Modern radiotherapy in cancer treatment during pregnancy

Mazzola, Rosario; Corradini, Stefanie; Eidemüeller, Markus; Figlia, Vanessa; Fiorentino, Alba; Giaj-Levra, Niccolò; Nicosia, Luca; Ricchetti, F.; Rigo, Michele; Musola, Mariella; Ceccaroni, Marcello; Gori, Stefania; Magrini, Stefano Maria; Alongi, Filippo

doi:10.1016/j.critrevonc.2019.02.002

Cited by 38 publications

(38 citation statements)

References 58 publications

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“…The administration of radiotherapy during pregnancy continues to be a topic of debate. In general, delaying radiotherapy is recommended until after delivery and it is contraindicated for tumours located in the pelvis because of the high risk of abortion and foetal harm [41].…”

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

“…IMRT-VMAT limits the exposure of high doses to a more restricted volume, with the disadvantage of administering low doses to a larger volume of normal tissue. Taking this into account, the use of advanced radiotherapy techniques in pregnant women with cancer may increase the probability of short-and long-term adverse effects on the foetus; therefore, IMRT-VMAT should be used with caution in strictly selected patients [41].…”

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

“…During organogenesis (weeks 2-7), the main effects of radiotherapy are congenital anomalies and growth retardation without mental retardation, although the risk increases with doses above 500 mGy [41]. The brain develops between weeks 8-15; therefore, in this phase, the potential effects of radiotherapy could be microcephaly and mental retardation.…”

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

“…The brain develops between weeks 8-15; therefore, in this phase, the potential effects of radiotherapy could be microcephaly and mental retardation. Mental function does not seem to decrease with doses < 100 mGy but does with doses > 100 mGy [41,49,50]. The incidence of mental retardation with doses between 100 and 499 mGy is estimated at 6% [41].…”

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

“…The main risks include mental retardation, microcephaly, cataracts, sterility and cancer. The incidence of mental retardation is 2% with doses < 500 mGy [41]. The risk of sterility and neurological damage is lower in the second trimester than in the first trimester [41].…”

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

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Multidisciplinary consensus on cancer management during pregnancy

et al. 2020

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Cancer during pregnancy is a challenge for multi- and interdisciplinary collaboration due to the diagnostic, prognostic and therapeutic implications, the need for an integrated harmonization of medical action for the pregnant patient and the embryo or foetus and the characteristics of each gestational period, which will determine the protocol to be proposed and its limitations. For this reason, a group of experts appointed by participating scientific societies, which includes the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica—SEOM), the Spanish Association of Surgeons (Asociación Española de Cirujanos—AEC), the Spanish Society of Gynaecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia—SEGO), the Spanish Society of Nuclear Medicine and Molecular Imaging (Sociedad Española de Medicina Nuclear e Imagen Molecular—SEMNIM), the Spanish Society of Oncological Radiotherapy (Sociedad Española de Oncología Radioterápica—SEOR) and the Spanish Society of Medical Radiology (Sociedad Española de Radiología Médica—SERAM), have worked together to establish consensus recommendations that allow the harmonization of management and ultimately the optimization of the healthcare of pregnant patients with cancer. When cancer is detected in a pregnant woman, the week of gestation in which the diagnosis is made must be considered, as well as the characteristics of the tumour. It is strongly recommended that a multidisciplinary team assesses the situation and guides the patient and her family during the informing, diagnosis and treatment process. Likewise, the foetus should be monitored and managed by specialized obstetricians who are part of a multidisciplinary cancer committee.

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Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

Section: Radiotherapy For Cancer During Pregnancymentioning

confidence: 99%

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Multidisciplinary consensus on cancer management during pregnancy

et al. 2020

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Radiation oncology department policy development for patients who may become pregnant

Fagerstrom

2024

J Applied Clin Med Phys

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In the context of radiation oncology, radiation exposure from radiation therapy simulation, image guidance, and radiation therapy procedures can have severe adverse biological effects on a developing embryo or fetus. Patients who may be pregnant are screened for the possibility of pregnancy to prevent unnecessary or excessive exposure of radiation in utero. Some radiation therapy patients for whom a pregnancy test is indicated may elect to decline the test. In addition, some patients who are found upon screening to be pregnant may decide, with their attending radiation oncologist, to continue with treatment. A radiation oncology department policy was developed to provide guidelines regarding screening and consent. The policy was designed to prevent unnecessary exposure to patients who may be pregnant, and to limit dose to the embryo or fetus in patients for whom treatment is medically indicated. The policy is presented as an example for physicists intending to develop or revise their own practice's policy regarding patients who may become pregnant.

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Ionizing radiation for maternal medical indications

Löwe

2019

Prenatal Diagnosis

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Ionizing radiation should be considered an avoidable exposure although all pregnant women receive some radiation from their environment. The potential effect of ionizing radiation on the fetus is determined by the dose and the timing of the exposure with growing interest in the potential risks of transgenerational effects of radiation as an epigenetic phenomenon. High dosage exposure is very unlikely in routine situations such as occupational, diagnostic, or therapeutic exposures. Individual diagnostic radiation procedures (fetal dosage <50 mGy), are not associated with any increase in lethality (miscarriage or stillbirth), genetic damage, teratogenicity, growth impairment, mental retardation, or sterility. More recent modeling has suggested that a 10 mGy fetal dose is associated with an excess risk of childhood cancer risk as low as 1 in 4545, well below historical estimates.When the mother's condition necessitates diagnostic radiation it is necessary to balance the risks of the procedure with the benefits to be gained. As almost all diagnostic imaging involves doses below the 50 mGy threshold, clinically indicated investigations should not be withheld because of concerns regarding fetal radiation exposure. Even radiotherapy directed away from the abdomen or pelvis may be considered during pregnancy, if the benefits outweigh the risks and no suitable alternative is available.

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Modern radiotherapy in cancer treatment during pregnancy

Cited by 38 publications

References 58 publications

Multidisciplinary consensus on cancer management during pregnancy

Multidisciplinary consensus on cancer management during pregnancy

Radiation oncology department policy development for patients who may become pregnant

Ionizing radiation for maternal medical indications

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