KEY POINTS
- Single-institution retrospective dosimetric analysis of 17 patients younger than 50 with cervical cancer who underwent ovarian transposition before pelvic external beam radiotherapy.
- Median age at diagnosis was 32 years, and median follow-up was 52.2 months; 15 patients underwent bilateral transposition and 2 underwent unilateral transposition.
- Premature ovarian insufficiency occurred in 12 of 17 patients (71%), with median time from radiotherapy completion to diagnosis of 70 days.
- Among patients with premature ovarian insufficiency, median mean dose and maximum dose to the least exposed ovary were 12.0 Gy and 19.3 Gy, compared with 4.4 Gy and 5.9 Gy among patients without premature ovarian insufficiency.
- All patients with least exposed ovary mean dose >8 Gy developed premature ovarian insufficiency versus 50% with mean dose <8 Gy (p = 0.03); all patients with maximum dose >16 Gy developed premature ovarian insufficiency versus 54.5% with maximum dose <16 Gy (p = 0.05).
CLINICAL TAKEAWAY
This study supports prospective contouring of transposed ovaries and active ovarian dose optimization during cervical cancer intensity modulated radiotherapy. The proposed values of mean dose <8 Gy and maximum dose <16 Gy should be treated as practical upper limits when lower doses are not achievable, not as safe thresholds. The evidence is limited by the very small retrospective cohort, heterogeneous treatment setting, and mixed definition of premature ovarian insufficiency.