Laurence E X M van de Loo1, Marleen H van den Berg1, Annelies Overbeek2, Marloes van Dijk1, Layla Damen1, Cornelis B Lambalk3, Cécile M Ronckers4, Marry M van den Heuvel-Eibrink5, Leontien C M Kremer6, Helena J van der Pal4, Joop S E Laven7, Wim J E Tissing8, Jacqueline J Loonen9, Birgitta Versluys10, Dorine Bresters11, Gerardus J L Kaspers12, Flora E van Leeuwen13, Eline van Dulmen-den Broeder14. 1. Department of Pediatric Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. 2. Department of Pediatric Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. 3. Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. 4. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 5. Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Division of Pediatric Oncology/Hematology, Department of Pediatrics, Sophia Childrens' Hospital/Erasmus MC University Medical, Rotterdam, the Netherlands. 6. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands. 7. Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. 8. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology/Hematology, University Medical Center Groningen, Groningen, the Netherlands. 9. Department of Hematology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. 10. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Oncology, Wilhelmina Childrens Hospital/University Medical Center, Utrecht, the Netherlands. 11. Willem-Alexander Children's Hospital/Leiden University Medical Center, Leiden, the Netherlands. 12. Department of Pediatric Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands. 13. Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands. 14. Department of Pediatric Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. Electronic address: eline.vandulmen-denbroeder@vumc.nl.
Abstract
OBJECTIVE: To evaluate whether abdominal-pelvic radiotherapy for childhood cancer impairs uterine function and increases the risk of pregnancy complications and adverse pregnancy outcomes. DESIGN: Nested cohort study. SETTING: Not applicable. PATIENT(S): Childhood cancer survivors previously exposed to abdominal-pelvic radiotherapy (RT-exposed CCSs) as part of their treatment for childhood cancer. INTERVENTION(S): Radiotherapy-exposed CCSs (n = 55) were age- and parity-matched to nonirradiated CCSs (non-RT-exposed CCSs; n = 110) and general population controls (n = 110). MAIN OUTCOME MEASURES: Uterine volume, pregnancy complications, and pregnancy outcomes. RESULT(S): Among nulligravidous participants, median (interquartile range) uterine volume was 41.4 (18.6-52.8) mL for RT-exposed CCSs, 48.1 (35.7-61.8) mL for non-RT-exposed CCSs, and 61.3 (49.1-75.5) mL for general population controls. Radiotherapy-exposed CCSs were at increased risk of a reduced uterine volume (<44.3 mL) compared with population controls (odds ratio [OR] 5.31 [95% confidence interval 1.98-14.23]). Surprisingly, the same was true for non-RT-exposed CCSs (OR 2.61 [1.16-5.91]). Among gravidous participants, RT-exposed CCSs had increased risks of pregnancy complications, preterm delivery, and a low birth weight infant compared with population controls (OR 12.70 [2.55-63.40], OR 9.74 [1.49-63.60], and OR 15.66 [1.43-171.35], respectively). Compared with non-RT-exposed CCSs, RT-exposed CCSs were at increased risk of delivering a low birth weight infant (OR 6.86 [1.08-43.75]). CONCLUSION(S): Uterine exposure to radiotherapy during childhood reduces adult uterine volume and leads to an increased risk of pregnancy complications and adverse pregnancy outcomes. Preconceptional counseling and appropriate obstetric monitoring is warranted.
OBJECTIVE: To evaluate whether abdominal-pelvic radiotherapy for childhood cancer impairs uterine function and increases the risk of pregnancy complications and adverse pregnancy outcomes. DESIGN: Nested cohort study. SETTING: Not applicable. PATIENT(S): Childhood cancer survivors previously exposed to abdominal-pelvic radiotherapy (RT-exposed CCSs) as part of their treatment for childhood cancer. INTERVENTION(S): Radiotherapy-exposed CCSs (n = 55) were age- and parity-matched to nonirradiated CCSs (non-RT-exposed CCSs; n = 110) and general population controls (n = 110). MAIN OUTCOME MEASURES: Uterine volume, pregnancy complications, and pregnancy outcomes. RESULT(S): Among nulligravidous participants, median (interquartile range) uterine volume was 41.4 (18.6-52.8) mL for RT-exposed CCSs, 48.1 (35.7-61.8) mL for non-RT-exposed CCSs, and 61.3 (49.1-75.5) mL for general population controls. Radiotherapy-exposed CCSs were at increased risk of a reduced uterine volume (<44.3 mL) compared with population controls (odds ratio [OR] 5.31 [95% confidence interval 1.98-14.23]). Surprisingly, the same was true for non-RT-exposed CCSs (OR 2.61 [1.16-5.91]). Among gravidous participants, RT-exposed CCSs had increased risks of pregnancy complications, preterm delivery, and a low birth weight infant compared with population controls (OR 12.70 [2.55-63.40], OR 9.74 [1.49-63.60], and OR 15.66 [1.43-171.35], respectively). Compared with non-RT-exposed CCSs, RT-exposed CCSs were at increased risk of delivering a low birth weight infant (OR 6.86 [1.08-43.75]). CONCLUSION(S): Uterine exposure to radiotherapy during childhood reduces adult uterine volume and leads to an increased risk of pregnancy complications and adverse pregnancy outcomes. Preconceptional counseling and appropriate obstetric monitoring is warranted.
Authors: D Garg; E B Johnstone; L Lomo; D B Fair; M P Rosen; R Taylor; B Silver; J M Letourneau Journal: J Assist Reprod Genet Date: 2020-04-28 Impact factor: 3.412
Authors: G Rozen; P Rogers; S Chander; R Anderson; O McNally; M Umstad; A Winship; K Hutt; W T Teh; A Dobrotwir; R Hart; W Ledger; K Stern Journal: Hum Reprod Open Date: 2020-10-25
Authors: Cathrine Everhøj; Filippa Nyboe Norsker; Catherine Rechnitzer; Sofie de Fine Licht; Thomas T Nielsen; Susanne K Kjær; Allan Jensen; Marie Hargreave; Jane Christensen; Federica Belmonte; Stine Kjaer Urhoj; Katrine Strandberg-Larsen; Jeanette F Winther; Line Kenborg Journal: EClinicalMedicine Date: 2022-04-04
Authors: Barbara Buonomo; Roberto Orecchia; Federica Tomao; Lino Del Pup; Alex Garcia-Faura; Fedro A Peccatori Journal: Ecancermedicalscience Date: 2020-05-06
Authors: M van Dijk; F E van Leeuwen; A Overbeek; C B Lambalk; M M van den Heuvel-Eibrink; W van Dorp; W J Tissing; L C Kremer; J J Loonen; B Versluys; D Bresters; C M Ronckers; H J van der Pal; C C M Beerendonk; G J L Kaspers; E van Dulmen-den Broeder; M H van den Berg Journal: J Cancer Res Clin Oncol Date: 2020-03-27 Impact factor: 4.553