The preservation of fertility and normal ovarian function may be achieved in women who receive radiation to the abdominal/pelvic lymph nodes for the treatment of Hodgkin’s disease, according to a recent article published in the journal Cancer.
Hodgkin’s lymphoma is a cancer of the lymph system, which is part of the immune (infection fighting) system that includes blood vessels, bone marrow, lymph nodes and lymph vessels that are present throughout the body. It also includes organs such as the spleen, thymus and tonsils. This cancer is characterized by the presence of the uncontrollable growth and division of atypical white blood cells (immune cells) that crowd lymph tissue, suppressing the formation and function of other cells normally found in this tissue. Hodgkin’s disease usually begins in a single lymph node and is capable of spreading throughout the body. Before treatment can begin, the stage, or extent of the disease needs to be determined. The extent of disease dictates treatment options. Persons with stage III have cancer that has spread from its site of origin to distant sites in the body, often involving in the pelvic regions of the body. Standard treatment involves chemotherapy and radiation therapy to affected areas.
Due to the anatomical placement of a female patients’ ovaries, radiation directed at cancerous lymph nodes in the pelvis invariably involves the ovaries. This treatment results in infertility and loss of ovarian function. Since Hodgkin’s disease commonly affects females of reproductive age, this can be a devastating side effect of treatment for these patients.
Recently, physicians have been refining a minimally invasive surgical procedure (laparoscopic oophoropexy) in which a patients’ ovaries are physically moved to different locations within the pelvis prior to radiation therapy. The patients’ ovaries are strategically placed in areas outside the field of radiation, sparing them from the treatment’s damaging effects.
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Physicians from the University of Florida recently evaluated 10 female patients of reproductive age who had stage III Hodgkin’s disease. All of these patients underwent a laparoscopic oophoropexy immediately prior to pelvic radiation. Five patients received up to 2 courses of chemotherapy, while the other 5 patients underwent multiple courses of chemotherapy. All of the patients who received up to 2 courses of chemotherapy achieved preservation of normal ovarian function following radiation treatment. Four of these 5 patients desired children, all of whom achieved pregnancies. Conversely, none of the patients who underwent multiple courses of chemotherapy resumed normal ovarian function following their treatment.
These results indicate that a laparoscopic oophoropexy immediately prior to pelvic radiation may preserve fertility and normal ovarian function in women with Hodgkin’s disease who receive minimal chemotherapy. These results are very encouraging, particularly for females who wish to have children. Female patients with Hodgkin’s disease that require pelvic radiation may wish to speak with their physician about the risks and benefits of a laparoscopic oophoropexy or the participation in a clinical trial further evaluating this procedure. (Cancer, Vol 86, No 10, pp 2138-2142, 2000).