Hum. Reprod. Advance Access originally published online on November 13, 2007
Human Reproduction 2008 23(1):117-121; doi:10.1093/humrep/dem368
Laparoscopic oophoropexy prior to radiation for pediatric brain tumor and subsequent ovarian function*
1 Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA 2 Division of Gynecology, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA 3 Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA 4 Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute/Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA 5 Department of Pediatric Oncology, Dana-Farber Cancer Institute, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA 6 Department of Medicine, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA 7 Present address: Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Sixth Floor, Boston, MA 02118, USA
8 Correspondence address. Tel: +1-617-355-5785; Fax: +1-617-730-0186; E-mail: marc.laufer{at}childrens.harvard.edu (M.R.L.)
BACKGROUND: Ovarian failure has been reported to occur in female cancer survivors who had received spinal radiation as children. We aimed to determine whether laparoscopic unilateral oophoropexy prior to radiotherapy effectively preserves ovarian function.
METHODS: In a retrospective analysis, the study group comprised girls, aged 18 and younger, who received spinal irradiation for a brain tumor. Ovarian dysfunction, the primary endpoint, was defined as an elevated follicle-stimulating hormone level or persistent amenorrhea.
RESULTS: After applying exclusion criteria, 15 patients comprised the group that had undergone laparoscopic oophoropexy, and 11 patients comprised the comparison group that did not have oophoropexy. Mean age at diagnosis, length of follow-up, proportion of high-risk tumors and doses and duration of chemotherapy and radiation were not different between the two groups. Two of 15 patients (13%, 95% CI 0.2–40%) with oophoropexy had ovarian dysfunction compared with five of 11 (45%, 95% CI 17–77%) in the comparison group (P = 0.09).
CONCLUSIONS: Oophoropexy may protect against radiation-induced ovarian failure in girls receiving spinal radiation. A high risk of ovarian dysfunction was seen in patients who did not undergo oophoropexy. In girls who underwent oophoropexy, a lower rate of ovarian dysfunction was seen.
Key words: brain tumor/children/laparoscopy/oophoropexy/radiation
* Presented in part at the 59th American Society for Reproductive Medicine Annual Meeting, San Antonio, TX, October 2003.
Submitted on May 29, 2007; resubmitted on October 8, 2007; accepted on October 18, 2007.