S479
Clinical - Gynaecological
ESTRO 2026
Material/Methods: A retrospective dosimetric analysis was performed in 25 female patients aged 3–39 years who received particle therapy for pelvic tumors, primarily sarcomatoid malignancies (e.g., Ewing and chondrosarcoma) and select gynecologic cancers. Patients were treated with intensity-modulated proton therapy (IMPT, n=20) or carbon ion radiotherapy (CIRT, n=5), with a median prescribed dose of 60.0 Gy (mean 62.4 Gy, range 24.0–76.8 Gy). Ovaries and uterus were delineated as organs at risk (OARs). Mean and maximum doses (D_mean, D_max) and volume-based parameters were evaluated according to PENTEC thresholds (D_mean <2–4 Gy for ovaries; <25 Gy for uterus). Photon-based VMAT comparison plans were generated on identical CT datasets with equivalent target coverage. Results: Particle therapy achieved a substantial reduction in radiation exposure to fertility- relevant organs compared with VMAT. For all patients, the mean ovarian dose (D_mean) for at least one ovary was <4 Gy, and in 90% <2 Gy; ovarian D_max was <5 Gy in 90% of IMPT cases. The median uterine mean dose was 5.92 Gy (range 0.02–45.08 Gy), well below the 25 Gy functional threshold. Volume-based analysis confirmed consistently lower values for both ovaries and uterus in the IMPT group, with target coverage comparable across modalities (PTV
Monge T, Agustoni F, Stragliotto S. The clinical value of nutritional care before and during active cancer treatment. Nutrients. 2021 Apr 5;13(4):1196. doi: 10.3390/nu13041196. PMID: 33916385; PMCID: PMC8065908. Keywords: Endometrial carcinoma, skeletal muscle index Digital Poster 4110 Low-Dose, High-Sparing: Fertility Preservation through Particle Therapy in AYA Patients Yvonne Goy 1 , Georgios Pernaris 1 , Antonio Carlino 1 , Petra Mozes 1 , Ulrike Mock 1 , Piero Fossati 1,2 , Carola Luetgendorf-Caucig 1 , Eugen Hug 1 1 Ion Therapy Center, MedAustron, Wiener Neustadt, Austria. 2 Radiooncology, Karl Landsteiner Private University, Krems, Austria Purpose/Objective: With advances in cancer treatment, the number of adolescent and young adult (AYA) patients and long-term survivors is steadily increasing. Consequently, fertility preservation has become a critical aspect of survivorship care. Pelvic radiotherapy is often associated with irreversible ovarian and uterine damage, with even low doses (<2 Gy) causing marked depletion of ovarian follicles and higher doses leading to uterine dysfunction, implantation failure, and pregnancy loss. Modern photon-based techniques such as IMRT and VMAT, combined with oophoropexy, can substantially reduce ovarian exposure, yet residual scatter and uterine doses remain clinically relevant. Particle therapy, due to its physical properties and the Bragg peak, enables superior dose conformity with minimal out-of-field exposure, allowing improved sparing of fertility-relevant organs. Preclinical and early clinical data suggest that ovarian reserve and uterine function can be largely preserved following particle irradiation.
V95 > 98%). Conclusion:
Particle therapy achieves substantial fertility preservation benefits over photon-based VMAT, maintaining ovarian and uterine doses below established thresholds, even without oophoropexy. These findings emphasize the potential of proton and carbon ion therapy to optimize fertility preservation. Given rising survival rates and the growing importance of oncofertility, early multidisciplinary consideration of particle therapy should become an integral component of treatment planning for AYA patients.
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