Madsen B L, Giudice L, Donaldson S S
Department of Radiation Oncology, Stanford University Medical Center, CA, USA.
Int J Radiat Oncol Biol Phys. 1995 Jul 30;32(5):1461-4. doi: 10.1016/0360-3016(95)00025-T.
To disprove the common view that women who have undergone irradiation to fields excluding the pelvis are at risk for radiation-induced premature menopause, we reviewed menstrual function and fertility among women treated with subtotal lymphoid irradiation for Hodgkin's Disease.
Treatment and follow-up records of all women less than age 50 at the time of diagnosis of Stage I or II supradiaphragmatic Hodgkin's Disease, treated with subtotal lymphoid irradiation alone and enrolled in radiotherapy trials from 1967 to 1985, were reviewed. In addition, patients were surveyed regarding their menstrual status and fertility history.
Thirty-six women, aged 10 to 40 years, with normal menstrual function at the time of Hodgkin's diagnosis, were identified. Mean follow-up was 14 years, with a range of 1.25-22.75 years. The average radiation dose to mantle and paraaortic fields was 40-44 Gy; the calculated scatter radiation dose to the pelvis at the ovaries was 3.2 Gy. There were 38 pregnancies in 18 women; all offspring are normal. One of 36 women (2.7%) experienced premature menopause. The reported rate of premature menopause in women who have not undergone irradiation is 1-3%; not significantly different than the rate in our study. There is a syndrome whereby antibodies to several endocrine organs occur (including the ovary), which is associated with premature ovarian failure. This syndrome may be associated with prior radiation to the thyroid, such as that given by mantle irradiation for Hodgkin's Disease. We report such a case.
There is little risk of premature menopause in women treated with radiation fields that exclude the pelvis. Women with presumed radiation-induced premature menopause warrant an evaluation to exclude other causes of ovarian failure, such as autoimmune disorders.
为了反驳一种普遍观点，即接受过不包括骨盆区域的放疗的女性有发生放射性早绝经的风险，我们回顾了接受次全淋巴照射治疗霍奇金病的女性的月经功能和生育情况。
回顾了1967年至1985年期间，所有诊断为I期或II期膈上霍奇金病且年龄小于50岁、仅接受次全淋巴照射并参加放疗试验的女性的治疗和随访记录。此外，对患者进行了关于月经状况和生育史的调查。
确定了36名年龄在10至40岁之间、在霍奇金病诊断时月经功能正常的女性。平均随访时间为14年，范围为1.25至22.75年。对斗篷野和腹主动脉旁野的平均辐射剂量为40 - 44 Gy；计算得出卵巢处骨盆的散射辐射剂量为3.2 Gy。18名女性中有38次妊娠；所有后代均正常。36名女性中有1名（2.7%）经历了早绝经。未接受过放疗的女性中报道的早绝经发生率为1 - 3%；与我们研究中的发生率无显著差异。有一种综合征，其中会出现针对多个内分泌器官（包括卵巢）的抗体，这与卵巢早衰有关。这种综合征可能与先前对甲状腺的放疗有关，如霍奇金病斗篷野照射所给予的放疗。我们报告了这样一个病例。
接受不包括骨盆区域的放疗的女性发生早绝经的风险很小。疑似放射性早绝经的女性需要进行评估，以排除卵巢衰竭的其他原因，如自身免疫性疾病。
