Department of Pediatric Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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.
Fertil Steril. 2019 Feb;111(2):372-380. doi: 10.1016/j.fertnstert.2018.10.016.
To evaluate whether abdominal-pelvic radiotherapy for childhood cancer impairs uterine function and increases the risk of pregnancy complications and adverse pregnancy outcomes.
Nested cohort study.
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).
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.
评估儿童癌症的腹盆腔放疗是否会损害子宫功能，增加妊娠并发症和不良妊娠结局的风险。
巢式队列研究。
不适用。
既往接受过腹盆腔放疗（RT 暴露）的儿童癌症幸存者（CCSs），作为其儿童癌症治疗的一部分。
RT 暴露 CCS（n=55）与未接受放疗的 CCS（非 RT 暴露 CCS；n=110）和一般人群对照（n=110）进行年龄和产次匹配。
子宫体积、妊娠并发症和妊娠结局。
在未生育参与者中，RT 暴露 CCSs 的中位（四分位间距）子宫体积为 41.4（18.6-52.8）mL，非 RT 暴露 CCSs 为 48.1（35.7-61.8）mL，一般人群对照为 61.3（49.1-75.5）mL。与一般人群对照组相比，RT 暴露 CCSs 子宫体积减小（<44.3 mL）的风险增加（优势比 [OR] 5.31[95%置信区间 1.98-14.23]）。令人惊讶的是，非 RT 暴露 CCSs 也是如此（OR 2.61[1.16-5.91]）。在妊娠参与者中，与一般人群对照组相比，RT 暴露 CCSs 妊娠并发症、早产和低出生体重儿的风险增加（OR 12.70[2.55-63.40]，OR 9.74[1.49-63.60]，OR 15.66[1.43-171.35]）。与非 RT 暴露 CCSs 相比，RT 暴露 CCSs 低出生体重儿的风险增加（OR 6.86[1.08-43.75]）。
儿童期子宫接受放疗会降低成年后子宫体积，并增加妊娠并发症和不良妊娠结局的风险。需要进行孕前咨询和适当的产科监测。
