Published April 2025European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
Errasti, T., Asadi-Azarbaijani, B., Güell, F., & Calleja-Agius, J. (2025). Review paper on fertility preservation in children and prepubertal adolescents with gynaecological cancer. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. https://doi.org/10.1016/j.ejso.2024.109483
Errasti T, Asadi-Azarbaijani B, Güell F, Calleja-Agius J. Review paper on fertility preservation in children and prepubertal adolescents with gynaecological cancer. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2025. doi:10.1016/j.ejso.2024.109483
Errasti, T., et al. "Review paper on fertility preservation in children and prepubertal adolescents with gynaecological cancer." European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2025.
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RRM Academy Synopsis
Early diagnosis comes first for fertility in girls with gynecologic cancer
Early diagnosis and, when needed, minimal surgery come first in preserving fertility, a narrative review of girls with gynecologic cancer says. In ovarian tumors, sparing surgery can keep the uterus and part of one ovary if the cancer allows it. For other tumor types, freezing ovarian tissue is one option when chemotherapy or radiotherapy is needed.
Key Findings
Ovarian cancer is the most frequent gynecologic cancer in girls, making up 1 % of all childhood cancers. Roughly 5 to 25 % of ovarian masses in children and adolescents prove malignant.
In more developed countries, survival five years after childhood cancer nears 80 %.
In malignant germ cell tumors, generally diagnosed in early stages, treatment consists of unilateral salpingo-oophorectomy, which leaves the contralateral ovary and the uterus in place.
The review cites 237 females with non-metastatic rhabdomyosarcoma of the genital tract, aged 0–21 years, among whom more than 50 % could be cured with neither systematic radiotherapy nor radical surgery.
More than 170 babies have been born after ovarian tissue cryopreservation and transplantation, a method the review describes as no longer experimental. Tumor cell contamination risk rules it out in ovarian tumors.
Interpretation
This narrative review searched PubMed and Web of Science for English articles published from January 2014 to February 2024. Two reviewers screened 519 articles from the first search and kept 23, and a second search added 5 more. The review draws on clinical studies, cohort studies, retrospective studies, case reports and reviews. The authors note a scarcity of published articles on gynecologic cancer in preadolescent girls. They state that data on the success of ovarian cortex transplantation in prepubertal girls are lacking. They also state that follow-up after uterine transposition has not been long enough to establish whether uterine function is preserved.
RRM Context
Restorative reproductive medicine aims to keep a patient's own reproductive system working. Fertility-sparing surgery fits that aim by leaving the uterus and part of one ovary in place. The authors say greater emphasis should go to procedures that avoid creating human embryos. They name one such procedure: freezing ovarian cortex tissue and transplanting it back to the ovary's usual site. The authors add that few tumors qualify.
Our editorial summary of this paper, not the article's abstract.
Abstract
Gynaecological cancer incidence in children and prepubertal girls is low but the risk of losing fertility potential is high due to the oncological treatments' toxicity. Consequently, fertility preservation is a top concern for survivors. This narrative review aims to summarize the best way of approaching each tumor treatment during prepubertal age with the goal of preserving fertility, and to discuss the latest methods used for fertility preservation for each gynaecological cancer. These procedures do not lack risks or uncertainities and offer a broad area of research.
General Gynecology › Cancer and Fertility › Fertility Preservation Before Treatment · Reproductive Surgery › Ovarian Surgery › Ovarian Reserve Preservation
PMID 39638650 39638650 DOI 10.1016/j.ejso.2024.109483 10.1016/j.ejso.2024.109483 Errasti et al. 2025, Errasti 2025
