Heimovaara Joosje H, Blommaert Jeroen, Free Jeffrey, Bolt René A, Gort Elske M, Depuydt Tom, Boso Martinez Cristina, Schoots Mirthe H, van Gerwen Mathilde, van den Heuvel-Eibrink Marry, Langendijk Johannes A, Schröder Carolien P, Amant Frédéric, Gordijn Sanne J, Oldehinkel Edwin
Department of Oncology, KU Leuven, Leuven, Belgium.
Department of Gynecologic Oncology, Netherlands Cancer Institute and Amsterdam University Medical Center, Amsterdam, the Netherlands.
Clin Transl Radiat Oncol. 2022 May 4;35:33-36. doi: 10.1016/j.ctro.2022.04.014. eCollection 2022 Jul.
Radiotherapy during pregnancy is rarely administered due to lack of data and practical challenges. This is the first detailed report of proton therapy as cancer treatment for a pregnant patient with nasopharyngeal carcinoma.
Pencil beam scanning proton therapy was prescribed to a pregnant patient to a total dose of 70 Gy (RBE) to the therapeutic CTV and 54.25 Gy to the prophylactic CTV, delivered in 35 fractions with a simultaneous integrated boost technique.
Phantom measurements showed a thirty-fold decrease in fetal radiation dose when using proton compared to photon therapy, with a total fetal dose of 5.5 mSv for the complete proton treatment, compared to 185 and 298 mSv for the photon treatment with and without lead shielding, respectively. After adminstering proton therapy during pregnancy, at 39 weeks of gestation, a healthy boy with a birthweight on the 83th percentile was delivered. Pediatric follow-up at 2 months of age of the offspring showed normal growth and age-adequate motor development with no signs of neurological problems. MR follow-up of the tumor 3 months after the end of treatment showed complete remission.
This case demonstrates the potential of proton therapy for treatment during pregnancy.Compared to photon therapy, proton therapy can significantly limit fetal dose, while simultaneously offering a more optimized treatment to the patient.
由于缺乏数据和实际操作挑战，孕期放疗很少进行。这是首例关于质子治疗用于一名患有鼻咽癌的孕妇癌症治疗的详细报告。
对一名孕妇采用笔形束扫描质子治疗，治疗性临床靶体积（CTV）的总剂量为70 Gy（相对生物效应），预防性CTV的总剂量为54.25 Gy，采用同步整合加量技术分35次给予。
模体测量显示，与光子治疗相比，使用质子治疗时胎儿辐射剂量降低了30倍，质子治疗全程胎儿总剂量为5.5 mSv，而光子治疗有铅屏蔽和无铅屏蔽时胎儿总剂量分别为185 mSv和298 mSv。孕期给予质子治疗后，在妊娠39周时，分娩出一名健康男婴，出生体重处于第83百分位。对后代2个月龄时的儿科随访显示生长正常且运动发育符合年龄，无神经问题迹象。治疗结束3个月后对肿瘤的磁共振成像（MR）随访显示完全缓解。
该病例证明了质子治疗在孕期治疗中的潜力。与光子治疗相比，质子治疗可显著限制胎儿剂量，同时为患者提供更优化的治疗。
