Institute of Image-Guided Surgery, IHU Strasbourg, 1 place de l'Hôpital, Strasbourg, 67091, France.
Research Institute against Digestive Cancer, IRCAD, Strasbourg, France.
World J Surg Oncol. 2024 Jun 3;22(1):147. doi: 10.1186/s12957-024-03423-4.
Radio(chemo)therapy is often required in pelvic malignancies (cancer of the anus, rectum, cervix). Direct irradiation adversely affects ovarian and endometrial function, compromising the fertility of women. While ovarian transposition is an established method to move the ovaries away from the radiation field, surgical procedures to displace the uterus are investigational. This study demonstrates the surgical options for uterine displacement in relation to the radiation dose received. METHODS: The uterine displacement techniques were carried out sequentially in a human female cadaver to demonstrate each procedure step by step and assess the uterine positions with dosimetric CT scans in a hybrid operating room. Two treatment plans (anal and rectal cancer) were simulated on each of the four dosimetric scans (1. anatomical position, 2. uterine suspension of the round ligaments to the abdominal wall 3. ventrofixation of the uterine fundus at the umbilical level, 4. uterine transposition). Treatments were planned on Eclipse® System (Varian Medical Systems®,USA) using Volumetric Modulated Arc Therapy. Data about maximum (Dmax) and mean (Dmean) radiation dose received and the volume receiving 14 Gy (V14Gy) were collected.
All procedures were completed without technical complications. In the rectal cancer simulation with delivery of 50 Gy to the tumor, Dmax, Dmean and V14Gy to the uterus were respectively 52,8 Gy, 34,3 Gy and 30,5cc (1), 31,8 Gy, 20,2 Gy and 22.0cc (2), 24,4 Gy, 6,8 Gy and 5,5cc (3), 1,8 Gy, 0,6 Gy and 0,0cc (4). For anal cancer, delivering 64 Gy to the tumor respectively 46,7 Gy, 34,8 Gy and 31,3cc (1), 34,3 Gy, 20,0 Gy and 21,5cc (2), 21,8 Gy, 5,9 Gy and 2,6cc (3), 1,4 Gy, 0,7 Gy and 0,0cc (4).
The feasibility of several uterine displacement procedures was safely demonstrated. Increasing distance to the radiation field requires more complex surgical interventions to minimize radiation exposure. Surgical strategy needs to be tailored to the multidisciplinary treatment plan, and uterine transposition is the most technically complex with the least dose received.
盆腔恶性肿瘤（肛门、直肠、子宫颈癌）常需放射（化疗）治疗。直接照射会对卵巢和子宫内膜功能产生不良影响，损害女性生育能力。虽然卵巢移位术是一种将卵巢移离放射野的成熟方法，但使子宫移位的手术仍在研究中。本研究旨在展示与接受辐射剂量相关的子宫移位技术。
在一名女性尸体上连续进行子宫移位技术，以逐步展示每个步骤，并在混合手术室中使用剂量学 CT 扫描评估子宫位置。在四个剂量学扫描中（1.解剖位置、2.圆韧带将子宫悬于腹壁、3.子宫底在脐水平处腹侧固定、4.子宫移位）对每个治疗计划（肛门和直肠癌）进行了模拟。在 Eclipse®系统（美国瓦里安医疗系统公司）上使用容积旋转调强弧形治疗技术进行治疗计划。收集子宫接受的最大（Dmax）和平均（Dmean）辐射剂量以及接受 14Gy（V14Gy）的体积数据。
所有手术均顺利完成，无技术并发症。在直肠癌模拟中，对肿瘤给予 50Gy 的照射，子宫的 Dmax、Dmean 和 V14Gy 分别为 52.8Gy、34.3Gy 和 30.5cc（1）、31.8Gy、20.2Gy 和 22.0cc（2）、24.4Gy、6.8Gy 和 5.5cc（3）、1.8Gy、0.6Gy 和 0.0cc（4）。对于肛门癌，对肿瘤给予 64Gy 的照射，子宫的 Dmax、Dmean 和 V14Gy 分别为 46.7Gy、34.8Gy 和 31.3cc（1）、34.3Gy、20.0Gy 和 21.5cc（2）、21.8Gy、5.9Gy 和 2.6cc（3）、1.4Gy、0.7Gy 和 0.0cc（4）。
安全地证明了几种子宫移位术的可行性。距离放射场越远，需要更复杂的手术干预以尽量减少辐射暴露。手术策略需要根据多学科治疗计划量身定制，子宫移位术是技术上最复杂的，且子宫接受的辐射剂量最小。
