Akahane Keiko, Kako Shinichi, Suzuki Masato, Takahashi Yuta, Hatanaka Shogo, Kawahara Masahiro, Nakada Yukari, Ogawa Kazunari, Takahashi Satoru, Fukuda Yukiko, Endo Masashi, Oyama-Manabe Noriko, Kanda Yoshinobu, Shirai Katsuyuki
aDepartment of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
bDivision of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Case Rep Oncol. 2022 Sep 20;15(3):809-815. doi: 10.1159/000526536. eCollection 2022 Sep-Dec.
Infertility is a well-known late complication in patients receiving hematopoietic stem cell transplantation (HSCT). We previously reported that total body irradiation (TBI) with ovarian shielding reduces the radiation dose to the ovaries to 2.4 Gy - one-fifth of the dose compared to conventional TBI - and preserves fertility without increasing the risk of relapse. Exposure to the uterus and ovaries can reportedly affect pregnancy and childbirth. However, the dose constraint of the uterus that causes infertility remains unknown. Herein, we report the pregnancy and birth outcomes of 2 patients who gave birth following TBI with ovarian shielding and evaluated the dose to the uterus using a dose-volume histogram. Case 1 involved a 30-year-old woman with acute myeloid leukemia who underwent HSCT at 21 years of age with a uterus mean dose ( ) of 7.0 Gy. She had a natural pregnancy and elective cesarean section at 38 weeks of gestation due to hypertensive disorders of pregnancy. She gave birth to a normal-birthweight infant. Case 2 involved a 32-year-old woman with T-cell acute lymphoblastic leukemia who underwent HSCT at 30 years of age with a uterus of 7.6 Gy. Her baby was delivered at full term with normal birthweight. These results indicate that a uterus between 7.0 and 7.6 Gy does not have a significant impact on pregnancy and delivery with the ovarian function being preserved for patients who received TBI with ovarian shielding after puberty.
不孕症是接受造血干细胞移植（HSCT）患者中一种众所周知的晚期并发症。我们之前报道过，采用卵巢屏蔽的全身照射（TBI）可将卵巢的辐射剂量降低至2.4 Gy，与传统TBI相比，该剂量仅为其五分之一，并且在不增加复发风险的情况下保留生育能力。据报道，子宫和卵巢受到照射会影响妊娠和分娩。然而，导致不孕的子宫剂量限制尚不清楚。在此，我们报告了2例在采用卵巢屏蔽的TBI后分娩的患者的妊娠和分娩结局，并使用剂量体积直方图评估了子宫所接受的剂量。病例1为一名30岁的急性髓系白血病女性，21岁时接受HSCT，子宫平均剂量（ ）为7.0 Gy。她自然受孕，因妊娠高血压疾病于妊娠38周时行择期剖宫产。她产下一名出生体重正常的婴儿。病例2为一名32岁的T细胞急性淋巴细胞白血病女性，30岁时接受HSCT，子宫 为7.6 Gy。她足月分娩，婴儿出生体重正常。这些结果表明，对于青春期后接受采用卵巢屏蔽的TBI的患者，7.0至7.6 Gy的子宫 对妊娠和分娩没有显著影响，同时卵巢功能得以保留。
