# Gonad Dose Assessment of Patients Undergoing Pelvic Radiotherapy
## 5 Conclusions  
Of the 70 patients studied, 58.6% were treated with the VMAT technique, while the remaining patients received treatment with the 3 DCRT technique. However, since 2020, all patients in this study were exclusively treated with the VMAT technique. Despite this, only 18.6% of patients met the maximum dose limits and 22.9% met the mean dose limits for the testicles and ovaries. No statistically significant differences were found between the right and left gonads, nor between the 3 DCRT and VMAT techniques.  
All patients with gynecological tumors who underwent ovarian transposition met the dose limits, with a dose reduction averaging up to 39 Gy for both the maximum and mean doses. It is important to acknowledge that only five patients in this study underwent ovarian transposition, limiting the statistical power and the generalizability of the findings. Although our results suggest that this technique is effective in reducing the ovarian dose, these data should be interpreted with caution. Further prospective research with larger cohorts is necessary to validate these preliminary observations and to assess potential complications and clinical feasibility in broader clinical settings.  
This study has some limitations that must be recognized. Its retrospective design may have introduced inherent selection bias and limited the control over confounding variables. Also, the small sample size--especially the low number of patients who underwent ovarian transposition--may have restricted the statistical power and generalizability of the findings. The absence of long-term follow-up data prevented the evaluation of actual fertility outcomes, such as hormonal function preservation or successful pregnancies post-treatment. Future prospective studies with larger cohorts, standardized gonadal contouring protocols, and longitudinal fertility outcomes are essential to validate and expand upon these findings.  
As future lines of research, is important to continue investing in the training of health professionals and patients in the field of oncofertility, to study how to assess the clinical efficacy of different fertility preservation techniques, and to explore new methods to reduce gonadal doses and minimize the damage caused by radiotherapy. Additionally, doses from new daily images could also be evaluated because they contribute to the cumulative doses in the gonads.  
**Author Contributions:** Validation, L.S.M.; Formal analysis, E.C.; Writing - original draft, D.R.; Supervision, M.B.; Project administration, A.C.S. All authors have read and agreed to the published version of the manuscript.  
**Funding:** This research received no external funding.  
**Institutional Review Board Statement:** The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Coimbra Local Health Unit (protocol code OBS.SF.114-2023 and date of approval 3 November 2023.  
**Informed Consent Statement:** Patient consent was waived as this was a retrospective, observational study on an anonymized basis, with no possibility of identification of nor any risk to patients.  
**Data Availability Statement:** The data presented in this study are available on request from the corresponding author.  
**Conflicts of Interest:** The authors declare no conflicts of interest.