Fertility preservation via concurrent ovarian tissue cryopreservation during radical resection of pelvic retroperitoneal soft-tissue sarcoma in prepubertal girls: A case series

Pelvic retroperitoneal soft-tissue sarcoma (STS) is extremely rare in prepubertal girls, and concurrent ovarian tissue cryopreservation (OTC) during radical resection, performed to preserve fertility before initiating highly gonadotoxic anticancer therapy without delaying overall treatment, has been scarcely reported. Case 1 was a 6-year-old girl with embryonal rhabdomyosarcoma (Stage III; T2bNxM0G3) undergoing concurrent OTC during radical resection after 2 cycles of neoadjuvant chemotherapy. Total operative time was 301 minutes, with 16 minutes dedicated to OTC. Histopathology confirmed no malignant cells in the ovarian tissue. After postoperative chemotherapy and radiotherapy (34.22 Gy), she remains disease-free at 33 months of follow-up. Case 2 was a 7-year-old girl with undifferentiated small round cell sarcoma (Stage III; T1bNxM0G4) who underwent OTC during radical surgery (total time: 408 minutes; OTC: 20 minutes) following neoadjuvant chemotherapy. No tumor cells were found in the ovarian cortex. She completed adjuvant therapy (55.80 Gy radiotherapy) and showed no recurrence at 36 months of follow up. Case 3 was a 10-year-old girl diagnosed with embryonal rhabdomyosarcoma (Stage III; T2bNxM0G3) who underwent concurrent OTC (10 minutes) within a 255-minute radical resection after 4 cycles of neoadjuvant chemotherapy. The ovarian tissue was tumor-free. Following adjuvant chemotherapy, radiotherapy (50.4 Gy), and stem cell transplantation, no recurrence was observed at 17 months of follow-up. OTC combined with radical tumor resection reduces the need for second surgery and preserves ovarian fertility and endocrine function before the development of gonadotoxicity. This approach appears to be safe and feasible for pelvic retroperitoneal STS.