Rozen G, Rogers P, Chander S, Anderson R, McNally O, Umstad M, Winship A, Hutt K, Teh W T, Dobrotwir A, Hart R, Ledger W, Stern K
Reproductive Services, Royal Women's Hospital, Parkville, VIC, Australia.
Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne and Gynaecology Research Centre, Parkville, VIC, Australia.
Hum Reprod Open. 2020 Oct 25;2020(4):hoaa045. doi: 10.1093/hropen/hoaa045. eCollection 2020.
What is the evidence to guide the management of women who wish to conceive following abdominopelvic radiotherapy (AP RT) or total body irradiation (TBI)?
Pregnancy is possible, even following higher doses of post-pubertal uterine radiation exposure; however, it is associated with adverse reproductive sequelae and pregnancies must be managed in a high-risk obstetric unit.
In addition to primary ovarian insufficiency, female survivors who are treated with AP RT and TBI are at risk of damage to the uterus. This may impact on its function and manifest as adverse reproductive sequelae.
A review of the literature was carried out and a multidisciplinary working group provided expert opinion regarding assessment of the uterus and obstetric management.
PARTICIPANTS/MATERIALS SETTING METHODS: Reproductive outcomes for postpubertal women with uterine radiation exposure in the form of AP RT or TBI were reviewed. This included Pubmed listed peer-reviewed publications from 1990 to 2019, and limited to English language..
The prepubertal uterus is much more vulnerable to the effects of radiation than after puberty. Almost all available information about the impact of radiation on the uterus comes from studies of radiation exposure during childhood or adolescence.An uncomplicated pregnancy is possible, even with doses as high as 54 Gy. Therefore, tumour treatment doses alone cannot at present be used to accurately predict uterine damage.
Much of the data cannot be readily extrapolated to adult women who have had uterine radiation and the publications concerning adult women treated with AP RT are largely limited to case reports.
This analysis offers clinical guidance and assists with patient counselling. It is important to include patients who have undergone AP RT or TBI in prospective studies to provide further evidence regarding uterine function, pregnancy outcomes and correlation of imaging with clinical outcomes.
STUDY FUNDING/COMPETING INTERESTS: This study received no funding and there are no conflicts of interest.
N/A.
对于希望在接受腹盆腔放疗（AP RT）或全身照射（TBI）后怀孕的女性，指导其管理的证据有哪些？
即使在青春期后子宫接受较高剂量的辐射照射后，怀孕也是有可能的；然而，这与不良生殖后遗症相关，并且怀孕必须在高危产科病房进行管理。
除了原发性卵巢功能不全外，接受AP RT和TBI治疗的女性幸存者有子宫受损的风险。这可能会影响其功能，并表现为不良生殖后遗症。
研究设计、规模、持续时间：进行了文献综述，一个多学科工作组就子宫评估和产科管理提供了专家意见。
参与者/材料、设置、方法：对青春期后接受AP RT或TBI形式的子宫辐射暴露的女性的生殖结局进行了综述。这包括1990年至2019年在PubMed上列出的同行评审出版物，且仅限于英文。
青春期前的子宫比青春期后更容易受到辐射影响。几乎所有关于辐射对子宫影响的现有信息都来自儿童期或青春期辐射暴露的研究。即使剂量高达54 Gy，也有可能实现无并发症的怀孕。因此，目前仅肿瘤治疗剂量不能用于准确预测子宫损伤。
局限性、谨慎的原因：许多数据不能轻易外推到接受过子宫辐射的成年女性，并且关于接受AP RT治疗的成年女性的出版物大多限于病例报告。
该分析提供了临床指导并有助于患者咨询。将接受过AP RT或TBI的患者纳入前瞻性研究很重要，以提供关于子宫功能、妊娠结局以及影像学与临床结局相关性的进一步证据。
研究资金/利益冲突：本研究未获得资金支持，也不存在利益冲突。
无。
