Document Detail

Pregnancy outcomes after abdominal irradiation that included or excluded the pelvis in childhood Wilms tumor survivors: a report from the National Wilms Tumor Study.
MedLine Citation:
PMID:  15050311     Owner:  NLM     Status:  MEDLINE    
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.
John A Kalapurakal; Susan Peterson; Eve M Peabody; Patrick R M Thomas; Daniel M Green; Giulio J D'angio; Norman E Breslow
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  58     ISSN:  0360-3016     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-30     Completed Date:  2004-04-27     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1364-8     Citation Subset:  IM    
Department of Radiation Oncology, Northwestern University, Chicago, IL, USA.
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MeSH Terms
Abortion, Spontaneous
Birth Weight
Child, Preschool
Fetal Death
Kidney Neoplasms / radiotherapy*
Poisson Distribution
Pregnancy Outcome*
Radiotherapy Dosage
Wilms Tumor / radiotherapy*
Grant Support
Comment In:
J Urol. 2005 Aug;174(2):719-20   [PMID:  16006959 ]

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