ESTRO 2022 - Abstract Book

S1108

Abstract book

ESTRO 2022

CoDMI algorithm leads to the “unbiased” (appropriately adjusted) probability of overall survival in locally advanced rectal cancer patients with Covid-19 infection, compared with that provided by a naïve application of the Kaplan-Meier approach. This allows a proper interpretation/use of Covid-19 events in survival analysis. A user-friendly version of CoDMI is freely available at https://github.com/alef-innovation/codmi.

PO-1313 Laparoscopic uterus transposition to preserve fertility in young patients with pelvic radiation

S. Marnitz 1 , M. Püsken 2 , A. Plaikner 3 , R. Fouassi 1 , A.S. Bereuter 1 , C. Köhler 4

1 University Cologne, Department of Radiation Oncology CyberKnife and Radiotherapy, Cologne, Germany; 2 University of Cologne, Medical Faculty, Department of Radiology, Cologne, Germany; 3 Sklepios-Clinic Hamburg-Altona, Department of Special Operative and Oncologic Gynecology, Hamburg, Germany; 4 Asklepios-Clinic Hamburg-Altona, Department of Special Operative and Oncologic Gynecology, Hamburg, Germany Purpose or Objective Anal/rectal cancer in women younger than 40 years is a rare event. However, due to high radiosensitivity of ovaries and endometrium pelvic radiation is inconsistent with fertility preservation. Materials and Methods Anastomosis between uterine and ovarian arteries provide sufficient blood supply to the uterus even after transsection of both uterine arteries. Thus, uterus can be released from all vaginal and parametrial attachments without impairment of uterine perfusion. After meticulous laparoscopic pelvic dissection and preservation of infundibulopevic ligaments mobile uterus together with both adnexae will be fixed on the anterior abdominal wall above the umbilicus with non-resorbable sutures (Figure 1). Finally, cervix uteri will be sutures to a 3cm umbilical fascia window to ensure menstruation and cervical secretion. Results Two patients were treated with uterus transposition (n=1) with total transposition as described, n=1 with anterior transposition). There was no severe perioperative morbidity. Patients underwent a neoadjuvant short course radiation (5x5Gy; n=1) and a primary chemo-radiation (1.8-59.4Gy; n=1). The dose distribution for the patient with the upper transposition showed the uterus and the ovaries within the 0.5 Gy isodose (Figure 2). Two years after anterior transposition, after an uneventful course of pregnancy after in vitro fertilization, primary cesarean section was performed at 37 weeks + 6 days of gestation 1 . Conclusion Anterior or upper uterus transposition offers the possibility to young women with pelvic malignancies to preserve ovarian function as well as to keep the endometrial dose within the uterus very low. This allows a pregnancy and successful delivery after cancer treatment. Figure 1: Sagittal MRI of the patient after total uterus transposition. The cervix is located in the umbilicus.

Figure 2: Dose distribution of radiation planning for short term neoadjuvant radiation for the patient with the uT3 N+ rectal cancer. Yellow= uterus. 0.5 gray isodosis covers the half of the uterus (purple volume), one gray isodose can be kept below the uterus (margenta).