Transposition and preservation of gonadal glands as a surgical strategy for radiation reduction in children

Abstract

[Background & Purpose] With recent improvements in the treatment outcomes of childhood cancer, surgical supportive care for pre­serving gonadal function and fertility have become increasingly vital. Herein, we reviewed space-making particle therapy using an absorbable spacer, and reported our surgical experiences of transpositioning and preserving the gonadal glands to avoid irradiation with subsequent pelvic radiotherapy for radiation reduction in children.

[Gonadal Transposition] Three patients with high-risk rhabdomyosarcoma underwent gonadal transposition prior to radiotherapy. One case underwent transposition of the bilateral ovaries laparoscopically, and the other underwent unilateral transposition. In the another case of a male, testicular transposition was relatively easy to perform.

[Ovarian Preservation] Three girls underwent laparoscopic unilateral oophorectomy for ovarian tissue cryopreservation prior to chemotherapy including alkylating agents. All of them had brain tumors and were prepubescent.

[CONCLUSION] An absorbable spacer, gonadal transposition, and ovarian tissue cryopreservation as radiation reduction surgery is feasible and should be considered if applicable. Long-term follow-up is needed to verify the contribution of these surgical procedures towards preserving fertility.