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Salman L, Covens A. Fertility Preservation in Cervical Cancer-Treatment Strategies and Indications. Curr Oncol 2024; 31:296-306. [PMID: 38248104 PMCID: PMC10814061 DOI: 10.3390/curroncol31010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Cervical cancer is frequently diagnosed in women during their reproductive years, and fertility preservation is an essential part of their cancer treatment. In highly selected patients with early stage, low-risk cervical cancer and a tumor size ≤ 2 cm, several treatment strategies can be offered for patients wishing to preserve fertility, including radical/simple trachelectomy or conization with pelvic lymph node assessment. Trachelectomy can be performed through a vaginal, abdominal, or minimally invasive approach and has been shown to have an equivalent oncologic outcome compared to radical hysterectomy. All surgical approaches for radical trachelectomy seem to have excellent survival with comparable oncologic outcomes. Nevertheless, patients undergoing vaginal trachelectomy have better obstetric outcomes compared to the other routes. In patients with larger tumors (2-4 cm), neoadjuvant chemotherapy followed by fertility-sparing surgery is an alternative option. Several chemotherapy regimens have been used for this indication, with a pathologic complete response rate of 17-73%. For locally advanced diseases that require radical hysterectomy or primary chemoradiation, fertility preservation can be performed using oocyte, embryo, or ovarian tissue cryopreservation, as well as ovarian transposition. For these patients, future pregnancy is possible through surrogacy. In addition to fertility preservation, ovarian transposition, where the ovaries are repositioned outside of the radiation field, is performed to maintain ovarian hormonal function and prevent premature ovarian failure. In summary, fertility-preservation treatment strategies for patients with early stage cervical cancer are continuously evolving, and less radical surgeries are becoming more acceptable. Additional and ongoing evidence is helping determine the impact of conservative procedures on oncologic and obstetric outcomes in these patients.
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Affiliation(s)
- Lina Salman
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON M5G 2M9, Canada;
| | - Allan Covens
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON M5G 2M9, Canada;
- Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
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2
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Findeklee S, Kasoha M, Radosa J, Radosa M, Haj Hamoud B, Sima R. WOMEN AND MEN WITH CANCER AND A FUTURE DESIRE FOR CHILDREN - WHAT SHOULD CLINICIANS CONSIDER IN COVID-19 PANDEMIC TIMES? ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2021; 17:234-240. [PMID: 34925573 PMCID: PMC8665243 DOI: 10.4183/aeb.2021.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The topic of fertility preservation has been gaining increasing importance since the beginning of this century. The reasons for this development are the advances in oncological therapy over the past few decades, with cure rates of approximately over 90%, and the fact that starting families is increasingly postponed in later periods of life in industrialized countries. Since March 2020 the whole medical and non-medical world experiences a pandemic due to Covid-19 (coronavirus disease 2019) which has never been seen before. This created a plenty of challenges for both, the patients and healthcare providers. This review article presents the fertility-protective methods currently available for women and men suffering from cancer with their clinical approach, value, advantages and disadvantages. Besides, it focuses on the changes and special considerations which have to be taken into account during pandemic times including preventive measures as well as the patient's access to the fertility preserving options. In conclusion every premenopausal woman and every man with incomplete family planning suffering from cancer should be counselled about the existing fertility preserving techniques before commencing cancer therapy.
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Affiliation(s)
- S. Findeklee
- Kinderwunschzentrum Niederrhein Mönchengladbach/Krefeld - Reproductive Medicine, Mönchengladbach, North Rhine-Westphalia, Germany
| | - M. Kasoha
- Saarland University Hospital Department of Gynaecology Obstetrics and Reproductive Medicine - Gynaecology, Obstetrics and Reproductive Medicine, Homburg, Saarland, Germany
| | - J.C. Radosa
- Saarland University Hospital Department of Gynaecology Obstetrics and Reproductive Medicine - Gynaecology, Obstetrics and Reproductive Medicine, Homburg, Saarland, Germany
| | - M.P. Radosa
- Klinikum Bremen-Nord gGmbH - Gynaecology and Obstetrics, Bremen, Germany
| | - B. Haj Hamoud
- Saarland University Hospital Department of Gynaecology Obstetrics and Reproductive Medicine - Gynaecology, Obstetrics and Reproductive Medicine, Homburg, Saarland, Germany
| | - R.M. Sima
- “Carol Davila” University of Medicine and Pharmacy - Gynaecology and Obstetrics, Bucharest, Romania
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3
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Czumaj A, Szrok-Jurga S, Hebanowska A, Turyn J, Swierczynski J, Sledzinski T, Stelmanska E. The Pathophysiological Role of CoA. Int J Mol Sci 2020; 21:ijms21239057. [PMID: 33260564 PMCID: PMC7731229 DOI: 10.3390/ijms21239057] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022] Open
Abstract
The importance of coenzyme A (CoA) as a carrier of acyl residues in cell metabolism is well understood. Coenzyme A participates in more than 100 different catabolic and anabolic reactions, including those involved in the metabolism of lipids, carbohydrates, proteins, ethanol, bile acids, and xenobiotics. However, much less is known about the importance of the concentration of this cofactor in various cell compartments and the role of altered CoA concentration in various pathologies. Despite continuous research on these issues, the molecular mechanisms in the regulation of the intracellular level of CoA under pathological conditions are still not well understood. This review summarizes the current knowledge of (a) CoA subcellular concentrations; (b) the roles of CoA synthesis and degradation processes; and (c) protein modification by reversible CoA binding to proteins (CoAlation). Particular attention is paid to (a) the roles of changes in the level of CoA under pathological conditions, such as in neurodegenerative diseases, cancer, myopathies, and infectious diseases; and (b) the beneficial effect of CoA and pantethine (which like CoA is finally converted to Pan and cysteamine), used at pharmacological doses for the treatment of hyperlipidemia.
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Affiliation(s)
- Aleksandra Czumaj
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Medical University of Gdansk, 80-211 Gdańsk, Poland;
| | - Sylwia Szrok-Jurga
- Department of Biochemistry, Faculty of Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland; (S.S.-J.); (A.H.); (J.T.)
| | - Areta Hebanowska
- Department of Biochemistry, Faculty of Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland; (S.S.-J.); (A.H.); (J.T.)
| | - Jacek Turyn
- Department of Biochemistry, Faculty of Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland; (S.S.-J.); (A.H.); (J.T.)
| | - Julian Swierczynski
- State School of Higher Vocational Education in Koszalin, 75-582 Koszalin, Poland;
| | - Tomasz Sledzinski
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Medical University of Gdansk, 80-211 Gdańsk, Poland;
- Correspondence: (T.S.); (E.S.); Tel.: +48-(0)-583-491-479 (T.S.)
| | - Ewa Stelmanska
- Department of Biochemistry, Faculty of Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland; (S.S.-J.); (A.H.); (J.T.)
- Correspondence: (T.S.); (E.S.); Tel.: +48-(0)-583-491-479 (T.S.)
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Ruddy KJ, Schaid DJ, Partridge AH, Larson NB, Batzler A, Häberle L, Dittrich R, Widschwendter P, Fink V, Bauer E, Schwitulla J, Rübner M, Ekici AB, Aivazova-Fuchs V, Stewart EA, Beckmann MW, Ginsburg E, Wang L, Weinshilboum RM, Couch FJ, Janni W, Rack B, Vachon C, Fasching PA. Genetic predictors of chemotherapy-related amenorrhea in women with breast cancer. Fertil Steril 2019; 112:731-739.e1. [PMID: 31371054 DOI: 10.1016/j.fertnstert.2019.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study how genetics may play a role in determining risk of chemotherapy-related amenorrhea (CRA) in young women with breast cancer. DESIGN Genome-wide association study. SETTING Not applicable. PATIENT(S) Premenopausal women ≤45 years of age enrolled in one of these three trials were included if they had at least one menstrual case report form after chemotherapy ended and if they were of European ancestry. Forms during and up to 3 months after receipt of GnRH agonist were excluded. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The association of single-nucleotide polymorphisms with post-chemotherapy menstruation adjusted for trial and arm, age, tamoxifen use, and nodal status. RESULT(S) The median age of the 1,168 women was 41 years (range 19-45). Among these, 457 (39%) never resumed menses after chemotherapy. Older age, tamoxifen use, and node-negative disease were associated with increased risk of CRA. Adjusting for these, rs147451859, in an intron of PPCDC (phosphopantothenoylcysteine decarboxylase), and rs17587029, located 5' upstream of RPS20P11 (ribosomal protein S20 pseudogene 11), were associated with post-chemotherapy menstruation. CONCLUSION(S) Genetic variation may contribute to risk of CRA. Better prediction of who will experience CRA may inform reproductive and treatment decision making in young women with cancer.
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Affiliation(s)
| | - Daniel J Schaid
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ann H Partridge
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicholas B Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Anthony Batzler
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Dittrich
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Widschwendter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Emanuel Bauer
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Judith Schwitulla
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Rübner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Elizabeth A Stewart
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Elizabeth Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Liewei Wang
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota
| | | | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Celine Vachon
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Findeklee S, Radosa JC, Takacs Z, Hamza A, Sima R, Solomayer E, Sklavounos P. Fertility preservation in female cancer patients: current knowledge and future perspectives. ACTA ACUST UNITED AC 2019; 71:298-305. [PMID: 30993959 DOI: 10.23736/s0026-4784.19.04387-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Protecting fertility in the presence of cancer has become highly significant, as the desire to give birth to a child is increasingly postponed to later in life, and long-term survival with cancer has increased. A variety of fertility-preserving methods have been developed. EVIDENCE ACQUISITION To find them, we performed a literature search in Medline using the key words "female fertility preservation in cancer" in December 2017. A total of 2381 different publications were found. EVIDENCE SYNTHESIS After screening the abstracts 78 publications in English, French, or German language had been assessed as relevant (17 dealing with medical approaches, six with surgical approaches, 15 with oocyte cryopreservation, 11 with ovarian tissue cryopreservation and 29 were review articles). In general, there are medical (non-surgical) and surgical approaches. Medical approaches comprise administration of GnRH-analogues during gonad toxic oncologic treatment, and cryopreservation of oocytes after ovarian stimulation. Surgical approaches comprise traditional methods of organ-saving surgery and ovarian transposition outside of the radiation portal as well as ovary cryopreservation as standard. CONCLUSIONS It is important to inquire about a prospective desire to have children with premenopausal women with cancer and comprehensively explain the fertility conserving methods available. Every premenopausal woman with cancer should be counseled about the methods of fertility protection currently available at a multiprofessional center.
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Affiliation(s)
- Sebastian Findeklee
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany -
| | - Julia C Radosa
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
| | - Zoltan Takacs
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
| | - Amr Hamza
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
| | - Romina Sima
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Erich Solomayer
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
| | - Panagiotis Sklavounos
- Department of Gynecology, Obstetrics, and Reproductive Medicine, University Hospital of Saarland, Homburg, Germany
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6
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Raffel N, Lotz L, Hoffmann I, Liebenthron J, Söder S, Beckmann MW, Dittrich R. Repetitive Maturation of Oocytes From Non-Stimulated Xenografted Ovarian Tissue From a Prepubertal Patient Indicating the Independence of Human Ovarian Tissue. Geburtshilfe Frauenheilkd 2017; 77:1304-1311. [PMID: 29269958 PMCID: PMC5734935 DOI: 10.1055/s-0043-122601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction
Modern anti-cancer strategies have distinctly increased survival rates; nevertheless, often accompanied by sterility. Currently, the only option for preserving fertility in prepubertal females is to cryopreserve ovarian tissue and re-transplant frozen-thawed tissue to restore fertility after treatment. Our aim was to report the occurrence of repetitive antral follicle formation and oocyte maturation in a prepubescent ovarian tissue xenograft without exogenous hormone stimulation.
Material and Methods
Frozen-thawed ovarian tissue from a 6-year-old patient suffering from nephroblastoma was xenotransplanted in oophorectomized severe combined immunodeficiency (SCID) mice to evaluate follicle development.
Ergebnisse
Repetitive follicle development to the antral stage occurred in the same xenograft of prepubertal ovarian tissue without exogenous hormone administration; 37 days after retrieving a maturing oocyte (this first retrieval has been previously published), another, completely mature oocyte was harvested from the xenograft. Subsequent histological evaluation of the grafted tissue showed primordial follicles, nearly all stages of developing follicles, as well as large atretic ones. Many clusters with dormant primordial follicles were also present.
Conclusion
Xenotransplanted prepubertal ovarian tissue has the potential for repetitive oocyte retrieval cycles without administering exogenous hormones. The results indicate that the human ovarian tissue might be able to synchronize the hypothalamus-hypophysis-axes of the mouse to the physiological human cycle; this should be investigated in future studies.
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Affiliation(s)
- Nathalie Raffel
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jana Liebenthron
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Bonn, Bonn, Germany
| | - Stephan Söder
- Institute of Pathology, University Hospital of Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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7
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Beckmann MW, Dittrich R, Lotz L, van der Ven K, van der Ven HH, Liebenthron J, Korell M, Frambach T, Sütterlin M, Schwab R, Seitz S, Müller A, von Wolff M, Häberlin F, Henes M, Winkler-Crepaz K, Krüssel JS, Germeyer A, Toth B. Fertility protection: complications of surgery and results of removal and transplantation of ovarian tissue. Reprod Biomed Online 2017; 36:188-196. [PMID: 29198423 DOI: 10.1016/j.rbmo.2017.10.109] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/13/2017] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
Fertility-preserving measures are becoming important for patients receiving oncological treatment. One method involves cryopreservation of ovarian tissue and transplanting it when treatment is completed. We report complications resulting from surgical and fertility medicine, and the results of procedures for the removal and transplantation of ovarian tissue carried out within the FertiProtekt network. A survey using a structured questionnaire was conducted among the FertiProtekt network centres between November 2015 and June 2016. The analysis included surgical techniques used to remove and transplant ovarian tissue, surgical complications and results. Laparoscopic removal and transplantation of ovarian tissue have a low risk of complications. Surgical complications occurred in three of the network's 1373 ovarian tissue removals (n = 1302) and transplantations (n = 71); two complications (0.2%) occurred during removal and one during transplantation. Menstruation resumed in 47 out of 58 women (81%) who underwent ovarian tissue transplantation. Hormonal activity occurred in 63.2% of transplantations with a follow-up of 6 months or over. Sixteen pregnancies occurred in 14 patients, with nine births. The risks and complications of removal and transplantation of ovarian tissue are similar to those of standard laparoscopy. These procedures are becoming standard for fertility protection in cancer patients.
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Affiliation(s)
- Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany.
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center ER-EMN, 91054 Erlangen, Germany
| | - Karin van der Ven
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Hans H van der Ven
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Jana Liebenthron
- Department of Obstetrics and Gynecology, Bonn University Hospital, University of Bonn, 53127 Bonn, Germany
| | - Matthias Korell
- Department of Obstetrics and Gynecology, Johanna-Etienne Hospital Neuss, 41462 Neuss, Germany
| | - Torsten Frambach
- Department of Obstetrics and Gynecology, St. Joseph Hospital Bremen, 28209 Bremen, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, Mannheim University Hospital, Ruprecht-Karls University of Heidelberg, 68167 Mannheim, Germany
| | - Roxana Schwab
- Department of Obstetrics and Gynecology, Freiburg University Hospital, Albert-Ludwigs University of Freiburg, 79106 Freiburg, Germany (now Mainz University Hospital, Johannes Gutenberg University of Mainz, 55122 Mainz, Germany)
| | - Stefan Seitz
- Department of Obstetrics and Gynecology, Caritas- Hospital St. Josef, University of Regensburg, 93053 Regensburg, Germany
| | - Andreas Müller
- Department of Obstetrics and Gynecology, Hospital Karlsruhe, 76133 Karlsruhe, Germany
| | - Michael von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, 3010 Berne, Switzerland
| | - Felix Häberlin
- Department of Obstetrics and Gynaecology, Kantonspital, 9007 St. Gallen, Switzerland
| | - Melanie Henes
- Department of Obstetrics and Gynecology, Tübingen University Hospital, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Katharina Winkler-Crepaz
- Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria
| | - Jan S Krüssel
- Department of Obstetrics and Gynecology, Düsseldorf University Hospital, Heinrich-Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Ariane Germeyer
- Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Ruprecht-Karls University of Heidelberg, 69120 Heidelberg, Germany (B.T. now Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria)
| | - Bettina Toth
- Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Ruprecht-Karls University of Heidelberg, 69120 Heidelberg, Germany (B.T. now Department of Gynecological Endocrinology and Reproductive Medicine, University of Innsbruck, 6020 Innsbruck, Austria)
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8
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Urech C, Ehrbar V, Boivin J, Müller M, Alder J, Zanetti Dällenbach R, Rochlitz C, Tschudin S. Knowledge about and attitude towards fertility preservation in young female cancer patients: a cross-sectional online survey. HUM FERTIL 2017; 21:45-51. [DOI: 10.1080/14647273.2017.1380317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Corinne Urech
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Verena Ehrbar
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Jacky Boivin
- School of Psychology, Cardiff University, Cardiff, UK
| | - Madleina Müller
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Judith Alder
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | - Christoph Rochlitz
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Sibil Tschudin
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
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9
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Stachs A, Hartmann S, Gerber B. Preservation of Fertility or Ovarian Function in Patients with Breast Cancer or Gynecologic and Internal Malignancies. Geburtshilfe Frauenheilkd 2017; 77:861-869. [PMID: 28845050 DOI: 10.1055/s-0043-116222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/08/2017] [Accepted: 07/09/2017] [Indexed: 12/17/2022] Open
Abstract
Because of the efficacy of systemic therapies, neoplasias which occur in pediatric and adolescent patients and in young adults have high cure rates. This means that fulfilling their wish to have children has become a more pressing concern, particularly among young women with malignant tumors. Premature ovarian failure is also a not insignificant problem as it has a lasting detrimental effect on quality of life. Every oncology patient who may potentially wish to have children should be informed about their options for preserving fertility prior to starting treatment. The rates of patient who received detailed briefing on this point remain low. This review presents the effects of different chemotherapeutic drugs on gonadal function together with an overview of currently valid recommendations on fertility preservation. Risk groups are defined and the specific approaches for malignancies of various organ systems are described. Cryopreservation of oocytes, fertilized embryos and ovarian tissue are fertility-preserving options for girls/young women. The data on the benefits of administering GnRH analogs for ovarian protection prior to starting chemotherapy are not clear. In postpubertal boys or male cancer patients, the standard approach is to cryopreserve sperm before starting therapy. The cryopreservation of testicular tissue is possible for prepubertal boys, however in-vitro sperm maturation is still in its experimental stages. This review also presents existing drug options for the preservation of ovarian function in oncology patients prior to chemotherapy, particularly for patients with (hormone-sensitive) breast cancer, and looks at the special issues of fertility-preserving surgery and radiation therapy in patients with gynecologic malignancies.
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Affiliation(s)
| | | | - Bernd Gerber
- Universitätsfrauenklinik Rostock, Rostock, Germany
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10
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Ehrbar V, Urech C, Rochlitz C, Dällenbach RZ, Moffat R, Stiller R, Fäh M, von Wolff M, Nawroth F, Dangel A, Germeyer A, Findeklee S, Tschudin S. Fertility Preservation in Young Female Cancer Patients: Development and Pilot Testing of an Online Decision Aid. J Adolesc Young Adult Oncol 2017; 7:30-36. [PMID: 28759303 DOI: 10.1089/jayao.2017.0047] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Impairment of fertility is a common sequela of successful cancer treatment. Therefore, fertility preservation (FP) should be discussed with all young cancer patients. Decisions about FP are challenging. Patients wish more specific support and the first results concerning the helpfulness of decision aids (DA) were promising. Aside from describing the process of development and the content of an online DA in German, the objective of this study was to pilot test users' satisfaction with the DA and its effect on knowledge about FP and decisional conflict (DC). METHODS In this prospective consecutive study, a control group (n = 20, fertility counseling) was followed by and compared with an intervention group (n = 20, counseling and additional use of the DA, developed by an interdisciplinary team) of recently diagnosed female cancer patients between 18 and 40 years. RESULTS Nearly all participants who applied the DA considered it helpful for decision-making and recommendable. Knowledge about FP was high with regard to FP techniques women went for. DC was moderate according to the mean score (M = 27.92, standard deviation = 13.27) and only in 20%, the score was above the threshold for high DC. There was no difference between the control and intervention group for knowledge and DC. CONCLUSION The DA seems to serve as additional and well-accepted support tool in decision-making for patients and professionals. Referral to a reproductive specialist is crucial to warrant comprehensive information. These results need to be confirmed with the current ongoing randomized controlled study.
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Affiliation(s)
- Verena Ehrbar
- 1 Department of Gynecology and Obstetrics, University Hospital Basel , Basel, Switzerland .,2 Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel , Basel, Switzerland
| | - Corinne Urech
- 1 Department of Gynecology and Obstetrics, University Hospital Basel , Basel, Switzerland
| | | | | | - Rebecca Moffat
- 1 Department of Gynecology and Obstetrics, University Hospital Basel , Basel, Switzerland
| | - Ruth Stiller
- 5 Department of Gynecology and Obstetrics, University Hospital Zurich , Zurich, Switzerland
| | - Monika Fäh
- 6 Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, University of Bern , Bern, Switzerland
| | - Michael von Wolff
- 6 Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, University of Bern , Bern, Switzerland
| | - Frank Nawroth
- 7 Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology , Amedes Hamburg, Germany
| | - Astrid Dangel
- 7 Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology , Amedes Hamburg, Germany
| | - Ariane Germeyer
- 8 Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, University Hospital of Heidelberg , Heidelberg, Germany
| | - Sebastian Findeklee
- 9 Comprehensive Cancer Center ER-MN, University Women's Hospital, University Hospital Friedrich-Alexander , Erlangen-Nürnberg, Germany
| | - Sibil Tschudin
- 1 Department of Gynecology and Obstetrics, University Hospital Basel , Basel, Switzerland
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11
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Nasioudis D, Kampaktsis PN, Frey M, Witkin SS, Holcomb K. Primary lymphoma of the female genital tract: An analysis of 697 cases. Gynecol Oncol 2017; 145:305-309. [PMID: 28284518 DOI: 10.1016/j.ygyno.2017.02.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Primary lymphoma of the female genital tract (PLFGT) is a rare entity. The aim of this population-based study was to elucidate the clinico-pathological, demographic characteristics and survival of women with PLFGT. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database was accessed and cases of PLFGT diagnosed between 1988 and 2012 were identified. Five-year overall (OS) and cancer-specific (CSS) survival rates were calculated with the Kaplan-Meier method. The influence of demographic and clinical parameters on survival was examined with the log-rank test. Factors independently associated with cancer-specific mortality were evaluated with a Cox proportional hazard model. RESULTS A total of 697 women with PLFGT were identified with a median age of 54years. The most prevalent histological subtypes were diffuse large B-cell (59.8%) and follicular (11.9%) lymphoma. Tumors were most commonly located in the ovary (37%), cervix (21.4%), and uterus (16.5%). According to the Ann Arbor staging system, 42.6% and 17.9% of cases had stage I and stage II disease, respectively. Cancer-directed surgery (CDS) was performed in the majority of cases (62.8%). Five-year OS and CSS were 70.2% and 75.2% respectively. Localized disease, premenopausal age and follicular histology were associated with superior cancer-specific mortality while CDS did not confer any mortality benefit. CONCLUSIONS This is the largest cohort of PLFGT presented in literature. While in our study surgical treatment was not associated with improved outcomes, larger multi-institutional studies should address the optimal management of women with PLFGT.
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Affiliation(s)
- Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA; Surgery Working Group, Society of Junior Doctors, Athens, Greece.
| | - Polydoros N Kampaktsis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece; Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Melissa Frey
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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12
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Beckmann MW, Dittrich R, Lotz L, Oppelt PG, Findeklee S, Hildebrandt T, Heusinger K, Cupisti S, Müller A. Operative techniques and complications of extraction and transplantation of ovarian tissue: the Erlangen experience. Arch Gynecol Obstet 2017; 295:1033-1039. [PMID: 28197717 DOI: 10.1007/s00404-017-4311-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/27/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Extracting ovarian tissue before oncologic therapy and transplanting it afterwards are increasingly being used to preserve fertility in women. This study describes standardized and safe operative procedures, with few complications, and reports the resulting ovarian function and pregnancy rates. METHODS The standardized operative techniques for removing and transplanting ovarian tissue used at the Erlangen center are: for tissue removal, one-third to half of the tissue from one ovary is excised with scissors, without tissue coagulation; for subsequent transplantation, pieces of ovarian tissue are placed in a retroperitoneal pocket without closure of the pocket. RESULTS Between January 2007 and December 2015, ovarian tissue was extracted in 399 women and transplanted following cancer therapy in 38. No surgical complications were observed within 28 days. To date, there have been ten pregnancies and nine live births after transplantation in seven different women; 26 of the 38 women developed hormonal activity, confirmed by a menstrual cycle or raised serum estradiol levels. CONCLUSIONS The techniques for laparoscopic removal and transplantation of ovarian tissue described here provide a standardized method with a very low risk of complications. The pregnancy rate after ovarian tissue transplantation, currently 15-30%, can be expected to rise further in the near future.
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Affiliation(s)
- Matthia W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Ralf Dittrich
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany.
| | - Laura Lotz
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Patricia G Oppelt
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Sebastian Findeklee
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Katharina Heusinger
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Susanne Cupisti
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstraße 21, 91054, Erlangen, Germany
| | - Andreas Müller
- Department of Gynecology and Obstetrics, Klinikum Karlsruhe, Karlsruhe, Germany
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13
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Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation. J Minim Invasive Gynecol 2017; 24:28-35. [DOI: 10.1016/j.jmig.2016.08.831] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/24/2016] [Accepted: 08/27/2016] [Indexed: 11/24/2022]
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14
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Findeklee S, Lotz L, Heusinger K, Hoffmann I, Dittrich R, Beckmann MW. Twenty-five-year-old Woman with Bilateral Borderline Ovarian Tumour Desiring to Preserve Fertility - Case Report and Literature Review on the Current State of Fertility Preservation in Women with Borderline Ovarian Tumours. Geburtshilfe Frauenheilkd 2016; 76:1189-1193. [PMID: 27904170 PMCID: PMC5123880 DOI: 10.1055/s-0042-109267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 01/05/2023] Open
Abstract
Borderline ovarian tumours are semimalignant tumours occurring unilaterally or bilaterally with a peak incidence among women of reproductive age. Since the affected women often wish to preserve fertility, particular precautions must be taken when counselling the patient and obtaining consent prior to planning an individual treatment. Options for preserving fertility include an organ-sparing surgical procedure and cryopreservation of oocytes and/or ovarian tissue. In this article, we report on a 25-year-old patient with a bilateral seromucinous borderline tumour who desired all fertility-preserving options. In order to perform the procedure without delay, we opted to perform luteal phase stimulation prior to oocyte retrieval. We conclude by discussing the current literature on the state of fertility preservation in the treatment of borderline ovarian tumours.
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Affiliation(s)
- S. Findeklee
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - L. Lotz
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - K. Heusinger
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - I. Hoffmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - R. Dittrich
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - M. W. Beckmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
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15
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Jabiry-Zieniewicz Z, Dabrowski FA, Pietrzak B, Wyzgal J, Bomba-Opoń D, Zieniewicz K, Wielgos M. Pregnancy in the liver transplant recipient. Liver Transpl 2016; 22:1408-17. [PMID: 27197796 DOI: 10.1002/lt.24483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 12/27/2022]
Abstract
During gestation, the woman's body undergoes various changes, and the line between physiology and pathology is very thin even in healthy women. Today, many of the liver transplant recipients are young women, who at one point in their lives may consider the possibility of pregnancy. Clinicians have to counsel them about the time of conception, the risk of miscarriage, the deterioration of the mother's health status, and the risk of birth defects. This review, based on our 20 years of clinical experience and up-to-date literature, provides comprehensive guidelines on pregnancy management in liver transplant recipients. Pregnancy in liver transplant recipients is possible but never physiological. Proper management and pharmacotherapy lowers the incidence of complications and birth defects. Critical factors for perinatal success include stable graft function before pregnancy, proper preparation for pregnancy, and cautious observation during its course. Liver Transplantation 22 1408-1417 2016 AASLD.
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Affiliation(s)
| | | | - Bronislawa Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Wyzgal
- Department of Nephrological Nursing, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Bomba-Opoń
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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16
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Beckmann MW, Dittrich R, Findeklee S, Lotz L. Surgical Aspects of Ovarian Tissue Removal and Ovarian Tissue Transplantation for Fertility Preservation. Geburtshilfe Frauenheilkd 2016; 76:1057-1064. [PMID: 27761026 PMCID: PMC5065421 DOI: 10.1055/s-0042-115017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 01/16/2023] Open
Abstract
Introduction: The removal of ovarian tissue prior to starting oncologic treatment and the subsequent transplantation of this tissue after completing therapy have become increasingly important surgical fertility-preserving techniques. The aim of this review was to investigate the different surgical techniques used for this method reported in the literature to date and to discuss the advantages and disadvantages of the respective techniques. Review: A search was done in MEDLINE using a defined algorithm to find studies published between January 2004 and December 2015. All study designs were included in our review if they contained statements on the surgical technique used. We found 16 publications (8 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 1898 female patients which reported on the surgical technique used for ovarian biopsy and 15 publications (7 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 455 women which mentioned the surgical technique used for ovarian transplantation. Different surgical techniques can be used both for ovarian biopsy and for the transplantation of ovarian tissue. A number of different surgical routes have been used, and the amount of tissue extracted, the instruments used, the treatment of the ovary, the transplantation site, the blood supply to the transplanted ovarian tissue and the procedure used for simultaneous surgical interventions vary. Conclusion: In future, one of the tasks will be to establish a standard surgical method for ovarian extraction and transplantation which will have a low rate of complications and a high pregnancy and birth rate while ensuring that the transplanted tissue is fully functional.
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Affiliation(s)
- M. W. Beckmann
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - R. Dittrich
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S. Findeklee
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - L. Lotz
- Frauenklinik, Comprehensive Cancer Center ER-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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