Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan (Republic of China).
Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (Republic of China).
Reprod Biomed Online. 2021 Apr;42(4):774-777. doi: 10.1016/j.rbmo.2021.01.022. Epub 2021 Feb 2.
It has been established that radiotherapy can increase the risk of adverse pregnancy outcomes. However, there is currently no consensus on the effective sterilizing dose of adulthood uterine radiotherapy.
This is a case report of a 36-year-old women with three different cancer types who received repeated high-dose radiotherapy of 66 Gy and 50 Gy to the pelvis. The study used a dose-volume histogram, the most widely used tool to calculate the radiation distribution within a volume of interest in a patient during radiotherapy. It was determined that the current patient's uterus might have received the highest uterine radiation dosage for full-term live birth that has been reported in the current literature.
Due to iatrogenic ovarian failure, the woman was only able to use donor eggs. After preparation of the endometrium for 18 days, it had reached 8.7 mm in thickness with a triple-line appearance. Two cleavage-stage embryos were transferred, one of which implanted successfully. The course of the pregnancy was uneventful. Finally, the patient gave birth to a healthy baby via Caesarean section at 38 weeks of gestation.
The uterus may be more resistant to radiotherapy than previously understood. Uterine fertility preservation methods should be guided by the age of the patient receiving radiotherapy and the actual dose of radiation exposure of the uterus. Future studies should implement a dose-volume histogram to calculate the radiation exposure of the reproductive organs.
已经确定放射治疗会增加不良妊娠结局的风险。然而，目前对于成年子宫放射治疗的有效绝育剂量尚无共识。
这是一例 36 岁女性的病例报告，她患有三种不同类型的癌症，曾接受过 66Gy 和 50Gy 的盆腔重复高剂量放疗。该研究使用剂量-体积直方图，这是放射治疗期间计算患者感兴趣体积内辐射分布的最广泛使用的工具。确定当前患者的子宫可能已接受当前文献中报告的全期活产的最高子宫放射剂量。
由于医源性卵巢衰竭，该妇女只能使用捐赠的卵子。在子宫内膜准备 18 天后，其厚度达到 8.7 毫米，呈三线状。移植了两个卵裂期胚胎，其中一个成功着床。妊娠过程顺利。最终，患者在 38 周妊娠时通过剖宫产分娩了一名健康婴儿。
子宫对放射治疗的耐受性可能比先前认为的要强。子宫生育力保存方法应根据接受放射治疗的患者年龄和子宫实际辐射暴露剂量来指导。未来的研究应实施剂量-体积直方图来计算生殖器官的辐射暴露。
