Chambers S K, Chambers J T, Kier R, Peschel R E
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510.
Int J Radiat Oncol Biol Phys. 1991 Jun;20(6):1305-8. doi: 10.1016/0360-3016(91)90242-v.
Lateral ovarian transposition (LOT) is a useful technique for preserving ovarian function in "high-risk" premenopausal Stage I cervix cancer patients who undergo hysterectomy and subsequent postoperative whole pelvic radiation therapy. From 1978 to 1988, 38 FIGO Stage I cervical cancer patients underwent LOT as part of their initial operative procedure and 14 of these patients (37%) subsequently received pelvic radiation therapy (LOT + RT) because of pathological findings such as metastatic pelvic lymph node involvement or positive surgical margins (13 patients) or recurrent disease (1 patient). Ten (71%) of the 14 (LOT + RT) patients have maintained ovarian function with a median follow-up of 35 months. Preservation of ovarian function was directly related to the estimated scatter dose to the ovaries. For patients whose estimated ovarian dose was 300 cGy or less, only 1 of 9 patients (11%) underwent menopause, whereas 3 of 5 patients (60%) became menopausal if the ovarian dose was more than 300 cGy. The placement of the ovaries was also crucial for preservation of ovarian function, with 100% of the patients developing menopause if the ovaries were placed below the iliac crest. A major side effect of LOT was the development of symptomatic ovarian cysts in 7 (18%) of the 38 Stage I patients who underwent LOT. In the 24 patients who underwent LOT alone without RT, the incidence of symptomatic ovarian cysts was 25% compared to only 7% of the patients who underwent LOT + RT, although this difference was not statistically significant (p = .18).
卵巢侧方移位术（LOT）是一种用于在接受子宫切除术及后续术后全盆腔放疗的“高危”绝经前I期宫颈癌患者中保留卵巢功能的有用技术。1978年至1988年期间，38例FIGO I期宫颈癌患者在其初始手术过程中接受了LOT，其中14例患者（37%）随后因转移性盆腔淋巴结受累或手术切缘阳性（13例患者）或复发性疾病（1例患者）等病理结果而接受了盆腔放疗（LOT + RT）。14例（LOT + RT）患者中有10例（71%）维持了卵巢功能，中位随访时间为35个月。卵巢功能的保留与卵巢的估计散射剂量直接相关。对于估计卵巢剂量为300 cGy或更低的患者，9例患者中只有1例（11%）进入绝经状态，而如果卵巢剂量超过300 cGy，5例患者中有3例（60%）进入绝经状态。卵巢的位置对于卵巢功能的保留也至关重要，如果卵巢置于髂嵴下方，100%的患者会进入绝经状态。LOT的一个主要副作用是，在接受LOT的38例I期患者中有7例（18%）出现了有症状的卵巢囊肿。在仅接受LOT而未接受RT的24例患者中，有症状卵巢囊肿的发生率为25%，而接受LOT + RT的患者中这一发生率仅为7%，尽管这一差异无统计学意义（p = 0.18）。
