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. 2022 Jun;44(6):573-577.
doi: 10.1055/s-0042-1746199. Epub 2022 May 26.

Practical Prediction Model for Ovarian Insufficiency after Radiation

Gabriel Oliveira Bernardes Gil  1   2 , Cassiano Asano  1 , Warne Pedro de Andrade  2   3 , Maria Luísa Braga Vieira Gil  1 , Eduardo Batista Cândido  4 , Marcos Regalin  5 , Izabella Nobre Queiroz  5 , Farley Soares Cantídio  5 , Darly Gomes Soares Delfino  6 , Agnaldo Lopes Silva-Filho  2   3
Affiliations

Practical Prediction Model for Ovarian Insufficiency after Radiation

Gabriel Oliveira Bernardes Gil et al. Rev Bras Ginecol Obstet. 2022 Jun.

Abstract
in English, Portuguese

Objective: The present study aimed to develop a useful mathematical model that predicts the age at which premature ovarian insufficiency might occur after teletherapy radiation. A diagnosis of premature or early menopause has physical and psychological consequences, so women may need support and long-term medical follow-up.

Methods: To correlate ovarian radiation dose with ovarian function, we used the formula described by Wallace et al.: √g(z) = 10(2-0,15z), where "g(z)" and "z" represent oocyte survival rate and the radiation dose (in Gray), respectively. By simulating different ages and doses, we observed a pattern that could be used to simplify the relationship between radiation dose and remaining time of ovarian function.

Results: We obtained a linear function between ovarian radiation dose and loss of ovarian function (LOF) that is the percentage of decrease in the time to the ovarian failure compared with the time expected for a woman at the same age without irradiation exposition. For patients < 40 years old and with ovarian radiation doses < 5 Gy, the equation LOF = 2.70 + (11.08 x Dose) can be applied to estimate the decrease in time to premature ovarian insufficiency.

Conclusion: The present study reports a practicable theoretical method to estimate the loss of ovarian function. These findings can potentially improve the management and counseling of young women patients submitted to radiotherapy during their reproductive years.

Objetivo: O presente estudo teve como objetivo desenvolver um modelo matemático útil que prediz a idade na qual a insuficiência ovariana prematura pode ocorrer após a radioterapia externa (teleterapia). O diagnóstico de menopausa prematura ou precoce tem consequências físicas e psicológicas; portanto, as mulheres podem precisar de apoio e acompanhamento médico de longo prazo. MéTODOS: Para correlacionar a dose de radiação ovariana com a função ovariana, foi usada a fórmula descrita por Wallace et al.: √g(z) = 10(2-0,15z), na qual “g(z)” e “z” representam a taxa de sobrevivência do oócito e a dose de radiação (em Gray), respectivamente. Ao simular diferentes idades e doses, observamos um padrão que poderia ser usado para simplificar a relação entre a dose de radiação e o tempo restante da função ovariana.

Resultados: Obtivemos uma função linear entre a dose de radiação ovariana e a perda da função ovariana (LOF, na sigla em inglês) que é a porcentagem de diminuição no tempo até a falência ovariana em relação ao tempo esperado para uma mulher da mesma idade sem exposição à radiação. Para pacientes < 40 anos de idade e com doses de radiação ovariana < 5 Gy, a equação LOF = 2,70 + (11,08 x Dose) pode ser aplicada para estimar a redução no tempo até a insuficiência ovariana. CONCLUSãO: O presente estudo relata um método teórico viável para estimar a perda da função ovariana. Estes achados podem melhorar potencialmente o manejo e o aconselhamento de pacientes jovens submetidas à radioterapia durante seus anos reprodutivos.

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Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
The influence of aging and fractionated radiation on oocyte number. Blue curve: healthy women; Green curve: woman who received 4 Gy in ovaries at 20 years old; Red curve: woman who received 8 Gy in ovaries at 20 years old.
Fig. 2
Fig. 2
Expected time of ovarian function remaining after a certain radiation dose for different ages.
Fig. 3
Fig. 3
Relationship between loss of ovarian function and ovarian radiation dose for the complete database.
Fig. 4
Fig. 4
Relationship between the loss of ovarian function according to the radiation dose in women aged 10 to 40 years.
Fig. 5
Fig. 5
Computed tomography planning with volumetric arc therapy (VMAT) (Monaco TPS – version 5.51) of a 27-year-old patient in adjuvant radiation for cervical cancer. Isodose (blue color wash) of 4 Gy does not touch the transposed ovary (white arrow).
See this image and copyright information in PMC

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