Pregnancy after fertility preservation and multimodal therapy including intensity-modulated radiotherapy for recurrent vulvar cancer: A case report

Advanced or recurrent vulvar cancer in women of reproductive age is extremely rare, and the effects of radiotherapy (RT) on uterine and ovarian function in such cases remain poorly understood. Here, we report the case of a 36-year-old woman with recurrent vulvar cancer after initial surgery. She strongly desired fertility preservation, so before undergoing resection of the recurrent lesion and inguinal lymphadenectomy, she underwent ovarian stimulation using a random-start progestin-primed ovarian stimulation (PPOS) protocol, and embryos were cryopreserved. Because of the high risk of recurrence, the patient underwent adjuvant intensity-modulated radiotherapy (IMRT) postoperatively. Three months after irradiation, ovarian function was lost; however, endometrial regrowth and withdrawal bleeding were observed with oral administration of norgestrel and ethinylestradiol. Despite significant vaginal and cervical atrophy, frozen-thawed embryo transfer was successfully performed in a hormone replacement cycle. Pregnancy was achieved with the second blastocyst transfer. Unfortunately, the patient subsequently developed acute myeloid leukemia, and continuation of the pregnancy was no longer feasible. This case suggests that IMRT may minimize scatter radiation to the uterine cavity, allowing for partial preservation of uterine function. Even in cases of advanced or recurrent vulvar cancer, fertility preservation strategies should be considered when appropriate.