A 29-year-old nulliparous woman requires definitive pelvic radiotherapy for FIGO Stage IIB cervical squamous cell carcinoma. She wishes to retain endocrine function. What should be performed before starting external beam radiotherapy?
- A Total laparoscopic hysterectomy
- B Bilateral salpingo-oophorectomy with hormone replacement
- C Laparoscopic ovarian transposition out of the radiation field ✓
- D Uterine artery embolisation
Correct answer: C. Laparoscopic ovarian transposition out of the radiation field
Explanation
Pelvic radiotherapy doses of 20 Gy or more permanently destroy ovarian function. In young women requiring pelvic irradiation, laparoscopic ovarian transposition (oophoropexy), moving the ovaries outside the intended field such as into the paracolic gutters, preserves hormonal function in a substantial proportion. Removing the ovaries defeats the purpose (option B), hysterectomy does not shield them from scatter and direct fields (option A), and uterine artery embolisation has no role (option D). Transposition must precede the first fraction.
Reference: Williams Gynecology, 4th ed.
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Written and medically reviewed by the StethoPrep medical team.