International Journal of Radiation Oncology * Biology * Physics
Volume 73, Issue 5 , Pages 1304-1312 , 1 April 2009

Impact of Radiotherapy on Fertility, Pregnancy, and Neonatal Outcomes in Female Cancer Patients

  • Jennifer Y. Wo, M.D.

      Affiliations

    • Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA
    • ,
  • Akila N. Viswanathan, M.D., M.P.H.

      Affiliations

    • Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
    • Corresponding Author InformationReprint requests to: Akila N. Viswanathan, M.D., M.P.H., Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115. Tel: (617) 732-6331; Fax: (617) 726-3616

Received 4 September 2008 ,Revised 12 December 2008 ,Accepted 14 December 2008.

References 

  1. Bath LE, Anderson RA, Critchley HO, et al. Hypothalamic-pituitary-ovarian dysfunction after prepubertal chemotherapy and cranial irradiation for acute leukaemia. Hum Reprod. 2001;16:1838–1844
  2. Bath LE, Wallace WH, Shaw MP, et al. Depletion of ovarian reserve in young women after treatment for cancer in childhood: Detection by anti-Mullerian hormone, inhibin B and ovarian ultrasound. Hum Reprod. 2003;18:2368–2374
  3. Wallace WH, Shalet SM, Crowne EC, et al. Ovarian failure following abdominal irradiation in childhood: Natural history and prognosis. Clin Oncol. 1989;1:75–79
  4. Wallace WH, Thomson AB, Kelsey TW. The radiosensitivity of the human oocyte. Hum Reprod. 2003;18:117–121
  5. Critchley HO, Wallace WH, Shalet SM, et al. Abdominal irradiation in childhood; the potential for pregnancy. Br J Obstet Gynaecol. 1992;99:392–394
  6. Bath LE, Critchley HO, Chambers SE, et al. Ovarian and uterine characteristics after total body irradiation in childhood and adolescence: Response to sex steroid replacement. Br J Obstet Gynaecol. 1999;106:1265–1272
  7. Green DM, Peabody EM, Nan B, et al. Pregnancy outcome after treatment for Wilms tumor: A report from the National Wilms Tumor Study Group. J Clin Oncol. 2002;20:2506–2513
  8. Schover LR, Rybicki LA, Martin BA, et al. Having children after cancer. A pilot survey of survivors' attitudes and experiences. Cancer. 1999;86:697–709
  9. Constine LS, Woolf PD, Cann D, et al. Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med. 1993;328:87–94
  10. Pai HH, Thornton A, Katznelson L, et al. Hypothalamic/pituitary function following high-dose conformal radiotherapy to the base of skull: Demonstration of a dose-effect relationship using dose-volume histogram analysis. Int J Radiat Oncol Biol Phys. 2001;49:1079–1092
  11. Baird DD, Weinberg CR, Zhou H, et al. Preimplantation urinary hormone profiles and the probability of conception in healthy women. Fertil Steril. 1999;71:40–49
  12. Soules MR, McLachlan RI, Ek M, et al. Luteal phase deficiency: Characterization of reproductive hormones over the menstrual cycle. J Clin Endocrinol Metab. 1989;69:804–812
  13. Nicholson HS, Byrne J. Fertility and pregnancy after treatment for cancer during childhood or adolescence. Cancer. 1993;71(10 Suppl):3392–3399
  14. Nygaard R, Clausen N, Siimes MA, et al. Reproduction following treatment for childhood leukemia: A population-based prospective cohort study of fertility and offspring. Med Pediatr Oncol. 1991;19:459–466
  15. Ogilvy-Stuart AL, Clayton PE, Shalet SM. Cranial irradiation and early puberty. J Clin Endocrinol Metab. 1994;78:1282–1286
  16. Oberfield SE, Soranno D, Nirenberg A, et al. Age at onset of puberty following high-dose central nervous system radiation therapy. Arch Pediatr Adolesc Med. 1996;150:589–592
  17. Byrne J, Fears TR, Mills JL, et al. Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2004;42:589–597
  18. Gleeson HK, Shalet SM. The impact of cancer therapy on the endocrine system in survivors of childhood brain tumours. Endocr Relat Cancer. 2004;11:589–602
  19. Faddy MJ, Gosden RG, Gougeon A, et al. Accelerated disappearance of ovarian follicles in mid-life: Implications for forecasting menopause. Hum Reprod. 1992;7:1342–1346
  20. Levy MJ, Stillman RJ. Reproductive potential in survivors of childhood malignancy. Pediatrician. 1991;18:61–70
  21. Levitt GA, Jenney ME. The reproductive system after childhood cancer. Br J Obstet Gynaecol. 1998;105:946–953
  22. Ogilvy-Stuart AL, Shalet SM. Effect of radiation on the human reproductive system. Environ Health Perspect. 1993;101(Suppl 2):109–116
  23. Wallace WH, Shalet SM, Hendry JH, et al. Ovarian failure following abdominal irradiation in childhood: The radiosensitivity of the human oocyte. Br J Radiol. 1989;62:995–998
  24. Lushbaugh CC, Casarett GW. The effects of gonadal irradiation in clinical radiation therapy: A review. Cancer. 1976;37(2 Suppl):1111–1125
  25. Wallace WH, Thomson AB, Saran F, et al. Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys. 2005;62:738–744
  26. Larsen EC, Muller J, Schmiegelow K, et al. Reduced ovarian function in long-term survivors of radiation- and chemotherapy-treated childhood cancer. J Clin Endocrinol Metab. 2003;88:5307–5314
  27. Chemaitilly W, Mertens AC, Mitby P, et al. Acute ovarian failure in the childhood cancer survivor study. J Clin Endocrinol Metab. 2006;91:1723–1728
  28. Kase KR, Svensson GK, Chen DTS. Radial distribution of scattered and leakage radiation dose for radiotherapeutic equipment. Vienna: IAEA-SM-249/25, 1982;111–124.
  29. Lee SJ, Schover LR, Partridge AH, et al. American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol. 2006;24:29172931
  30. Warne GL, Fairley KF, Hobbs JB, et al. Cyclophosphamide-induced ovarian failure. N Engl J Med. 1973;289:1159–1162
  31. Nicosia SV, Matus-Ridley M, Meadows AT. Gonadal effects of cancer therapy in girls. Cancer. 1985;55:2364–2372
  32. Koyama H, Wada T, Nishizawa Y, et al. Cyclophosphamide-induced ovarian failure and its therapeutic significance in patients with breast cancer. Cancer. 1977;39:1403–1409
  33. Byrne J, Fears TR, Gail MH, et al. Early menopause in long-term survivors of cancer during adolescence. Am J Obstet Gynecol. 1992;166:788–793
  34. Meirow D, Nugent D. The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update. 2001;7:535–543
  35. Chiarelli AM, Marrett LD, Darlington GA. Pregnancy outcomes in females after treatment for childhood cancer. Epidemiology. 2000;11:161–166
  36. Norwitz ER, Stern HM, Grier H, et al. Placenta percreta and uterine rupture associated with prior whole body radiation therapy. Obstet Gynecol. 2001;98:929–931
  37. Larsen EC, Schmiegelow K, Rechnitzer C, et al. Radiotherapy at a young age reduces uterine volume of childhood cancer survivors. Acta Obstet Gynecol Scand. 2004;83:96–102
  38. Holm K, Nysom K, Brocks V, et al. Ultrasound B-mode changes in the uterus and ovaries and Doppler changes in the uterus after total body irradiation and allogeneic bone marrow transplantation in childhood. Bone Marrow Transplant. 1999;23:259–263
  39. Laursen EM, Holm K, Brocks V, et al. Doppler assessment of flow velocity in the uterine artery during pubertal maturation. Ultrasound Obstet Gynecol. 1996;8:341–345
  40. Pridjian G, Rich NE, Montag AG. Pregnancy hemoperitoneum and placenta percreta in a patient with previous pelvic irradiation and ovarian failure. Am J Obstet Gynecol. 1990;162:1205–1206
  41. Li FP, Gimbrere K, Gelber RD, et al. Outcome of pregnancy in survivors of Wilms' tumor. J Am Med Assoc. 1987;257:216–219
  42. Hawkins MM, Smith RA. Pregnancy outcomes in childhood cancer survivors: Probable effects of abdominal irradiation. Int J Cancer. 1989;43:399–402
  43. Green DM, Fine WE, Li FP. Offspring of patients treated for unilateral Wilms' tumor in childhood. Cancer. 1982;49:2285–2288
  44. Byrne J, Mulvihill JJ, Connelly RR, et al. Reproductive problems and birth defects in survivors of Wilms' tumor and their relatives. Med Pediatr Oncol. 1988;16:233–240
  45. Green DM, Whitton JA, Stovall M, et al. Pregnancy outcome of female survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Am J Obstet Gynecol. 2002;187:1070–1080
  46. Signorello LB, Cohen SS, Bosetti C, et al. Female survivors of childhood cancer: Preterm birth and low birth weight among their children. J Natl Cancer Inst. 2006;98:1453–1461
  47. McCall MI, Keaty EC, Thompson JD. Conservation of ovarian tissue in the treatment of carcinoma of the cervix with radical surgery. Am J Obstet Gynecol. 1958;75:590–600discussion 600–605
  48. Cowles RA, Gewanter RM, Kandel JJ. Ovarian repositioning in pediatric cancer patients: Flexible techniques accommodate pelvic radiation fields. Pediatr Blood Cancer. 2007;49:339–341
  49. Williams RS, Littell RD, Mendenhall NP. Laparoscopic oophoropexy and ovarian function in the treatment of Hodgkin disease. Cancer. 1999;86:2138–2142
  50. Classe JM, Mahe M, Moreau P, et al. Ovarian transposition by laparoscopy before radiotherapy in the treatment of Hodgkin's disease. Cancer. 1998;83:1420–1424
  51. Kurt M, Uncu G, Cetintas SK, et al. Successful spontaneous pregnancy in a patient with rectal carcinoma treated with pelvic radiotherapy and concurrent chemotherapy: The unique role of laparoscopic lateral ovary transposition. Eur J Gynaecol Oncol. 2007;28:408–410
  52. Carde P, Hagenbeek A, Hayat M, et al. Clinical staging versus laparotomy and combined modality with MOPP versus ABVD in early-stage Hodgkin's disease: The H6 twin randomized trials from the European Organization for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol. 1993;11:2258–2272
  53. Morice P, Juncker L, Rey A, et al. Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination. Fertil Steril. 2000;74:743–748
  54. Sella T, Mironov S, Hricak H. Imaging of transposed ovaries in patients with cervical carcinoma. Am J Roentgenol. 2005;184:1602–1610
  55. Covens AL, van der Putten HW, Fyles AW, et al. Laparoscopic ovarian transposition. Eur J Gynaecol Oncol. 1996;17:177–182
  56. Howell SJ, Shalet SM. Fertility preservation and management of gonadal failure associated with lymphoma therapy. Curr Oncol Rep. 2002;4:443–452
  57. Gabriel DA, Bernard SA, Lambert J, et al. Oophoropexy and the management of Hodgkin's disease. A reevaluation of the risks and benefits. Arch Surg. 1986;121:1083–1085
  58. Morice P, Castaigne D, Haie-Meder C, et al. Laparoscopic ovarian transposition for pelvic malignancies: Indications and functional outcomes. Fertil Steril. 1998;70:956–960
  59. Kuohung W, Ram K, Cheng DM, et al. Laparoscopic oophoropexy before radiation for pediatric brain tumor and subsequent ovarian function. Hum Reprod. 2008;23:117–121
  60. Le Floch O, Donaldson SS, Kaplan HS. Pregnancy following oophoropexy and total nodal irradiation in women with Hodgkin's disease. Cancer. 1976;38:2263–2268
  61. Lobo RA. Potential options for preservation of fertility in women. N Engl J Med. 2005;353:64–73
  62. Clough KB, Goffinet F, Labib A, et al. Laparoscopic unilateral ovarian transposition before irradiation. Cancer. 1996;77:2638–2645

 Conflict of interest: none.

PII: S0360-3016(08)03912-6

doi: 10.1016/j.ijrobp.2008.12.016

International Journal of Radiation Oncology * Biology * Physics
Volume 73, Issue 5 , Pages 1304-1312 , 1 April 2009

Article Tools

* Image Usage & Resolution