Laparoscopic Oophoropexy Prior to Radiation for Pediatric Brain Tumor and Subsequent Ovarian Function

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Cancers of the nervous system are the commonest solid tumors to affect children and frequently are treated by craniospinal irradiation following surgical resection. Primary ovarian damage reportedly occurs in more than half of the girls treated in this way, with or without chemotherapy. The investigators planned a retrospective analysis of 26 girls aged 18 and younger who received spinal radiotherapy for a brain tumor.

Fifteen participants underwent unilateral laparoscopic oophoropexy before radiotherapy, while 11 made up a comparison group. The 2 groups were similar in mean age at diagnosis, length of follow-up, proportion of high-risk tumors (all but 3 girls had medulloblastoma), and the dosage and duration of chemotherapy. At surgery, the most mobile of the 2 ovaries was transposed. Ovarian dysfunction—the primary end point—was defined as either an elevated follicle-stimulating hormone level or persistent amenorrhea for longer than 6 months.

None of the girls undergoing laparoscopic oophoropexy had surgical complications. Two of the 15 operated patients (13%) had ovarian dysfunction, compared to 5 of the 11 comparison patients who did not have the laparoscopic procedure (45%). No significant group differences were found in the median radiation dose to the spine, the duration of either radiotherapy or chemotherapy, or the doses of the most commonly used chemotherapeutic agents (cisplatin, cyclophosphamide, vincristine, lomustine).

These findings indicate that laparoscopic oophoropexy may protect to some degree against radiation-induced ovarian failure in girls who are to be treated for brain tumor.

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