Preserving Fertility in Adolescent Girls and Young Women Requiring Craniospinal Irradiation: A Case Report and Discussion of Options to Be Considered Prior to Treatment

Abstract

Craniospinal irradiation (CSI) is associated with infertility risk for adolescent/young adult women. We explore two methods of reducing ovarian exposure: oophoropexy (surgical removal of the ovaries from the path of the X-ray beam) and proton therapy (to allow the beam to stop without exposing the ovaries/uterus). In the case discussed, oophoropexy followed by X-ray CSI reduced ovarian dose to that at which 50% of oocytes are expected to survive, and the patient appears to have viable oocytes; this technique did not reduce uterine dose. Proton therapy would have eliminated the ovarian and uterine dose and the need for oophoropexy.

Keywords: craniospinal irradiation; fertility after radiation; fertility preservation in cancer survivors; oophoropexy; proton therapy.

FIG. 1.

Radiation dose distribution of craniospinal radiation plans using X-rays (left) and protons (right) for an adolescent girl receiving 36 Gy(RBE) to the craniospinal axis. The color-washed areas represent all areas receiving 0.5 Gy(RBE) or greater radiation dose. The uterus contour is outlined in yellow and the ovaries after oophoropexy are in green. Note the elimination of radiation dose to the uterus and other pelvic organs through use of proton therapy. RBE, relative biologic effectiveness.Color images available online at www.liebertpub.com/jayao