Accuracy of Edinburgh Ovarian Tissue Cryopreservation Criteria in Girls and Young Women With Cancer
A study reported in The Lancet Oncology by Wallace et al evaluated the accuracy of criteria used for predicting ovarian insufficiency and offering ovarian tissue cryopreservation in young women with cancer at the Edinburgh Children’s Cancer Centre. Ovarian tissue cryopreservation with later reimplantation remains experimental in children and adolescents.
Study Details
As described by the authors, cryopreservation of ovarian tissue has been selectively offered to girls and young women with cancer who met the Edinburgh selection criteria since 1996. The criteria can be summarized as follows: age < 35 years; no previous chemotherapy or radiotherapy in patients aged ≥ 15 years at diagnosis, but mild, nongonadotoxic chemotherapy permitted in those aged < 15 years; realistic probability of surviving for 5 years; high risk of premature ovarian insufficiency (> 50%); informed consent; negative serology for HIV, syphilis, and hepatitis B; and not pregnant and no existing children.
Clinical judgment was used to determine whether a patient was at high risk of premature ovarian insufficiency. Most of the patients categorized as being at high risk had planned high-dose alkylating agent–based treatment or radiotherapy to a field including the ovaries.
Between January 1996 and June 2012, 410 patients aged < 18 years at diagnosis were treated for cancer, including leukemia and brain tumors. Patients aged < 12 years at data cutoff in January 2013 were excluded from analysis.
Frequency of Premature Ovarian Insufficiency
Of the 410 patients, 34 (8%) met the selection criteria and were offered ovarian tissue cryopreservation prior to starting cancer treatment. Of these, 13 patients declined the procedure and 21 consented, with the procedure being successfully completed in 20.
Of the 20 patients who had successful cryopreservation of tissue, 14 were available for assessment of ovarian function; of these, 6 had developed premature ovarian insufficiency at a median age of 13.4 years, 1 of whom also had a natural pregnancy. Of the 13 patients who declined the procedure, 6 were available for assessment of ovarian function; of these, 1 had developed premature ovarian insufficiency. Median age of the 20 assessable patients was 16.9 years at follow-up. Assessment of ovarian function in 141 of the 376 patients who were not offered cryopreservation showed that only 1 had developed premature ovarian insufficiency.
The cumulative probability of developing premature ovarian insufficiency after cancer treatment was completed was significantly higher for patients who met the criteria for ovarian tissue cryopreservation vs those who did not, with 15-year probabilities of 35% (95% confidence interval [CI] = 10%–53%) vs 1% (95% CI = 0%–2%; P < .0001) and a 10-year hazard ratio of 56.8 (95% CI = 6.2–521.6).
The investigators concluded: “The results of this analysis show that the Edinburgh selection criteria accurately identify the few girls and young women who will develop premature ovarian insufficiency, and validate their use for selection of patients for ovarian tissue cryopreservation. Further follow-up of this cohort of patients is likely to allow refinement of the criteria for this experimental procedure in girls and young women with cancer.”
W. Hamish B. Wallace, MD, of the Royal Hospital for Sick Children, Edinburgh, is the corresponding author for the The Lancet Oncology article.
The study was funded by the UK Medical Research Council. The study authors reported no potential conflicts of interest.
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