Ovarian function after ovarian transposition and additional pelvic radiotherapy: A systematic review.

Objective: To investigate the ovarian survival (OS) after ovarian transposition (OT) and pelvic radiation.

Design: Systematic review. Electronic databases were searched to identify studies on OT prior to external beam radiation therapy (EBRT, to the pelvic). Primary outcome was the ovarian function after radiotherapy and ovarian transposition. Secondary outcomes were complication-rate. Only studies in English, German or French were included.

Setting: Not applicable.

Patients: Fertile women undergoing ovarian transposition prior to pelvic radiation therapy.

Interventions: We included all studies, containing >5 patients, treated with OT prior to radiation therapy.

Main Outcome Measure: Ovarian function.

Results: Our search yielded a total of 1130 studies of which 38 were eligible with a total of 765 patients. All studies were cohort studies or case-series. Heterogeneity among studies could not be rejected hence meta-analysis could not be performed. OS after OT and EBRT ranged from 20% to 100%. The median follow-up ranged from 7 to 102 months. OS was higher after OT and brachytherapy (OS 63.6-100%) when compared to OT and EBRT (20-100%) and OT concomitant chemoradiotherapy (0-69.2%). Only 22 studies (with 112 patients) reported on complications: among these studies the complication-rate was 0%-28.6%.

Conclusion: From our systematic review of literature we conclude that the preservation of ovarian function after OT prior to EBRT is successful in 20-100% of patients. Most favorable outcome with regard to preservation of ovarian function is seen in patients after OT and BT, followed by OT and EBRT and OT and RT combined with chemotherapy.