| 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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MedLine Citation:
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PMID: 15050311 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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John A Kalapurakal; Susan Peterson; Eve M Peabody; Patrick R M Thomas; Daniel M Green; Giulio J D'angio; Norman E Breslow |
Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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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:
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Created Date: 2004-03-30 Completed Date: 2004-04-27 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 7603616 Medline TA: Int J Radiat Oncol Biol Phys Country: United States |
Other Details:
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Languages: eng Pagination: 1364-8 Citation Subset: IM |
Affiliation:
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Department of Radiation Oncology, Northwestern University, Chicago, IL, USA. j-kalapurakal@northwestern.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Abortion, Spontaneous Adult Birth Weight Child Child, Preschool Female Fetal Death Humans Infant Kidney Neoplasms / radiotherapy* Pelvis Poisson Distribution Pregnancy Pregnancy Outcome* Radiotherapy Dosage Survivors* Wilms Tumor / radiotherapy* |
| Grant Support | |
ID/Acronym/Agency:
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R01 CA 54498/CA/NCI NIH HHS |
| Comments/Corrections | |
Comment In:
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J Urol. 2005 Aug;174(2):719-20
[PMID:
16006959
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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