Department of Oncology, First Faculty of Medicine, Charles University in Prague and Thomayer Hospital Prague, Czech Republic.
Department of Oncology, Second Faculty of Medicine, Charles University in Prague and University Hospital Motol Hospital, Prague, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021 Mar;165(1):99-101. doi: 10.5507/bp.2020.039. Epub 2020 Sep 21.
Curative sphincter sparing radiotherapy is a treatment option for early rectal cancer. There are many methods developed for fertility preservation in young patients treated with pelvic radiotherapy. Pregnancy rates after radiotherapy are dependent on the radiation dose to ovaries and uterus. Data on outcomes of total body irradiation suggest a pregnancy is possible following 12-14 Gy TBI, despite elevated rates of preterm deliveries and other complications.
We report a case of full-term delivery of twins after curative chemoradiotherapy for anorectal adenocarcinoma T2 N0 M0 with the total dose 58.6 Gy. The patient underwent laparoscopic laterocranial ovarian transposition before radiotherapy.
Long term complete remission was achieved after treatment. Although a spontaneous conception was not successful, the patient underwent an in vitro fertilisation procedure with donor eggs and conceived twins 10 years after the radiotherapy treatment. The mean dose to the uterus was 16 Gy and to the uterine cervix 35 Gy. She reached a full-term pregnancy and delivered two healthy babies by caesarean section at a gestational age of 38 weeks, weighing 2420 g and 2220 g.
This is the first case report of the successful pregnancy following sphincter sparing curative pelvic radiotherapy for rectal cancer. Furthermore it allows us to propose an increased limit dose to the uterus enabling fertility sparing beyond the limits achieved from total body irradiation series with 12-14 Gy and accept 16 Gy as uterine body (35 Gy for uterine cervix) limit for IMRT treatment planning in young patients asking for maintaining fertility potential.
保肛放疗是早期直肠癌的一种治疗选择。对于接受盆腔放疗的年轻患者，有许多方法可用于生育力保存。放疗后的妊娠率取决于卵巢和子宫的辐射剂量。关于全身照射后结果的数据表明，尽管早产率和其他并发症增加，但在接受 12-14 Gy TBI 后仍有可能怀孕。
我们报告了 1 例接受肛门直肠腺癌 T2N0M0 根治性放化疗的患者，总剂量为 58.6 Gy，行腹腔镜侧颅卵巢移位术，然后进行保肛放疗，成功分娩双胞胎的病例。
治疗后获得长期完全缓解。尽管自然受孕不成功，但患者在放疗 10 年后接受了供卵体外受精，成功受孕双胞胎。子宫的平均剂量为 16 Gy，子宫颈为 35 Gy。她达到了足月妊娠，并在 38 周的妊娠龄时通过剖宫产分娩了两个健康的婴儿，体重分别为 2420 克和 2220 克。
这是首例保肛放疗治疗直肠癌后成功妊娠的病例报告。此外，它使我们能够提出增加子宫的限制剂量，从而在接受 12-14 Gy 的全身照射系列治疗后，实现生育力保存，并且接受 16 Gy 作为子宫体（子宫颈为 35 Gy）的限制剂量，以适用于要求保留生育潜能的年轻患者的调强放疗计划。
