 0.6%(0.0%-2.7%) and 2.3%(0.9%-4.1%). CONCLUSION Fertility-sparing treatment including CON or RT for eCC is feasible and carefully selected women can preserve fertility and achieve pregnancy resulting in live births. CON seems to result in better pregnancy outcomes than RT with similar rates of recurrence and mortality.
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Affiliation(s)
- Qing Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Wenhui Li
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Margaux J Kanis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gonghua Qi
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Minghao Li
- Shandong University School of Medicine, Ji'nan, Shandong, P.R. China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
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Ali Mohamed MS. A new strategy and system for the ex vivo ovary perfusion and cryopreservation: An innovation. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.6.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Lewin J, Ma JMZ, Mitchell L, Tam S, Puri N, Stephens D, Srikanthan A, Bedard P, Razak A, Crump M, Warr D, Giuliani M, Gupta A. The positive effect of a dedicated adolescent and young adult fertility program on the rates of documentation of therapy-associated infertility risk and fertility preservation options. Support Care Cancer 2017; 25:1915-1922. [PMID: 28155019 DOI: 10.1007/s00520-017-3597-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Minimal data exist regarding documentation of therapy-associated infertility risk (IR) and fertility preservation (FP) options during the initial oncology consultation prior to systemic therapy. This study investigated factors affecting IR/FP documentation and assessed the effect of implementation of an Adolescent and Young Adult (AYA) program on documentation rates. METHODS A retrospective review of charts of patients receiving gonadotoxic therapy was undertaken for documentation of IR/FP pre- and post-implementation of an AYA program. Change in documentation rates was assessed using univariate and multiple logistic regression. RESULTS A total of 173 charts were reviewed. On univariate analysis, IR/FP documentation was less likely if patients had metastatic disease (P < 0.01, P < 0.01), by tumor type (P < 0.01, P < 0.01), received less intensive chemotherapy (P = 0.03, P = 0.06), were older (P = 0.14, P < 0.01), had more children (P < 0.01, P < 0.01), or lacked AYA program involvement (P < 0.01, P < 0.01). FP discussion was more common in males (P = 0.02). On multivariable analysis, more children (P = 0.01, P = 0.03), older age (P < 0.01, P < 0.01), tumor type (P < 0.01, P = 0.01), stage (P = 0.02, NS), relationship (P = 0.03, NS), and lack of AYA involvement (P < 0.01, P < 0.01) were associated with lower rates of IR/FP documentation. Following AYA program implementation, IR/FP rates increased from 56% (CI 46-65%) to 85% (CI 74-92%, P < 0.01) and 54% (CI 45-64%) to 86% (CI 75-93%, P < 0.01), respectively. The effect of AYA program implementation on IR/FP documentation was most noticeable in leukemia, lymphoma, and breast groups (P < 0.01). CONCLUSIONS Implementing an AYA consultation service at an adult cancer institution had a positive effect on the rates of IR/FP documentation. Specific programming can improve service delivery to AYA cancer patients, and fertility counseling should be integrated for patients undergoing gonadotoxic therapy.
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Affiliation(s)
- Jeremy Lewin
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada. .,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
| | - Justin Ming Zheng Ma
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Seline Tam
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Natasha Puri
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Derek Stephens
- Centre for Biostatistics, Hospital for Sick Children, Toronto, Canada
| | - Amirrtha Srikanthan
- Department of Medical Oncology, Vancouver Centre, BC Cancer Agency, Vancouver, Canada
| | - Philippe Bedard
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Albiruni Razak
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Michael Crump
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - David Warr
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Abha Gupta
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2M9, Canada
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Female fertility preservation strategies: cryopreservation and ovarian tissue in vitro culture, current state of the art and future perspectives. ZYGOTE 2016; 24:635-53. [PMID: 27141985 DOI: 10.1017/s096719941600006x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In the present review, the main strategies of female fertility preservation are covered. Procedures of fertility preservation are necessary for women who suffer from diseases whose treatment requires the use of aggressive therapies, such as chemotherapy and radiotherapy. These kinds of therapy negatively influence the health of gametes and their progenitors. The most commonly used method of female fertility preservation is ovarian tissue cryopreservation, followed by the retransplantation of thawed tissue. Another approach to female fertility preservation that has been actively developed lately is the ovarian tissue in vitro culture. The principal methods, advantages and drawbacks of these two strategies are discussed in this article.
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Effect of oral versus intrauterine progestins on weight in women undergoing fertility preserving therapy for complex atypical hyperplasia or endometrial cancer. Gynecol Oncol 2016; 140:234-8. [DOI: 10.1016/j.ygyno.2015.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/02/2015] [Accepted: 12/13/2015] [Indexed: 12/21/2022]
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17
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Langbeen A, De porte HF, Bartholomeus E, Leroy JL, Bols PE. Bovine in vitro reproduction models can contribute to the development of (female) fertility preservation strategies. Theriogenology 2015; 84:477-89. [DOI: 10.1016/j.theriogenology.2015.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/01/2015] [Accepted: 04/11/2015] [Indexed: 01/06/2023]
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Dittrich R, Lotz L, Fehm T, Krüssel J, von Wolff M, Toth B, van der Ven H, Schüring AN, Würfel W, Hoffmann I, Beckmann MW. Xenotransplantation of cryopreserved human ovarian tissue--a systematic review of MII oocyte maturation and discussion of it as a realistic option for restoring fertility after cancer treatment. Fertil Steril 2015; 103:1557-65. [PMID: 25881879 DOI: 10.1016/j.fertnstert.2015.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To systematically review the reporting of MII (MII) oocyte development after xenotransplantation of human ovarian tissue. DESIGN Systematic review in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). SETTING Not applicable. PATIENT(S) Not applicable. INTERVENTION(S) Formation of MII oocytes after xenotransplantation of human ovarian tissue. MAIN OUTCOME MEASURE(S) Any outcome reported in Pubmed. RESULT(S) Six publications were identified that report on formation of MII oocytes after xenotransplantation of human ovarian tissue. CONCLUSION(S) Xenografting of human ovarian tissue has proved to be a useful model for examining ovarian function and follicle development in vivo. With human follicles that have matured through xenografting, the possibility of cancer transmission and relapse can also be eliminated, because cancer cells are not able to penetrate the zona pellucida. The reported studies have demonstrated that xenografted ovarian tissue from a range of species, including humans, can produce antral follicles that contain mature (MII) oocytes, and it has been shown that mice oocytes have the potential to give rise to live young. Although some ethical questions remain unresolved, xenotransplantation may be a promising method for restoring fertility. This review furthermore describes the value of xenotransplantation as a tool in reproductive biology and discusses the ethical and potential safety issues regarding ovarian tissue xenotransplantation as a means of recovering fertility.
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Affiliation(s)
- Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Jan Krüssel
- Department of Obstetrics and Gynecology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Michael von Wolff
- Division of Gynecologic Endocrinology and Reproductive Medicine, University Women's Hospital, Berne, Switzerland
| | - Bettina Toth
- Department of Gynecologic Endocrinology and Fertility Disorders, Ruprecht-Karls University Hospital, Heidelberg, Germany
| | - Hans van der Ven
- Department of Obstetrics and Gynecology, Bonn University Hospital, Bonn, Germany
| | - Andreas N Schüring
- Department of Obstetrics and Gynecology, UKM Kinderwunschzentrum, Münster University Hospital, Münster, Germany
| | | | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Park JY, Nam JH. Progestins in the fertility-sparing treatment and retreatment of patients with primary and recurrent endometrial cancer. Oncologist 2015; 20:270-8. [PMID: 25673106 DOI: 10.1634/theoncologist.2013-0445] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in developed countries. Approximately 3%-14% of endometrial cancers are diagnosed in young women under 40 who want to preserve their fertility. The incidence of endometrial cancer in this age group is increasing, for which fertility-sparing therapy is increasingly used because it is one of the most important quality of life issues in these women. Progestin therapy is the most common type of fertility-sparing therapy. In this review, the most up-to-date findings regarding fertility-sparing progestin therapy for young women with primary and recurrent endometrial cancer is addressed in terms of diagnosis, treatment, follow-up, and oncologic and reproductive outcomes. Fertility-sparing progestin therapy is highly effective in selected young women with primary and recurrent endometrial cancer. The selection of appropriate patients through comprehensive pretreatment evaluation is of paramount importance to achieve the best outcomes without compromising survival. Because of the high rate of recurrence after successful fertility-sparing therapy, close surveillance is mandatory, and prophylactic hysterectomy is the best option for patients who have completed family planning. Pregnancy outcomes are very promising with the aid of assisted reproductive technologies. Continuous daily oral medroxyprogesterone acetate and megestrol acetate are the preferred progestins for fertility-sparing therapy, but future studies should be performed to determine the optimal dose and treatment duration of these agents.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Fertility preservation by photodynamic therapy combined with conization in young patients with early stage cervical cancer: a pilot study. Photodiagnosis Photodyn Ther 2014; 11:420-5. [PMID: 24927981 DOI: 10.1016/j.pdpdt.2014.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vaginal radical trachelectomy (VRT) is the standard fertility preserving procedure for early stage cervical cancer patients. There have been reports in the literature, however, that VRT to be too radical procedure for early stage cervical cancer, as its post-operative obstetric morbidity was high. In this study, PDT with Loop electrosurgical excision procedure (LEEP) or conization was investigated as a less radical fertility preserving treatment alternative to VRT for early stage cervical cancer patients. METHODS We analyzed data of 21 patients with early stage cervical cancer (stages IA-IIA) who underwent PDT with LEEP/conization from 2003 to 2012. LEEP or conization was performed before PDT in every case. For patients in stage IB1 or above, only those who were confirmed to be free of malignancy in frozen section by pelvic lymph node dissection received PDT. Surface photoillumination with red laser light at a wavelength of 630nm was applied to the cervix and the endocervical canal 48h after intravenous injection of 2mg/kg of photosensitizer. RESULTS Median age of the 21 patients was 31 years old (range: 22-43), 19 patients (90.5%) of whom were nulliparous. Majority of the lesions were at stage IA1 (47.6%) or IB1 (42.9%). Histologically, 80.9% were squamous cell carcinoma. 5 patients (23.8%) had a lesion of 2cm or larger in diameter. There was one recurrence (4.7%) and no death during 52.6 months (6-114 months). Of the 13 women who attempted to get pregnant, 10 (76.9%) women conceived a total of 11 pregnancies. The first and second trimester miscarriages were 2 and 1 respectively, and 7 (70%) of the pregnancies reached the third trimester, of which 5 delivered at term. No tumor-related deaths or PDT-related severe adverse effects were noted. CONCLUSION PDT combined with LEEP/conization could be an effective fertility sparing conservative treatment for young patients with early stage cervical cancer.
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Park JY, Joo WD, Chang SJ, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Long-term outcomes after fertility-sparing laparoscopic radical trachelectomy in young women with early-stage cervical cancer: An Asan Gynecologic Cancer Group (AGCG) study. J Surg Oncol 2014; 110:252-7. [DOI: 10.1002/jso.23631] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/05/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Korea
| | - Won Deok Joo
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center; CHA University; Seoul Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology; Ajou University School of Medicine; Suwon Korea
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Korea
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Rodriguez-Wallberg KA, Oktay K. Fertility preservation during cancer treatment: clinical guidelines. Cancer Manag Res 2014; 6:105-17. [PMID: 24623991 PMCID: PMC3949560 DOI: 10.2147/cmar.s32380] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The majority of children, adolescents, and young adults diagnosed with cancer today will become long-term survivors. The threat to fertility that cancer treatments pose to young patients cannot be prevented in many cases, and thus research into methods for fertility preservation is developing, aiming at offering cancer patients the ability to have biologically related children in the future. This paper discusses the current status of fertility preservation methods when infertility risks are related to surgical oncologic treatments, radiation therapy, or chemotherapy. Several scientific groups and societies have developed consensus documents and guidelines for fertility preservation. Decisions about fertility and imminent potentially gonadotoxic therapies must be made rapidly. Timely and complete information on the impact of cancer treatment on fertility and fertility preservation options should be presented to all patients when a cancer treatment is planned.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Sweden
- Reproductive Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Kutluk Oktay
- Innovation Institute for Fertility Preservation, Rye and New York
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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Successful pregnancy by direct intraperitoneal insemination in an infertile patient with failure of recanalization of isthmic stenosis after laparoscopic radical trachelectomy. Obstet Gynecol Sci 2014; 57:82-5. [PMID: 24596824 PMCID: PMC3924744 DOI: 10.5468/ogs.2014.57.1.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/17/2013] [Accepted: 08/17/2013] [Indexed: 11/08/2022] Open
Abstract
Radical trachelectomy is a promising fertility-sparing treatment for patients with early stage cervical cancer who want to preserve their fertility. However, isthmic stenosis occurs frequently in patients who received radical trachelectomy and it is one of the causes of infertility following radical trachelectomy. Moreover, despite the treatment for recanalization of isthmic stenosis, recanalization can fail or isthmic stenosis can recur. Herein we report a successful pregnancy and birth by direct intraperitoneal insemination in an infertile woman with failure of recanalization of isthmic stenosis after laparoscopic radical trachelectomy.
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25
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Klonoff-Cohen H. Establishing a fertility preservation database: no time like the present. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Harp D, Chowdhury I, Garcia-Barrio M, Welch C, Matthews R, Thompson W. Maintaining the reproductive potential of cancer patients during cancer treatment. Front Biosci (Schol Ed) 2014; 6:39-49. [PMID: 24389259 PMCID: PMC6178803 DOI: 10.2741/s412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cancer therapies are known to alter the reproductive potential in cancer patients. Due to improved survival rates in cancer patients of reproductive age, considerations of the long-term effects of cancer therapy have become more significant. Oncofertility is a new discipline in medicine that deals with maintaining the reproductive potential of cancer patients while they are receiving gonadotoxic cancer treatment. The purpose of this review is to explore how cancer treatment impairs reproductive functioning and present the current options for preservation of fertility in women. All patients with reproductive potential should be made aware of the possible treatment-related infertility and be offered appropriate fertility preservation options before cancer treatment is instituted. The hope is that, in the future, mechanism(s) can be developed to preserve immature germ cells in the ovary, so that they can be used for fertilization in vivo or in vitro.
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Affiliation(s)
- Djana Harp
- Department of Obstetrics and Gynecology
- Reproductive Science Research Program
| | - Indrajit Chowdhury
- Department of Obstetrics and Gynecology
- Reproductive Science Research Program
| | - Minerva Garcia-Barrio
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia 30310
| | | | - Roland Matthews
- Department of Obstetrics and Gynecology
- Reproductive Science Research Program
| | - Winston Thompson
- Department of Obstetrics and Gynecology
- Reproductive Science Research Program
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Ronn R, Holzer HEG. Oncofertility in Canada: gonadal protection and fertility-sparing strategies. ACTA ACUST UNITED AC 2013; 20:e602-7. [PMID: 24311962 DOI: 10.3747/co.20.1359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. METHODS Here, we review the fertility preservation measures currently available. Medical and surgical strategies are both outlined. RESULTS Fertility-preserving strategies and gonadal protection have demonstrated variable success in a number of approaches. The value of hormone suppression is still in question for women. Progestins for endometrial cancer and alternative chemotherapies are other medical approaches. Gonadal shielding and protective surgical approaches have also been attempted. CONCLUSIONS The techniques discussed here may be selectively considered and integrated into patient care in an attempt to preserve future fertility before initiating cancer treatment.
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Affiliation(s)
- R Ronn
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
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Abstract
PURPOSE OF REVIEW The development of new reproductive medicine techniques creates opportunities for preserving fertility in transgender persons. Before, losing fertility was accepted as the price to pay for transitioning. RECENT FINDINGS The desire for children is present in many trans persons, as in the general population. Ethical concerns are sometimes raised against the preservation of fertility; however, the only unique aspect of this group is the gender transition of one of the parents. All other elements such as same sex parenthood, use of donor gametes, social stigma, etc., can be found in other groups of parents. Not all reproductive options for all trans persons are equal because not only the gametes are of importance, but also the sex of the (future) partner. In trans women, the best option to preserve gametes is cryopreservation of sperm by preference initiated before starting hormonal therapy. In trans men, donor sperm is most often used, but in theory, there are three options available to preserve fertility: oocyte banking, embryo banking and banking of ovarian tissue. SUMMARY Fertility is possible for both trans men and women, but it requires timely cryopreservation of gametes or stopping cross-sex hormones and possible fertility treatments which are costly and may be unpleasant. Centers should elucidate their policy and inform trans persons on the possibilities and limitations.
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Affiliation(s)
- Guy TʼSjoen
- aDepartment of Endocrinology bCenter for Sexology and Gender problems, Ghent University Hospital, Ghent, Belgium
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Zhang Y, Xiao Z, Wang Y, Luo S, Li X, Li S. Gonadotropin-releasing hormone for preservation of ovarian function during chemotherapy in lymphoma patients of reproductive age: a summary based on 434 patients. PLoS One 2013; 8:e80444. [PMID: 24312222 PMCID: PMC3842920 DOI: 10.1371/journal.pone.0080444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/02/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Gonadotropin-releasing hormone agonists (GnRHa) might play a role in preserving ovarian function in lymphoma patients by inhibiting chemotherapy-induced ovarian follicular damage. However, studies of its clinical efficacy have reported conflicting results. METHOD We conducted a meta-analysis to determine the effect of the preservation of ovarian function by administering GnRHa in young patients with lymphoma undergoing chemotherapy. Seven studies were identified that met inclusion criteria and comprised 434 patients assigned to GnRHa combined chemotherapy or chemotherapy alone. RESULTS The incidence of women with premature ovarian failure (POF) demonstrated a statistically significant difference in favor of the use of GnRHa (OR=0.32, 95% CI 0.13-0.77). In addition, the final level of FSH in the GnRH group was significantly lower than control group. (MD= -11.73, 95% CI,-22.25- -1.20), and the final level of AMH in the GnRH group was significantly higher than control group (MD=0.80; 95% CI, 0.61-0.98). However, there was no statistically significant difference between treatment and the control groups in the incidence of a spontaneous pregnancy (OR=1.11; 95% CI, 0.55-2.26). CONCLUSION This meta-analysis suggests that GnRHa may be effective in protecting ovarian function during chemotherapy in lymphoma patients. More well-designed prospective studies are needed to carry out for further understanding of this topic.
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Affiliation(s)
- Yaoyao Zhang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Zhun Xiao
- Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Yan Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Shan Luo
- Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Xiaohong Li
- Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Shangwei Li
- Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- * E-mail:
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Large conization and laparoendoscopic single-port pelvic lymphadenectomy in early-stage cervical cancer for fertility preservation. Case Rep Surg 2013; 2013:207191. [PMID: 24223319 PMCID: PMC3816043 DOI: 10.1155/2013/207191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/12/2013] [Indexed: 11/18/2022] Open
Abstract
Fertility preservation in early-stage cervical cancer is a hot topic in gynecologic oncology. Although radical vaginal trachelectomy (RVT) is suggested as a fertility preserving approach, there are some serious concerns like cervical stenosis, second trimester loss, preterm delivery in survivors, and lack of residual tumor in the majority of the surgical specimens. Therefore, less radical surgical operations have been proposed in early-stage cervical carcinomas. On the other hand, single-incision laparoscopic surgery (SILS) is an evolving endoscopic approach for minimal access surgery. In this report, we present a case with early-stage cervical cancer who wishes to preserve fertility. We successfully performed single-port pelvic lymphadenectomy and large conization to preserve fertility potential of the patient. We think that combination of less radical approach like conization and single-port pelvic lymphadenectomy might be less minimally invasive and is still an effective surgical approach in well-selected cases with cervical carcinomas. Incorporation of single-port laparoscopy into the minimally invasive fertility sparing management of the cervical cancer will improve patients outcome with less complications and better cosmesis. Further studies are needed to reach a clear conclusion.
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Nam JH, Park JY. Fertility-Sparing Surgery for Young Women with Early-Stage Epithelial Ovarian Cancer. Gynecol Obstet Invest 2013; 76:14-24. [DOI: 10.1159/000350797] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 03/20/2013] [Indexed: 11/19/2022]
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Fertility Preservation via Photodynamic Therapy in Young Patients With Early-Stage Uterine Endometrial Cancer. Int J Gynecol Cancer 2013; 23:698-704. [DOI: 10.1097/igc.0b013e31828b5ba2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mersereau JE, Sandbulte JT. Fertility Preservation in Young Women with Breast Cancer. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-012-0035-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Husseinzadeh N, Husseinzadeh HD. Preservation of Fertility in Female Cancer Patients Desiring Future Child Bearing; What is Available and What can be Offered. World J Oncol 2013; 4:1-7. [PMID: 29147324 PMCID: PMC5649913 DOI: 10.4021/wjon616w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 11/03/2022] Open
Abstract
The aim of this review is to present an overview of available methods for preservation of ovarian function and fertility in female cancer patients who desire to maintain their child-bearing capacity for future pregnancies. A Medline search was conducted. Published articles from American and European studies from 1976 to present were reviewed. The effect of cancer treatment on the ovary, as well as different methods of fertility preservation and their reproductive outcomes are presented. Pregnancy rates vary according to the type of primary malignancy, stage of disease, method of fertility preservation (for example, hormonal therapy, cryopreservation, fertility-sparing surgery), and other confounding factors such as the patient's age, reproductive capacity, status of partnership, and genetic disposition. The highest rates of successful pregnancy were observed with embryo cryopreservation. Today, higher cure rates and longer survival are a result of earlier cancer diagnosis and treatment. In conjunction with the advances in assisted reproduction, the preservation of ovarian function and fertility is a major part of multidisciplinary care that should be offered to any young female patient with cancer. Fertility preservation in young cancer patients raises a number of ethical issues particularly regarding standard versus experimental therapies, and long-term financial cost.
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Affiliation(s)
- Nader Husseinzadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Cincinnati, 231 Albert Sabin Way. Cincinnati, Ohio 45267, USA
| | - Holleh D Husseinzadeh
- Taussig Cancer Center, Cleveland Clinic Foundation. 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
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A prospective single-center study of sentinel lymph node detection in cervical carcinoma: is there a place in clinical practice? Int J Gynecol Cancer 2012; 22:1044-9. [PMID: 22622952 DOI: 10.1097/igc.0b013e318253a9c9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer. MATERIALS AND METHODS Sentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination. RESULTS The SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1-7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8-35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8-80 months). CONCLUSION Sentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.
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Salama M, Winkler K, Murach KF, Seeber B, Ziehr SC, Wildt L. Female fertility loss and preservation: threats and opportunities. Ann Oncol 2012; 24:598-608. [PMID: 23129121 DOI: 10.1093/annonc/mds514] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ovarian aging and cytotoxic treatments are the most common causes for fertility loss in women. With increasing numbers of young female survivors following cytotoxic cancer treatments, the issue of fertility preservation has assumed greater importance. METHODS We review the literature on the causes of female fertility loss as well as the recent advances in fertility preservation options and strategies that might be of interest to oncologists. Currently, several methods and techniques exist for fertility preservation of female patients with cancer including embryo freezing, ovarian protection techniques, oocyte cryopreservation, ovarian tissue cryopreservation followed by autotransplantation, and recently in vitro culture of ovarian tissue, follicles, and oocytes. Each method or technique has advantages and disadvantages related to current success rate, required delay in cancer treatment, sperm requirement, and risk of reintroducing cancer cells. RESULTS To date, embryo freezing is the only established method successfully and widely used for fertility preservation of female patients with cancer. The other methods are promising but still considered experimental. CONCLUSION Patient awareness, physician knowledge, early counseling, costs management, international registry, interdisciplinary networks, and research development are necessary to improve the current care in the field of female fertility preservation.
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Affiliation(s)
- M Salama
- Department of Gynecological Endocrinology and Reproductive Medicine, Innsbruck Medical University, A-6020 Innsbruck, Austria
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Park JY, Kim DY, Kim JH, Kim YM, Kim KR, Kim YT, Seong SJ, Kim TJ, Kim JW, Kim SM, Bae DS, Nam JH. Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002). Eur J Cancer 2012; 49:868-74. [PMID: 23072814 DOI: 10.1016/j.ejca.2012.09.017] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/12/2012] [Accepted: 09/15/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyse the long-term oncologic outcomes of a fertility-sparing management using oral progestin in young women with endometrial cancer. METHODS We analysed 148 patients (age≤40 years) with stage IA, grade 1, endometrioid adenocarcinoma of the uterus who underwent fertility-sparing management using daily oral medroxyprogesterone acetate (MPA) or megestrol acetate (MA). RESULTS 115 (77.7%) showed complete response (CR) to progestin treatment, and 35 (30.4%) of them experienced recurrence after median follow-up time of 66 months. The 5-year recurrence-free survival was 68% (95% confidence interval [CI], 58.5-76.9%). However, 33 patients (22.3%) who failed to achieve CR underwent definitive surgical management, and no one had recurrence after median follow-up time of 41 months. During progestin treatment and at the time of recurrence, no patient showed clinical progression of disease over stage IA. Body mass index (BMI) ≥25 kg/m(2) was the only significant factor associated with a failure to achieve CR (odds ratio [OR], 3.00; 95% CI, 1.35-6.66; P=0.007). Upon multivariate analysis, BMI≥25 kg/m(2) (OR, 2.14; 95% CI, 1.06-4.31; P=0.033) was significantly associated with a higher risk of recurrence and the use of MPA (compared to MA) (OR, 0.44; 95% CI, 0.22-0.88; P=0.021), maintenance treatment (OR, 0.22; 95% CI, 0.05-0.94; P=0.042) and pregnancy (OR, 0.25; 95% CI, 0.11-0.56; P=0.001) were significantly associated with a lower risk of recurrence. CONCLUSION Fertility-sparing management was highly effective and safe. BMI<25 kg/m(2), MPA (compared to MA), maintenance treatment and pregnancy were associated with higher possibility of long-term success.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Coexisting ovarian malignancy in patients with clinical stage I endometrial carcinoma. Arch Gynecol Obstet 2012; 286:1241-5. [DOI: 10.1007/s00404-012-2402-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/29/2012] [Indexed: 01/22/2023]
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Hu J, Zhu LR, Liang ZQ, Meng YG, Guo HY, Qu PP, Ma CL, Xu CJ, Yuan BB. Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma. J Zhejiang Univ Sci B 2012; 12:787-95. [PMID: 21960341 DOI: 10.1631/jzus.b1100166] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma (EOC). METHODS A retrospective study of young EOC inpatients (≤40 years old) was performed during January 1994 and December 2010 in eight institutions. RESULTS Data were analyzed from 94 patients treated with fertility-sparing surgery with a median follow-up time of 58.7 months. As histologic grade increased, overall survival (OS) and disease-free survival (DFS) of patients receiving fertility-sparing surgery declined. Neither staging surgery nor laparoscopy of early stage EOC with conservative surgery had a significant effect on OS or DFS. Normal menstruation recommenced after chemotherapy in 89% of the fertility-sparing group. Seventeen pregnancies among twelve patients were achieved by the end of the follow-ups. CONCLUSIONS Fertility-sparing treatment for patients with EOC Stage I Grade 1 could be cautiously considered for young patients. The surgical procedure and surgical route might not significantly influence the prognosis. Standard chemotherapy is not likely to have an evident impact on ovarian function or fertility in young patients.
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Affiliation(s)
- Jun Hu
- Department of Gynecology, Peking University First Hospital, Beijing, China
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Kim CH, Jeon GH. Fertility preservation in female cancer patients. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:807302. [PMID: 22462006 PMCID: PMC3302115 DOI: 10.5402/2012/807302] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 11/29/2011] [Indexed: 11/25/2022]
Abstract
With improved survival rates among cancer patients, fertility preservation is now being recognized as an issue of great importance. There are currently several methods of fertility preservation available in female cancer patients and the options and techniques via assisted reproduction and cryopreservation are increasing, but some are still experimental and continues to be evaluated. The established means of preserving fertility include embryo cryopreservation, gonadal shielding during radiation therapy, ovarian transposition, conservative gynecologic surgery such as radical trachelectomy, donor embryos/oocytes, gestational surrogacy, and adoption. The experimental methods include oocyte cryopreservation, ovarian cryopreservation and transplantation, in vitro maturation, and ovarian suppression. With advances in methods for the preservation of fertility, providing information about risk of infertility and possible options of fertility preservation to all young patients with cancer, and discussing future fertility with them should be also considered as one of the important parts of consultation at the time of cancer diagnosis.
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Affiliation(s)
- Chung-Hoon Kim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poognap-dong, Songpa-gu, Seoul 138-736, Republic of Korea
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Fatemi HM, Kyrou D, Al-Azemi M, Stoop D, De Sutter P, Bourgain C, Devroey P. Ex-vivo oocyte retrieval for fertility preservation. Fertil Steril 2011; 95:1787.e15-7. [DOI: 10.1016/j.fertnstert.2010.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/27/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
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Abstract
Of the estimated 1.5 million men and women who were diagnosed as having cancer in 2010, approximately 10% are younger than 45 years. For these individuals, cancer treatment can be lifesaving but can permanently affect reproductive capacity. The American Society of Clinical Oncology has recommended that oncologists discuss the possibility of infertility with reproductive-age cancer patients and offer referral for fertility preservation consultation and therapy. Fertility preservation is an emerging field that offers treatment aimed at protecting future reproductive ability for individuals with cancer or other serious illnesses. Although fertility preservation strategies vary by patient age and sex, many allow patients to store gametes or reproductive tissues for potential future use to create offspring. As an emerging discipline, many questions remain about the role of fertility preservation. We performed a MEDLINE search from 1950 to June 2010 using the following MeSH terms: amenorrhea; antineoplastic agents; ovarian failure; premature; infertility, female; fertility preservation; infertility, male; adolescent and cancer; child and cancer; cryopreservation; and reproductive technologies, assisted. Studies considered for inclusion included those written in English and published before June 2010.
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Affiliation(s)
- Jani R Jensen
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN 55905, USA.
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Ovarian function, reproduction and strategies for fertility preservation after breast cancer. Crit Rev Oncol Hematol 2010; 76:1-12. [DOI: 10.1016/j.critrevonc.2009.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 12/09/2009] [Accepted: 12/16/2009] [Indexed: 11/23/2022] Open
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Wolff EF, Hughes M, Merino MJ, Reynolds JC, Davis JL, Cochran CS, Celi FS. Expression of benign and malignant thyroid tissue in ovarian teratomas and the importance of multimodal management as illustrated by a BRAF-positive follicular variant of papillary thyroid cancer. Thyroid 2010; 20:981-7. [PMID: 20718682 PMCID: PMC2964358 DOI: 10.1089/thy.2009.0458] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The most common type of ovarian germ cell tumor is the teratoma. Thyroid tissue, both benign and malignant, may be a component of an ovarian teratoma. Here we review this topic and illustrate major features by presenting multimodal management of a patient with BRAF-positive disseminated follicular thyroid cancer arising in an ovarian teratoma. SUMMARY Malignant thyroid tissue is often difficult to distinguish from benign thyroid tissue arising in ovarian teratomas. Preoperatively, an elevated thyroglobulin (Tg) level, laboratory or clinical evidence of hyperthyroidism, or ultrasonography appearance of "struma pearl" should prompt referral to oncologist for surgical management of a possibly malignant ovarian teratoma. Postoperatively, tumor tissue should be referred to pathologists experienced with differentiating benign from malignant struma ovarii. Once diagnosed, treatment of this rare condition should be handled by a team of specialists with combined treatment modalities. We cared for woman with disseminated thyroid cancer arising in an ovarian teratoma whose history illustrates the complexity of managing ovarian teratomas with malignant thyroid tissue. At age 33 she had an intraoperative rupture of an ovarian cyst, thought to be struma ovarii. During her next pregnancy, pelvic masses were noted; biopsies revealed well-differentiated papillary thyroid carcinoma, follicular variant. She was euthyroid, but had elevated serum Tg levels. Surgical staging demonstrated widely metastatic intraabdominal dissemination. A thyroidectomy revealed no malignancy. A post-(131)I treatment scan revealed diffuse uptake throughout the abdomen. She then developed abdominal pain and, on computed tomography, was found to have multiple intraabdominal foci of disease. Serum Tg was 264 ng/mL while on L-thyroxine for hypothyroidism and to obtain thyrotropin suppression. A 18 fluorodeoxyglucose positron emission tomography scan showed no pathological uptake. The tumor was found to be BRAF mutation positive (K601E). She underwent extensive secondary debulking and a second course of (131)I with lithium pretreatment. Posttreatment scan revealed diffuse abdominal uptake. Six months posttherapy, the patient is asymptomatic with a serum Tg of 18.1 ng/mL. CONCLUSIONS Aggressive multimodal management appears to be the most promising approach for malignant thyroid tissue arising in ovarian teratomas.
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Affiliation(s)
- Erin F. Wolff
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Marybeth Hughes
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J. Merino
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Jeremy L. Davis
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Craig S. Cochran
- Clinical Endocrinology Branch, National Institute of Diabetes, Digestive, and Kidney Diseases; National Institutes of Health, Bethesda, Maryland
| | - Francesco S. Celi
- Clinical Endocrinology Branch, National Institute of Diabetes, Digestive, and Kidney Diseases; National Institutes of Health, Bethesda, Maryland
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Ovarielle Reserve und Fertilitätserhalt. GYNAKOLOGISCHE ENDOKRINOLOGIE 2010. [DOI: 10.1007/s10304-010-0358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chimiothérapie et préservation de la fertilité féminine. Presse Med 2010; 39:786-93. [DOI: 10.1016/j.lpm.2010.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 01/04/2010] [Indexed: 11/23/2022] Open
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Shyamala G. Conservative Approach in Gynecologic Malignancies. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2009.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guruvare Shyamala
- Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal, India
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Ovarian stimulation during the luteal phase for fertility preservation of cancer patients: case reports and review of the literature. J Assist Reprod Genet 2010; 27:491-4. [PMID: 20455017 DOI: 10.1007/s10815-010-9429-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 04/27/2010] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To report the case of a patient with a diagnosis of infiltrative ductal carcinoma of the breast (case 1) and of a patient with Hodgkin's lymphoma (case 2), both submitted to ovarian stimulation during the luteal phase of the menstrual cycle in order to cryopreserve embryos and oocytes, respectively, in view of the need to start chemotherapy within a maximum of three weeks. METHODS Case reports. RESULTS Both patients were submitted to ovarian stimulation with recombinant follicle stimulating hormone together with pituitary blockade with a GnRH antagonist during the luteal phase of the cycle. Oocyte retrieval was performed nine days after the beginning of ovarian stimulation, with 12 mature oocytes being obtained in both cases. In case 1, all mature oocytes were submitted to ICSI, with fertilization and cleavage rates of 83.3% and 70%, respectively, and with the formation of seven good quality embryos. In case 2, all of mature oocytes were cryopreserved. CONCLUSIONS These cases demonstrate that it is possible to obtain mature oocytes when ovarian stimulation is started in the luteal phase in situations in which there is not sufficient time for conventional stimulation.
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de Bree E, Makrigiannakis A, Askoxylakis J, Melissas J, Tsiftsis DD. Pregnancy after breast cancer. A comprehensive review. J Surg Oncol 2010; 101:534-42. [PMID: 20401921 DOI: 10.1002/jso.21514] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pregnancy after breast cancer treatment has become an important issue since many young breast cancer patients have not completed their family. Generally, these patients should not be discouraged to become pregnant when they want to, since published data suggest no adverse effect of pregnancy on survival. As fertility may be impaired by chemotherapy, different fertility preserving strategies have been developed. Births seem to sustain no adverse effects, while breastfeeding appears to be feasible and safe.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, Herakleion, Greece.
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