She is a 12-year-old Roman girl, being treated for a sarcoma, the first minor patient to have ovarian tissue removed for cryopreservation, at the Agostino Gemelli Irccs University Hospital Foundation in Rome. The girl underwent surgery to remove the sarcoma in May and, later (on July 5), the removal of ovarian tissue. Ovarian tissue retrieval (and the most common egg retrieval and freezing) – and subsequent freezing – should be common practice when using therapies that could harm female fertility.
Before chemotherapy
“The girl was suffering from an undifferentiated cell sarcoma of the soft tissues of the pubic area, which appeared as a swelling – she explains. Antonio Ruggiero, UOSD Director of Pediatric Oncology of the Agostino Gemelli IRCCS University Polyclinic Foundation – fortunately the tumor had not yet metastasized and therefore we are optimistic about the prognosis of our patient. Treatment of these tumors involves surgical excision, followed by systemic treatment (chemotherapy) and sometimes even radiotherapy. Given the need for chemotherapy treatment, which can compromise fertility, the child and her family were offered the opportunity to access this cryopreservation program. Among pediatric cancers, those that could access this program are non-metastatic solid cancers that have to undergo chemotherapy “.
The agreement with the Bank
The collection was carried out by virtue of an agreement signed in January 2022 with the Bank of Ovarian Tissue and Germ Cells (BTO) of the Lazio Region (at the IFO of Rome and directed by Enrico Vizza), which is currently the only bank in Italy certified by the National Transplant Center (CNT) and the only one included in the European compendium of tissue institutes. In the previous months, again by virtue of this agreement, ovarian tissue taken from three young women in oncological therapy had been sent from the Gemelli Polyclinic.
The agreement with the bank
The intervention was carried out by Professor Lorenzo NanniUOSD Director of Pediatric Surgery of the Gemelli University Hospital Foundation in collaboration with Giacomo Corrado, Medical Director UOC Oncological Gynecology and coordinator of the PCA Oncofertility of the same Polyclinic. “A very important aspect – explains Corrado – is that until the signing of this agreement, to carry out the ovarian tissue sampling, it was necessary to transfer the patient to the IFO ‘bank’, but this discouraged many patients who ended up giving up this possibility (since 2018 those who have accepted are 18, of which 2 girls). Thanks to this agreement, the sampling can be carried out directly at the Gemelli Polyclinic. At the moment, this of Gemelli, together with that stipulated with the Bambino Gesù Pediatric Hospital of Rome – IRCCS, represent the only agreements of this type active in Italy with the Bank of Ovarian Tissue and Germ Cells (BTO) of the Lazio Region, while the other hospitals continue to refer patients to the IFO for sampling “.
The importance of the network
Enrico VizzaDirector of the Clinical and Oncological Research Department of IFO-Regina Elena and Head of the BTO of the Lazio Region, underlines “the importance of networking for highly specialized issues such as the protection of fertility in young cancer patients for which it is required both specialized competence as well as high technical and technological professionalism in the biological field. This interaction between two institutes so relevant both nationally and internationally has in fact important repercussions for patients and for the world of research “.
How the fabric is picked up
“The surgery – recalls Lorenzo Nanni, who carried out the ovarian tissue sampling – is the last link in a chain, which comes after an impressive elaboration to create this agreement. The girl is in excellent condition and the tissue sampling ovarian does not involve the patient in an important way. It is performed laparoscopically, in this case with three accesses (‘holes’) on the abdomen, one for the optics and two for the instruments. The procedure is simple from the laparoscopic point of view. if the abdomen has not already been subjected to surgery, and lasts half an hour in all “.
Freezing in nitrogen at -196 degrees
The tissue taken by the surgeon is placed in a specific culture medium and immediately transported with a cold chain to the IFO bank. Here arrived, the team of biologists of the bank headed by the biologist responsible Marcello Iacobelli, prepare it and freeze it in nitrogen at -196 degrees. “Before the collection, in the informed consent forms – recalls Corrado – the patient (and his family) is asked what to do with this tissue if it cannot be used for pregnancy. The possible alternatives are to destroy it or donate it to research. . So far all the patients have donated it to research “.
What is oncofertility
Every year in our country about 5,000 women under 40, therefore of reproductive age, are diagnosed with cancer. Advances in cancer therapy have led to significant long-survival rates (up to 85% in breast cancers and lymphomas), but at the same time systemic treatments can irreversibly damage women’s ovarian reserve, leading to infertility problems. , which have a major impact on the quality of life. It is from these premises that the branch of oncofertility is born, a bridge discipline between oncology and reproductive endocrinology, which aims to preserve fertility in young women struggling with an oncological disease.