Fertility-sparing uterine displacement for pelvic malignancies: surgical options and radiotherapy dosimetry on a human cadaver

Fertility-sparing uterine displacement for pelvic malignancies: surgical options and radiotherapy dosimetry on a human cadaver | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fertility-sparing uterine displacement for pelvic malignancies: surgical options and radiotherapy dosimetry on a human cadaver Matteo Pavone, Laure Waeldin, Barbara Seeliger, Nicolò Bizzarri, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3891901/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Radio(chemo)therapy is often required in pelvic malignancies (cancer of the anus, rectum, cervix). Direct irradiation adversely affects ovarian and endometrial function, compromising the fertility of women. While ovarian transposition is an established method to move the ovaries away from the radiation field, surgical procedures to displace the uterus are investigational. This study demonstrates the surgical options for uterine displacement in relation to the radiation dose received. Methods The uterine displacement techniques were carried out sequentially in a human female cadaver to demonstrate each procedure step by step and assess the uterine positions with dosimetric CT scans in a hybrid operating room. Two treatment plans (anal and rectal cancer) were simulated on each of the four dosimetric scans (1. anatomical position, 2. uterine suspension of the round ligaments to the abdominal wall 3. ventrofixation of the uterine fundus at the umbilical level, 4. uterine transposition). Treatments were planned on Eclipse® System (Varian Medical Systems®,USA) using Volumetric Modulated Arc Therapy. Data about maximum (Dmax) and mean (Dmean) radiation dose received and the volume receiving 14Gy (V14Gy) were collected. Results All procedures were completed without technical complications. In the rectal cancer simulation with delivery of 50Gy to the tumor, Dmax, Dmean and V14Gy to the uterus were respectively 52,8Gy, 34,3Gy and 30,5cc ( 1 ), 31,8Gy, 20,2Gy and 22.0cc ( 2 ), 24,4Gy, 6,8Gy and 5,5cc ( 3 ), 1,8Gy, 0,6Gy and 0,0cc ( 4 ). For anal cancer, delivering 64Gy to the tumor respectively 46,7Gy, 34,8Gy and 31,3cc ( 1 ), 34,3Gy, 20,0Gy and 21,5cc ( 2 ), 21,8Gy, 5,9Gy and 2,6cc ( 3 ), 1,4Gy, 0,7Gy and 0,0cc ( 4 ). Conclusions The feasibility of several uterine displacement procedures was safely demonstrated. Increasing distance to the radiation field requires more complex surgical interventions to minimize radiation exposure. Surgical strategy needs to be tailored to the multidisciplinary treatment plan, and uterine transposition is the most technically complex with the least dose received. Full Text Additional Declarations No competing interests reported. Supplementary Files DISPLUTvideo.mp4 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3891901","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":268943304,"identity":"702625b1-8d00-4219-8021-98430062883b","order_by":0,"name":"Matteo Pavone","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYPCDCgk5EHXgAV5VzIwNCM4ZC2OwlgSitTC2VSSCefi06LafP/7gQ8UdeYPjvQcfMLBJpM8PO/wQaIudnG4Ddi1mZ5IZG2eceWa44cy5ZAMGHoncjbfTDIBako3NDuDQciCZsZm37TDjzBk5ZhIMEkAtsxNAWg4kbsOl5fxjxua/bYftgVrMfzAYSKQbzk7/gF/LDaAtjG2HE/slcsyA3pZIkJfOIWDLjceGM3vOPEvu5zljLJFwQMJwg3ROwYEEAzx+OZ/44MOPiju2bew9hh8+/quTl5+dvvnDhwo7OVxaoAAqmwDEBmC2AV7lSFpAQL6BoOpRMApGwSgYYQAAfGhnBP1v1jwAAAAASUVORK5CYII=","orcid":"","institution":"IHU Strasbourg","correspondingAuthor":true,"prefix":"","firstName":"Matteo","middleName":"","lastName":"Pavone","suffix":""},{"id":268943305,"identity":"53e9550e-8393-442b-a878-de63fb93222c","order_by":1,"name":"Laure Waeldin","email":"","orcid":"","institution":"Institut de Cancérologie Strasbourg Europe (ICANS)","correspondingAuthor":false,"prefix":"","firstName":"Laure","middleName":"","lastName":"Waeldin","suffix":""},{"id":268943306,"identity":"8ee9f57a-1a4a-4625-8d16-907cc7caec11","order_by":2,"name":"Barbara Seeliger","email":"","orcid":"","institution":"IHU Strasbourg","correspondingAuthor":false,"prefix":"","firstName":"Barbara","middleName":"","lastName":"Seeliger","suffix":""},{"id":268943307,"identity":"eed29918-77f4-410d-b272-258375c68ea8","order_by":3,"name":"Nicolò Bizzarri","email":"","orcid":"","institution":"UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. 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Direct irradiation adversely affects ovarian and endometrial function, compromising the fertility of women. While ovarian transposition is an established method to move the ovaries away from the radiation field, surgical procedures to displace the uterus are investigational. This study demonstrates the surgical options for uterine displacement in relation to the radiation dose received.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe uterine displacement techniques were carried out sequentially in a human female cadaver to demonstrate each procedure step by step and assess the uterine positions with dosimetric CT scans in a hybrid operating room. Two treatment plans (anal and rectal cancer) were simulated on each of the four dosimetric scans (1. anatomical position, 2. uterine suspension of the round ligaments to the abdominal wall 3. ventrofixation of the uterine fundus at the umbilical level, 4. uterine transposition). Treatments were planned on Eclipse\u0026reg; System (Varian Medical Systems\u0026reg;,USA) using Volumetric Modulated Arc Therapy. Data about maximum (Dmax) and mean (Dmean) radiation dose received and the volume receiving 14Gy (V14Gy) were collected.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll procedures were completed without technical complications. In the rectal cancer simulation with delivery of 50Gy to the tumor, Dmax, Dmean and V14Gy to the uterus were respectively 52,8Gy, 34,3Gy and 30,5cc (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), 31,8Gy, 20,2Gy and 22.0cc (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), 24,4Gy, 6,8Gy and 5,5cc (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), 1,8Gy, 0,6Gy and 0,0cc (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). For anal cancer, delivering 64Gy to the tumor respectively 46,7Gy, 34,8Gy and 31,3cc (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), 34,3Gy, 20,0Gy and 21,5cc (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), 21,8Gy, 5,9Gy and 2,6cc (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), 1,4Gy, 0,7Gy and 0,0cc (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe feasibility of several uterine displacement procedures was safely demonstrated. Increasing distance to the radiation field requires more complex surgical interventions to minimize radiation exposure. Surgical strategy needs to be tailored to the multidisciplinary treatment plan, and uterine transposition is the most technically complex with the least dose received.\u003c/p\u003e","manuscriptTitle":"Fertility-sparing uterine displacement for pelvic malignancies: surgical options and radiotherapy dosimetry on a human cadaver","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-25 17:23:09","doi":"10.21203/rs.3.rs-3891901/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"24db893c-582d-4bf6-b26b-82ea90e47ef1","owner":[],"postedDate":"January 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-14T21:14:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-25 17:23:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3891901","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3891901","identity":"rs-3891901","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}