The role of ovarian transposition prior to pelvic radiation: A review

Objectives: This review aims to summarize the indications, surgical techniques, and outcomes of ovarian transposition (OT) prior to pelvic radiation for cancers in the pelvis to inform providers for patient counseling and candidate selection. Methods: -analyses, retrospective cohort studies, and case series were included. These studies evaluated patients with cervical cancer, anorectal cancer, and Hodgkin's lymphoma. Results: Reported success rates for preservation of ovarian function following OT vary (15-100%) depending on the type of cancer, radiation dosing, location of transposed ovaries, use of adjuvant chemotherapy, and individual patient factors. Approximately 50-65% of patients with cervical cancer who undergo OT followed by external beam radiation therapy with or without brachytherapy maintain ovarian function; adjuvant chemotherapy further reduces ovarian function preservation. Ovarian function is more likely to be preserved the further ovaries are transposed from the radiation field. The location of transposed ovaries should be at least 4 cm from the radiation field or 1.5 cm above the iliac crest to avoid gonadotoxic radiation doses. Perioperative complications are uncommon, and the risk of ovarian metastasis is very low (0.36%) in appropriately selected patients. Conclusion: Maintaining ovarian function helps prevent radiation-induced primary ovarian insufficiency and its associated morbidities, enables avoidance of hormone replacement therapy, and preserves certain fertility options. OT should be offered to pre-menopausal women aged 40 or younger without elevated ovarian metastasis risk who are planned to receive pelvic radiation.