Laparoscopic oophoropexy and ovarian function in the treatment of Hodgkin disease

BACKGROUND. Hodgkin disease commonly affects women of reproductive age. Tot al lymph node irradiation (TNI) typically delivers a dose of 2000-4000 cent igray (cGy) to the ovaries, which invariably results in premature ovarian f ailure (POF) and infertility unless the ovaries are shielded. Transposition of the ovaries at staging laparotomy has had mixed success and may be remo te in time from pelvic radiation. METHODS. A laparoscopic technique has been described that allows transposit ion of the ovaries just prior to pelvic radiation. This is a report of the outcome of 12 patients who underwent laparoscopic oophoropexy at the Univer sity of Florida from 1989 to 1995. Two were excluded from analysis, because one died and the other had a second malignancy for which radiation was abo rted. RESULTS. At follow-up, five patients had evidence of ovarian function, and the four patients of these five who desired children achieved pregnancies. All five had zero to two courses of chemotherapy. Two patients who subseque ntly had pregnancies had staging laparotomy with oophoropexy 5 and 6 months , respectively, before laparoscopy. In both cases the ovaries had migrated back to their original positions, and their therapy would have resulted in ovarian failure had the repeat procedure not been performed. Five patients had ovarian failure at follow-up. Four of the five had received multiple co urses of chemotherapy; the other had pelvic primary disease and received 35 00 cGy to die femoral lymph nodes and pelvis, with little central shielding . CONCLUSIONS. Laparoscopic oophoropexy performed immediately prior to pelvic irradiation is effective in preserving ovarian function in nearly all pati ents who are to undergo TNI for Hodgkin disease and who receive minimal or no chemotherapy. Cancer 1999;86:2138-42. (C) 1999 American Cancer Society.