2423 - Rates of Fertility/Hormonal Preservation among Locally Advanced Cervical Cancer Patients Treated with Definitive Chemoradiation and Brachytherapy
Presenter(s)
S. C. Lymberis1, H. Koduru2, C. Sport3, M. Lightfoot4, M. Stasenko4, W. Growdon4, P. B. Schiff1, E. M. Aviki5, and L. Boyd4; 1Department of Radiation Oncology, NYU Langone Health and Perlmutter Cancer Center, New York, NY, 2Vanderbilt University, Nashville, TN, 3Virginia Commonwealth University School of Medicine, Richmond, VA, 4Department of Gynecologic Oncology, NYU Langone Health, New York, NY, 5Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Health Long Island, Mineola, NY
Purpose/Objective(s): Radiation therapy for locally advanced cervical cancer causes damage to the ovaries and uterus, leading to sterility and premature ovarian insufficiency (POI). This study aims to determine the frequency of oncofertility counseling and to assess rates of hormonal and fertility preservation using ovarian transposition (OT) at a single institution.
Materials/Methods: We performed a retrospective review of premenopausal patients, diagnosed with cervical cancer who received definitive chemoradiation and brachytherapy from 2009-2024. Clinical notes from initial consultation to last follow up were reviewed to determine if the physician documented discussing fertility preservation/POI. Patients received IMRT radiation therapy to the pelvis or extended field of 45-50.4Gy, followed by intracavitary brachytherapy (7 Gray x 4 fractions). Patients who underwent bilateral OT received IMRT technique with limited radiation dose to the ovaries.
Results: 88 patients with a median age of 43 (range 28-49 years) were included: 14.8% Stage I, 39.8% Stage II, 37.5% Stage III, 4.6% Stage IV. Racial demographics: 15.9% white, 19.3% African American, 10.2% Asian, 42.0% Hispanic, and 13.6% other. Insurance: 20.5% commercial, 79.5% public. At initial radiation oncology consultation, 55/88 (62.5%) had documented counseling regarding premature menopause and infertility after radiation therapy, 24/88 (27.3%) were presented with OT option and 32/88 (36.4%) were not offered OT. 8/88 (9%) patients underwent fertility preservation: 5 had OT, 3 had egg retrieval. For the 8 patients who underwent fertility preservation, the median time from diagnosis to treatment initiation was 85 days (65-134) compared with 49 days (4-300) for the rest of the cohort (p=0.21). Five patients underwent bilateral laparoscopic OT. One patient with OT above the iliac crest median ovarian dose of 2.82Gy after extended field IMRT, had preserved ovarian function without hormone replacement therapy or menopausal symptoms. Out of 8 patients who underwent fertility preservation, 62.3% progressed and 2 died of metastatic disease. Three patients underwent fertility preservation with egg retrieval and one patient had a child via surrogate. One year post RT treatment, 25% of the patients in the entire cohort were started on hormonal therapy at the conclusion of their treatment: 19.3% on vaginal estrogen, 5.7% on estradiol/progesterone, and 38% no hormonal therapy.
Conclusion: In a diverse cohort of premenopausal women with LACC, approximately 60% received oncofertility counseling prior to treatment with approximately 10% ultimately receiving a form of fertility/hormonal preservation. Since fertility/hormonal preservation can be associated with oncologic treatment delay, future work is needed to determine if there are any disease-specific harms or benefits associated with fertility/hormonal preservation and the ideal techniques to improve overall outcomes.