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Successful Pregnancy and Delivery After Radiation With Ovarian Shielding for Acute Lymphocytic Leukemia Before Menarche.

Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Tanaka Y, Chin M, Mugishima H - J. Pediatr. Hematol. Oncol. (2015)

Bottom Line: For bone marrow transplantation, she received total body irradiation of 12 Gy with uterine and ovarian shielding at 13 years of age.The patient remained in remission and menarche began at 14 years of age.At 23, she became pregnant and delivered a baby naturally with no abnormalities.

View Article: PubMed Central - PubMed

Affiliation: Departments of *Radiology §Pediatrics and Child Health, Nihon University School of Medicine, Itabashi †Radiology Clinic, Saonoda Medical Corporations, Adachi, Tokyo ‡Department of Radiation Oncology, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan.

ABSTRACT
Total body irradiation is performed as a preconditioning regimen to inhibit graft-versus-host disease after bone marrow transplantation and to eradicate remaining tumor cells. However, these regimens result in delayed secondary sex characteristics and failure of ovarian function recovery, leading to amenorrhea and infertility. Herein, we report a case of an 11-year-old girl diagnosed with acute lymphocytic leukemia who received induction chemotherapy and prophylactic cranial irradiation. For bone marrow transplantation, she received total body irradiation of 12 Gy with uterine and ovarian shielding at 13 years of age. The patient remained in remission and menarche began at 14 years of age. At 23, she became pregnant and delivered a baby naturally with no abnormalities.

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A, Radiograph for confirmation of the uterine and ovarian shielding location. The box shows the location of the lead block. B, A portal image obtained at the location of the uterine and ovarian shielding in TBI. TBI indicates total body irradiation.
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Figure 1: A, Radiograph for confirmation of the uterine and ovarian shielding location. The box shows the location of the lead block. B, A portal image obtained at the location of the uterine and ovarian shielding in TBI. TBI indicates total body irradiation.

Mentions: The patient was treated with radiotherapy using 2 anteroposterior opposed fields with 10 MV x-rays from a linear accelerator (PRIMUS; Toshiba Medical Systems Corp., Tokyo, Japan). A dose of 3 Gy per fraction was delivered once daily 4 times during the 4-day period (total: 12 Gy), and the dose rate was 10 cGy/min. For ovarian shielding, pelvic computed tomography was performed before TBI to identify the locations of the uterus and ovaries. Next, pelvic radiographs were obtained and using pelvic computed tomography images for reference, the locations of the uterus and ovaries were identified and shielding was performed with an 80 mm thick lead block (Fig. 1). The attenuation rate of the lead block was measured using a water-equivalent phantom corresponding to the size measured in the patient; it was one eighth. Accordingly, the ovarian dose was reduced to approximately 1.5 Gy.


Successful Pregnancy and Delivery After Radiation With Ovarian Shielding for Acute Lymphocytic Leukemia Before Menarche.

Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Tanaka Y, Chin M, Mugishima H - J. Pediatr. Hematol. Oncol. (2015)

A, Radiograph for confirmation of the uterine and ovarian shielding location. The box shows the location of the lead block. B, A portal image obtained at the location of the uterine and ovarian shielding in TBI. TBI indicates total body irradiation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4472319&req=5

Figure 1: A, Radiograph for confirmation of the uterine and ovarian shielding location. The box shows the location of the lead block. B, A portal image obtained at the location of the uterine and ovarian shielding in TBI. TBI indicates total body irradiation.
Mentions: The patient was treated with radiotherapy using 2 anteroposterior opposed fields with 10 MV x-rays from a linear accelerator (PRIMUS; Toshiba Medical Systems Corp., Tokyo, Japan). A dose of 3 Gy per fraction was delivered once daily 4 times during the 4-day period (total: 12 Gy), and the dose rate was 10 cGy/min. For ovarian shielding, pelvic computed tomography was performed before TBI to identify the locations of the uterus and ovaries. Next, pelvic radiographs were obtained and using pelvic computed tomography images for reference, the locations of the uterus and ovaries were identified and shielding was performed with an 80 mm thick lead block (Fig. 1). The attenuation rate of the lead block was measured using a water-equivalent phantom corresponding to the size measured in the patient; it was one eighth. Accordingly, the ovarian dose was reduced to approximately 1.5 Gy.

Bottom Line: For bone marrow transplantation, she received total body irradiation of 12 Gy with uterine and ovarian shielding at 13 years of age.The patient remained in remission and menarche began at 14 years of age.At 23, she became pregnant and delivered a baby naturally with no abnormalities.

View Article: PubMed Central - PubMed

Affiliation: Departments of *Radiology §Pediatrics and Child Health, Nihon University School of Medicine, Itabashi †Radiology Clinic, Saonoda Medical Corporations, Adachi, Tokyo ‡Department of Radiation Oncology, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan.

ABSTRACT
Total body irradiation is performed as a preconditioning regimen to inhibit graft-versus-host disease after bone marrow transplantation and to eradicate remaining tumor cells. However, these regimens result in delayed secondary sex characteristics and failure of ovarian function recovery, leading to amenorrhea and infertility. Herein, we report a case of an 11-year-old girl diagnosed with acute lymphocytic leukemia who received induction chemotherapy and prophylactic cranial irradiation. For bone marrow transplantation, she received total body irradiation of 12 Gy with uterine and ovarian shielding at 13 years of age. The patient remained in remission and menarche began at 14 years of age. At 23, she became pregnant and delivered a baby naturally with no abnormalities.

Show MeSH
Related in: MedlinePlus