Fertility Preservation for Young Women with Rectal Cancer—A Combined Approach from One Referral Center
ABSTRACT BackgroundUp to 6% of women with colorectal cancer are diagnosed in the reproductive age and are at risk for premature ovarian failure
and infertility due to pelvic irradiation and chemotherapy.
Study DesignBetween 1997 and 2007, six women with rectal carcinoma were referred to the McGill Reproductive Center (Montreal, Canada)
for fertility preservation. Following resection of their primary tumor, they were scheduled to undergo pelvic irradiation.
ResultsFive patients underwent laparoscopic ovarian lateral transposition before radiotherapy in order to relocate their ovaries
outside the radiation field. A concomitant ovarian wedge resection was performed for ovarian cryopreservation. In two of these
women, before dissecting the ovarian cortical tissue for cryopreservation, all visible follicles were aspirated. The sixth
patient who had had low anterior resection underwent hormonal ovarian stimulation followed by oocyte retrieval and embryo
ConclusionsFertility preservation in women with rectal cancer is feasible. This includes laparoscopic ovarian transposition and cryopreservation
of ovarian tissue, embryo, or oocyte.
- SourceAvailable from: Colin M Howles[show abstract] [hide abstract]
ABSTRACT: Gonadotrophin-releasing hormone (GnRH) antagonists have recently been introduced into clinical practice. They appear to offer a promising alternative to the long-established GnRH agonist regimens for prevention of a premature LH surge during ovarian stimulation for assisted reproductive techniques. Clinical outcomes achieved with antagonists are comparable with those of a long GnRH agonist protocol, while treatment times and gonadotrophin requirements are reduced and safety is improved. In particular, the antagonists appear to be associated with a lower risk of ovarian hyperstimulation syndrome (OHSS) than do agonists. Patient surveys suggest a preference for antagonist over agonist treatment cycles. These benefits suggest that GnRH antagonists have the potential to replace agonists as the treatment of choice in ovarian stimulation for assisted reproductive techniques. Two agents, cetrorelix and ganirelix, are currently in clinical use. Cetrorelix is available in single- and multiple-dose formulations, offering increased flexibility compared with ganirelix.Reproductive biomedicine online 02/2002; 4 Suppl 3:64-71. · 2.68 Impact Factor
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ABSTRACT: The majority of patients with nonmetastatic rectal cancer are candidates for an aggressive multimodality approach with curative intent. Preoperative staging is critical in determining which patients should be offered neoadjuvant therapy. Available staging tools include digital rectal examination, transrectal ultrasound, computed tomography, positron-emission tomography, and magnetic resonance imaging scans. Magnetic resonance imaging has emerged as the most accurate staging modality in experienced centers. Multidisciplinary preoperative patient evaluation, better staging techniques, neoadjuvant chemoradiation, acceptance of shorter distal rectal margins, and transanal excision of T1 N0 rectal tumors in close proximity to the anal sphincter have resulted in decreased rates of abdominoperineal resections. Total mesorectal excision has been adopted as the standard surgical approach because of a reduction in rates of pelvic relapse. Preoperative and postoperative radiation therapy was shown to decrease the local recurrence rate, but not overall survival, in patients with resectable rectal cancer. The addition of chemotherapy to radiation was consistently shown to improve local control, and in some trials, improved overall survival. Neoadjuvant combined chemotherapy and radiation therapy are superior to adjuvant combined-modality therapy because of higher rates of sphincter preservation, less toxicity, and lower local recurrence rates. For patients with stage II or III disease, neoadjuvant continuous-infusion 5-fluorouracil (5-FU), concurrently with pelvic radiation, followed by postoperative 5-FU-based chemotherapy, remains the standard multimodality approach. Ongoing trials are testing the integration of newer cytotoxic agents such as capecitabine, oxaliplatin, irinotecan, and biologic agents such as cetuximab and bevacizumab to chemoradiation.Clinical Colorectal Cancer 12/2008; 7(6):369-75. · 1.80 Impact Factor
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ABSTRACT: The incidence of colorectal cancer in women of reproductive age is low. Physicians lack awareness of infertility difficulties in these patients. We studied the frequency of women of child-bearing age with colorectal cancer receiving pretreatment fertility counseling. This retrospective review from 1996 to 2004 screened women of reproductive age treated for colorectal cancer for documentation of fertility counseling or referral to fertility specialists before initiating treatment. Twenty-one women met the age criteria (range, 18-45 y). Eight patients were excluded for prior sterilization procedures or tumor involvement of reproductive organs. In the 13 remaining women, 2 had pretreatment fertility counseling documentation. These 2 patients had fewer than 2 children and had rectal tumors. Thirty-eight percent had pregnancy or menses difficulty after treatment. Few young women with colorectal cancer had pretreatment fertility counseling, whereas several had fertility complications posttreatment. Physicians need to discuss infertility concerns with their female colorectal cancer patients before intervention.American journal of surgery 01/2008; 194(6):765-7; discussion 767-8. · 2.36 Impact Factor