Brain radiotherapy during pregnancy: an analysis of conceptus dose using anthropomorphic phantoms.

Abstract

The aims of this study were: (a) to determine conceptus dose resulting from brain radiotherapy; (b) to investigate the necessity of using shielding devices over patient's abdomen during treatment; and (c) to estimate the components of conceptus dose. Radiation doses received by conceptus were measured using anthropomorphic phantoms simulating pregnancy at 4, 12 and 24 weeks gestation and thermoluminescent dosemeters. All irradiations were performed with two lateral and opposed fields approximating the minimum, medium and maximum field size used during treatment of brain malignancies. For a treatment course delivering 65 Gy to tumour without using shielding equipment, conceptus dose never exceeded 100 mGy. Appropriate positioning of 5.1 cm of lead over the phantom's abdomen provided reduction of conceptus dose from 26% to 71%, depending upon gestational age, field size and distance from the field isocentre. The contribution of scatter arising from within the phantom to the conceptus dose was small compared with that from head leakage and collimator scatter. Our dosimetric results indicate that the construction of special shielding equipment is not a prerequisite for treating brain malignancies during pregnancy. However, based on the concept that exposures in women of childbearing age should be kept as low as reasonably achievable, we suggest that shielding devices should be used whenever possible.

Perioperative considerations for neurosurgical procedures in the gravid patient: Continuing Professional Development

“…Pituitary adenomas have an excellent prognosis if treated appropriately. 4 Medical management with bromocriptine (or cabergoline for bromocriptine-intolerant patients) is usually indicated for prolactinomas; however, pituitary apoplexy often presents as visual deterioration and needs urgent surgical intervention. The neurological emergencies related to brain tumours require urgent surgical decompression.…”

“…The neurological emergencies related to brain tumours require urgent surgical decompression. [1][2][3][4] Cerebrovascular pathology Cerebrovascular disease is an important nonobstetrical cause of maternal mortality. Stroke remains the commonest cerebrovascular pathology in pregnant patients (10-34 per 100,000 pregnancies) and may present as intracerebral hemorrhage, cerebral infarction, cortical vein thrombosis, subarachnoid hemorrhage, episodes of cardioembolism, cerebral angiopathy, and rupture of arteriovenous anomalies.…”

“…S'ils sont bien traités, les adénomes pituitaires ont un excellent pronostic. 4 La bromocriptine (ou la cabergoline pour les patientes intolérantes à la bromocriptine) est en générale indiquée pour la prise en charge médicale des prolactinomes; toutefois, l'apoplexie pituitaire se présente souvent sous forme de détérioration visuelle et requiert une intervention chirurgicale urgente. Les urgences neurologiques liées aux tumeurs cérébrales nécessitent une décompression chirurgicale urgente.…”

“…Les urgences neurologiques liées aux tumeurs cérébrales nécessitent une décompression chirurgicale urgente. [1][2][3][4] Les pathologies vasculaires cérébrales Les maladies vasculaires cérébrales sont une importante cause non obstétricale de mortalité maternelle. L'accident vasculaire cérébral demeure la pathologie vasculaire cérébrale la plus répandue chez les patientes enceintes (10-34 par 100 000 grossesses) et peut se présenter sous forme d'hémorragie intracérébrale, d'infarctus cérébral, de thrombose veineuse corticale, d'hémorragie sous-arachnoïdienne, d'épisode d'embolie cardiaque, d'angiopathie cérébrale ou de rupture des malformations artérioveineuses.…”

Melanoma During Pregnancy

“…A large number of series of irradiation therapy of supradiaphragmally localized Hodgkin lymphoma in pregnant women, who gave birth to healthy children, is also presented in literature (Zucali et al, 1981;Mazonakis et al, 2003;Lishner et al, 1992). Fetal dose in brain irradiation with 54 Gy at Varian accelerator is about 0.22 Gy, and even without any shielding, the fetus dosage almost never exceeds 0.1 Gy (Haba et al, 2004;Mazonakis et al, 1999). There was one case of a pregnant patient who underwent a gamma-knife treatment due to melanoma metastases without any consequences upon her child (Yu et al, 2003).…”