Woo S Y, Fuller L M, Cundiff J H, Bondy M L, Hagemeister F B, McLaughlin P, Velasquez W S, Swan F, Rodriguez M A, Cabanillas F
Department of Clinical Radiotherapy, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Int J Radiat Oncol Biol Phys. 1992;23(2):407-12. doi: 10.1016/0360-3016(92)90761-6.
Between 1956 and 1990, 775 women were treated for Hodgkin's disease at The University of Texas M.D. Anderson Cancer Center. Of these, 25 (3.2%) were pregnant at diagnosis. Seven of these women were in the first trimester, 10 in the second, and eight in the third. Prior to treatment, three women in the third trimester had normal deliveries, and six patients in the first trimester had abortions. Sixteen patients received radiotherapy for supradiaphragmatic presentations during their pregnancies. All these patients had nodular sclerosing Hodgkin's disease: Two had clinical stage IA presentations and 14 had clinical stage IIA. In two patients radiotherapy (35 Gy) was limited to the neck, three patients were treated definitively to the neck and mediastinum (40 Gy), and 11 patients received mantle irradiation (40 Gy). Four to five half-value layers of lead were used to shield the uterus during radiotherapy. The dose to the fetus was estimated individually in nine patients, using a combination of an Alderson-Rando and a water phantom. The estimated total dose to the mid-fetus ranged from 1.4 to 5.5 cGy for treatment with 6 MV photons, and from 10 to 13.6 cGy for Cobalt 60. All 16 patients subsequently delivered full-term, normal infants. Following delivery, all of the patients had further staging procedures; eight received additional treatment. Subsequently, the disease relapsed in four patients; two eventually died of Hodgkin's disease. The 10-year determinant and overall survival rates were 83% and 71%, respectively. Currently, all offspring are physically and mentally normal, and none has developed a malignancy. Radiotherapy is an appropriate initial treatment for supradiaphragmatic presentations of Hodgkin's disease during the second and third trimesters of pregnancy, provided special attention is paid to treatment and shielding techniques. The outcome for women treated with irradiation for clinical stage I and II Hodgkin's disease during pregnancy has not been shown to be adversely affected by pregnancy, and after the first 8 weeks of gestation, the risk to the fetus appears to be minimal.
1956年至1990年间，德克萨斯大学MD安德森癌症中心对775名女性进行了霍奇金淋巴瘤治疗。其中，25名（3.2%）女性在确诊时已怀孕。这些女性中，7名处于妊娠早期，10名处于中期，8名处于晚期。治疗前，3名晚期女性顺产，6名早期女性进行了人工流产。16名患者在孕期接受了膈上病变的放射治疗。所有这些患者均为结节硬化型霍奇金淋巴瘤：2例为临床IA期，14例为临床IIA期。2例患者的放射治疗（35 Gy）仅限于颈部，3例患者接受了颈部和纵隔的根治性治疗（40 Gy），11例患者接受了斗篷野照射（40 Gy）。放射治疗期间使用4至5个半价层的铅来屏蔽子宫。9例患者使用Alderson-Rando模型和水模组合单独估算胎儿所受剂量。用6 MV光子治疗时，胎儿中部的估计总剂量为1.4至5.5 cGy，用钴60治疗时为10至13.6 cGy。所有16例患者随后均足月分娩出正常婴儿。分娩后，所有患者都进行了进一步的分期检查；8例接受了额外治疗。随后，4例患者疾病复发；2例最终死于霍奇金淋巴瘤。10年的决定因素生存率和总生存率分别为83%和71%。目前，所有后代身心健康，均未发生恶性肿瘤。对于妊娠中晚期膈上型霍奇金淋巴瘤，放射治疗是一种合适的初始治疗方法，前提是特别注意治疗和屏蔽技术。孕期接受放射治疗的临床I期和II期霍奇金淋巴瘤女性的治疗结果并未显示受到妊娠的不利影响，妊娠8周后，对胎儿的风险似乎最小。
