Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer (IRCAD) France, Strasbourg, France; UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
UOC Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Eur J Surg Oncol. 2024 Jan;50(1):107270. doi: 10.1016/j.ejso.2023.107270. Epub 2023 Nov 15.
(Chemo)radiation may be a required treatment in young women with pelvic malignancies. Irradiation may result in ovarian and uterine failure, compromising the fertility of those patients. While ovarian transposition is an established method to move the ovaries away from the irradiation field, similar surgical procedures regarding the uterus remain investigational. The aim of this study was to carry out a systematic review of the literature on uterine displacement techniques (ventrofixation/transposition) and to simulate the radiation dose received by the uterus in different heights place after the procedures.
The systematic review was performed according PRISMA guidelines. PubMed, Scopus, Web of Science and EMBASE were queried to identify included study until March 2023. Retrospectively, a dosimetric study was also performed and Volumetric Modulated Arc Therapy (VMAT) radiotherapy treatment plans were calculated, to assess the dose received by the uterus according to hypothetical different displacement positions taking the case of irradiation for rectal or anal cancer as model.
A total of 187 studies were included, after the screening 9 studies were selected for synthesis. Data from the dose simulation revealed that the transposition approach was the most protective with a maximum dose of about 3 and 8 Gy for anal and rectal cancer respectively. None of the simulated ventrofixation positions received a Dmean surpassing 14 Gy.
According to the literature review and the simulation results of the present study we may conclude are feasible and safe as fertility sparing approach in young rectal/anal cancer patients.
（化）放疗可能是年轻女性盆腔恶性肿瘤的必要治疗方法。放疗可能导致卵巢和子宫功能衰竭，使这些患者丧失生育能力。虽然卵巢移位术是一种将卵巢从照射野中移开的成熟方法，但关于子宫的类似手术方法仍在研究中。本研究的目的是对子宫移位技术（腹侧固定/转位）的文献进行系统评价，并模拟手术后子宫在不同高度位置所接受的辐射剂量。
根据 PRISMA 指南进行系统评价。检索 PubMed、Scopus、Web of Science 和 EMBASE，以确定纳入的研究，检索时间截至 2023 年 3 月。回顾性地，还进行了一项剂量学研究，并计算了容积调强弧形治疗（VMAT）放疗计划，以评估假设不同的移位位置对子宫的剂量，以直肠或肛门癌的照射为例。
共纳入 187 项研究，经过筛选，有 9 项研究被选入综合分析。剂量模拟数据显示，转位方法的保护作用最强，对于肛门和直肠癌，其最大剂量分别约为 3 和 8 Gy。没有任何模拟的腹侧固定位置的 Dmean 超过 14 Gy。
根据本研究的文献综述和模拟结果，我们可以得出结论，对于年轻的直肠/肛门癌患者，这种方法是可行且安全的，可作为保留生育能力的方法。
