# Gonad Dose Assessment of Patients Undergoing Pelvic Radiotherapy
In the case of pelvic radiotherapy, the risk of infertility can be high as a result of direct ovarian gonadotoxicity or uterine functional alterations in women [11]. In the case of men, it is due to the direct gonadotoxicity of the testicle or alterations in ejaculatory function or sexual dysfunction [11; 12]. Selecting the optimal fertility preservation option for pelvic cancer patients depends on factors such as age, marital status, economic situation, cancer type and stage, treatment plan, and timeframe for initiating therapy [13]. In addition to the most commonly used techniques like the cryopreservation of oocytes, sperm, embryos, and ovarian and testicular tissue, women undergoing pelvic radiotherapy can opt for ovarian transposition [14]. Ovarian transposition, also called oophorepsy, is a surgical maneuver used to prevent damage to the ovaries during radiation therapy. Before treatment begins, one or both ovaries and the fallopian tubes are separated from the uterus and attached to the wall of the abdomen away from where the radiation will be given [15]. According to the literature, this technique allows the successful preservation of hormonal function in 70-93% of cases and the ovarian dose is reduced by three to four times compared with leaving the ovaries in their anatomical position. Ovarian transposition may be useful for women who want to have children after radiation therapy [15; 16]. Performing oophorepsy prior to radiotherapy may help to preserve ovarian hormonal function for a certain period and fertility may still be achievable through surrogate pregnancy. When successful, ovarian transposition can enhance overall health and wellbeing, expand reproductive options, and potentially improve the quality of life in patients with cervical and other gynecologic cancers [17]. In a recent study of 18 patients who underwent ovarian transposition before radiotherapy, the authors suggest that in patients who wish to preserve fertility or hormonal function, more aggressive strategies for ovary-sparing approaches may be justified [18]. For photon radiotherapy treatments, Three-Dimensional Conformal Radiotherapy (3 DCRT), Intensity-Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) techniques can be used [19]. Although there have been no significant differences in survival rates, several studies have demonstrated the advantages of usingthe VMAT technique to significantly reduce doses to organs at risk, particularly the gonads, as well as reduce late toxicity in the small intestine, consequently decreasing late morbidity [20,21]. This study was conducted in a radiotherapy department with the following aims: (i) to assess whether the doses to the gonads of the 70 patients met the tolerance doses used in radiotherapy planning, (ii) to compare the 3 DCRT technique with the VMAT technique, and (iii) to determine if ovarian transposition reduces the dose to the ovaries. The literature on gonadal dose assessment is scarce, particularly when evaluating doses to the gonads and even more so with the use of the ovarian transposition technique. This study stands out for considering the segmented gonads as organs at risk in 70 real patients under the age of 45.