2019 - Advancing Multidisciplinary Protocols for Early Menopause after Pelvic Radiation for Locally Advanced Rectal Cancer in Young Patients

03:00pm - 04:00pm ET

Poster Hall - Exhibit Hall A

Screen: 16

POSTER

Presenter(s)

Shari Bodofsky, MD - Yale Therapeutic Radiology, New Haven, CT

S. Bodofsky¹, K. L. Johung¹, and M. J. Minkin²; ¹Yale University, Department of Therapeutic Radiology, New Haven, CT, ²Yale School of Medicine department of Obstetrics, Gynecology & Reproductive Sciences, New Haven, CT

Purpose/Objective(s):

As rectal cancer incidence rises in young patients, premenopausal females requiring pelvic radiation therapy (PRT) face early menopause (EM) and consequent risks of cardiovascular disease, osteoporosis, dementia, and infertility. We evaluated patterns of counseling and intervention regarding fertility preservation (FP) and hormone replacement therapy (HRT) for females under 45 with locally advanced rectal cancer (LARC) treated with PRT and gathered multidisciplinary input to propose recommendations for EM management in this growing population.

Materials/Methods:

We retrospectively identified female patients under 45 with LARC, treated with PRT as part of definitive intent therapy at a single institution 2014-25. Chart review was performed for the following parameters: age, FP/HRT counseling in consultation, prophylactic FP (ovarian transposition, egg harvesting), referrals for FP/HRT, menopausal symptoms, time to referral or HRT post-radiation, types of HRT, documented births, and DEXA scans. We then gathered perspectives from Radiation Oncology, Gynecology, and Gynecologic Oncology to advance recommendations for FP/HRT counseling in Radiation Oncology clinics.

Results:

We identified 11 females under 45 (range 30-45, median 39) with LARC (cT3-4b N0-2b) treated definitively with PRT (50-54 Gy in 25-30 fx to primary with concurrent capecitabine). Median follow up 81 months, median OS of 49 months. 10/11 Radiation Oncology consultations documented infertility as a potential side effect of PRT. 5/11 charts included discussion of FP or HRT before starting PRT, and those patients all went on to FP, referral for HRT, or both. Of the 6 patients who did not initially discuss FP/HRT, only 2 went on to referral for HRT. The patient who had ovarian transposition began PRT 8 months after radiation consultation, compared to an average of 2 months. 8/11 patients reported post-PRT menopausal symptoms including vaginal dryness, dyspareunia, hot flashes, sweats, and sleep disturbances; 5/8 then started HRT, initiating 11-17 months after completing PRT.

Conclusion:

Female patients under 45 with LARC receiving PRT enter EM, making fertility and hormonal sequelae increasingly relevant to radiation oncologists. Early intervention can prevent delays in FP/HRT and mitigate risks of bone loss, cardiovascular disease, and dementia. Radiation consultation is a pivotal opportunity to discuss FP/HRT and is associated with subsequent appropriate management and avoidance of consequential late effects of PRT. Multidisciplinary recommendations for radiation oncologists to address EM in LARC include counseling for FP, baseline DEXA scans, early HRT initiation, and referral to Sexuality/Menopause clinics. Standardizing EM management may improve survivorship outcomes, minimizing preventable symptom burden and downstream complications.