Pregnancy outcomes after abdominal irradiation that included or excluded the pelvis in childhood Wilms tumor survivors: A report from the National Wilms Tumor Study
Pregnancy outcomes after abdominal irradiation that included or excluded the pelvis in childhood Wilms tumor survivors: A report from the National Wilms Tumor Study
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DOI：
10.1016/j.ijrobp.2003.08.031
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发表时间：
2004-04-01
影响因子：
7
通讯作者：
Breslow, NE
中科院分区：
文献类型：
--
作者：
Kalapurakal, JA;Peterson, S;Breslow, NE
目的：这份报告描述了7名儿童肾母细胞瘤，谁是治疗的国家肾母细胞瘤研究（NWTS）与放射治疗（RT）的门户网站，延伸到flank.Methods和材料之一的幸存者之间的妊娠结局：妊娠结局的女性儿童肾母细胞瘤的幸存者接受腹部照射NWTS 1-4的长期随访研究的一部分进行了分析。医疗记录和产妇问卷调查被用来收集信息妊娠outcomes.Results：共130例患者接受腹部RT，并存活到至少15岁。7例患者（5.4%）至少记录了1次妊娠。确定了126例患者的RT野范围。4例患者的RT野范围无法确定。12名女孩使用包括上腹部但不是整个骨盆的入口接受RT。其中5例患者记录了10次妊娠; 9例活产，1例流产。114名女孩使用包括整个腹部和骨盆的入口接受RT。这114例患者的腹部RT剂量分布如下：9例接受0-10.49戈伊，22例接受10.5-14.99戈伊，83例接受15+戈伊。其中2例患者记录了4次妊娠。1例患者在腹部和骨盆接受21戈伊后，3例妊娠均导致流产和胎儿死亡。然而，在10.5戈伊后，另一例患者报告正常活产。如果RT入口包括骨盆，则妊娠相关并发症也更常见。结论：肾母细胞瘤儿童在接受上腹部RT（10-20戈伊）（不包括整个骨盆）后可以保留生育能力。在极少数情况下，低剂量全腹RT（10.5戈伊）后可保留生育能力。与NWTS-1和NWTS-2相比，目前使用的RT的适应症和剂量已大大改进。儿童期肾母细胞瘤幸存者应被认为是在其生育年龄的不孕症和妊娠相关并发症的高风险。及时的产科评估是最佳的产前，产前和产后护理。(C)2004爱思唯尔公司
Purpose: This report describes the pregnancy outcomes among 7 survivors of childhood Wilms tumor, who were treated on one of the National Wilms Tumor Studies (NWTS) with radiation therapy (RT) portals that extended beyond the flank.Methods and Materials: Pregnancy outcomes among female survivors of childhood Wilms tumor treated with abdominal irradiation in NWTS 1-4 were analyzed as part of the long-term follow-up study. Medical records and maternal questionnaires were used to gather information on pregnancy outcomes.Results: A total of 130 patients received abdominal RT and survived to at least 15 years of age. Seven patients (5.4%) had at least 1 recorded pregnancy. The extent of RT fields was ascertained in 126 patients. For 4 patients, the extent of RT fields could not be determined. Twelve girls received RT using portals that included the upper abdomen but not the entire pelvis. Ten pregnancies were recorded in 5 of these patients; 9 resulted in live births, and 1 resulted in a miscarriage. One hundred fourteen girls received RT using portals that included the entire abdomen and pelvis. The abdominal RT dose distribution among these 114 patients was as follows: 9 received 0-10.49 Gy, 22 patients received 10.5-14.99 Gy, and 83 patients received 15+ Gy. Four pregnancies were recorded in 2 of these patients. After 21 Gy to the abdomen and pelvis in 1 patient, all 3 pregnancies resulted in miscarriages and fetal deaths. However, after 10.5 Gy, a normal live birth was reported in the other patient. Pregnancy-related complications were also more common if the RT portals included the pelvis.Conclusions: Fertility can be preserved in children with Wilms tumor after upper abdominal RT (10-20 Gy) that does not include the entire pelvis. In rare instances, fertility can be preserved after low-dose whole-abdominal RT (10.5 Gy). The indications and dosages for RT currently used have been greatly refined compared to NWTS-1 and NWTS-2. Childhood Wilms tumor survivors should be considered to be at a high risk for infertility and pregnancy-related complications during their reproductive years. Prompt obstetric evaluation is indicated for optimal prenatal, antenatal, and postnatal care. (C) 2004 Elsevier Inc.