TY - JOUR
T1 - Uterine function, pregnancy complications, and pregnancy outcomes among female childhood cancer survivors
AU - van de Loo, Laurence E.X.M.
AU - van den Berg, Marleen H.
AU - Overbeek, Annelies
AU - van Dijk, Marloes
AU - Damen, Layla
AU - Lambalk, Cornelis B.
AU - Ronckers, Cécile M.
AU - van den Heuvel-Eibrink, Marry M.
AU - Kremer, Leontien C.M.
AU - van der Pal, Helena J.
AU - Laven, Joop S.E.
AU - Tissing, Wim J.E.
AU - Loonen, Jacqueline J.
AU - Versluys, Birgitta
AU - Bresters, Dorine
AU - Kaspers, Gerardus J.L.
AU - van Leeuwen, Flora E.
AU - van Dulmen-den Broeder, Eline
N1 - Funding Information:
Supported by the Dutch Cancer Society (grant no. VU 2006-3622) and by the Foundation Children Cancer Free (grant 20). Philips Health Systems Benelux supported this work by providing a three-dimensional ultrasound system and concomitant custom-made analytic software. The funding sources had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Publisher Copyright:
© 2018 American Society for Reproductive Medicine
PY - 2019/2/1
Y1 - 2019/2/1
N2 - OBJECTIVE: To evaluate whether abdominal-pelvic radiotherapy for childhood cancer impairs uterine function and increases the risk of pregnancy complications and adverse pregnancy outcomes.DESIGN: Nested cohort study.SETTING: Not applicable.PATIENT(S): Childhood cancer survivors previously exposed to abdominal-pelvic radiotherapy (RT-exposed CCSs) as part of their treatment for childhood cancer.INTERVENTION(S): Radiotherapy-exposed CCSs (n = 55) were age- and parity-matched to nonirradiated CCSs (non-RT-exposed CCSs; n = 110) and general population controls (n = 110).MAIN OUTCOME MEASURES: Uterine volume, pregnancy complications, and pregnancy outcomes.RESULT(S): Among nulligravidous participants, median (interquartile range) uterine volume was 41.4 (18.6-52.8) mL for RT-exposed CCSs, 48.1 (35.7-61.8) mL for non-RT-exposed CCSs, and 61.3 (49.1-75.5) mL for general population controls. Radiotherapy-exposed CCSs were at increased risk of a reduced uterine volume (<44.3 mL) compared with population controls (odds ratio [OR] 5.31 [95% confidence interval 1.98-14.23]). Surprisingly, the same was true for non-RT-exposed CCSs (OR 2.61 [1.16-5.91]). Among gravidous participants, RT-exposed CCSs had increased risks of pregnancy complications, preterm delivery, and a low birth weight infant compared with population controls (OR 12.70 [2.55-63.40], OR 9.74 [1.49-63.60], and OR 15.66 [1.43-171.35], respectively). Compared with non-RT-exposed CCSs, RT-exposed CCSs were at increased risk of delivering a low birth weight infant (OR 6.86 [1.08-43.75]).CONCLUSION(S): Uterine exposure to radiotherapy during childhood reduces adult uterine volume and leads to an increased risk of pregnancy complications and adverse pregnancy outcomes. Preconceptional counseling and appropriate obstetric monitoring is warranted.
AB - OBJECTIVE: To evaluate whether abdominal-pelvic radiotherapy for childhood cancer impairs uterine function and increases the risk of pregnancy complications and adverse pregnancy outcomes.DESIGN: Nested cohort study.SETTING: Not applicable.PATIENT(S): Childhood cancer survivors previously exposed to abdominal-pelvic radiotherapy (RT-exposed CCSs) as part of their treatment for childhood cancer.INTERVENTION(S): Radiotherapy-exposed CCSs (n = 55) were age- and parity-matched to nonirradiated CCSs (non-RT-exposed CCSs; n = 110) and general population controls (n = 110).MAIN OUTCOME MEASURES: Uterine volume, pregnancy complications, and pregnancy outcomes.RESULT(S): Among nulligravidous participants, median (interquartile range) uterine volume was 41.4 (18.6-52.8) mL for RT-exposed CCSs, 48.1 (35.7-61.8) mL for non-RT-exposed CCSs, and 61.3 (49.1-75.5) mL for general population controls. Radiotherapy-exposed CCSs were at increased risk of a reduced uterine volume (<44.3 mL) compared with population controls (odds ratio [OR] 5.31 [95% confidence interval 1.98-14.23]). Surprisingly, the same was true for non-RT-exposed CCSs (OR 2.61 [1.16-5.91]). Among gravidous participants, RT-exposed CCSs had increased risks of pregnancy complications, preterm delivery, and a low birth weight infant compared with population controls (OR 12.70 [2.55-63.40], OR 9.74 [1.49-63.60], and OR 15.66 [1.43-171.35], respectively). Compared with non-RT-exposed CCSs, RT-exposed CCSs were at increased risk of delivering a low birth weight infant (OR 6.86 [1.08-43.75]).CONCLUSION(S): Uterine exposure to radiotherapy during childhood reduces adult uterine volume and leads to an increased risk of pregnancy complications and adverse pregnancy outcomes. Preconceptional counseling and appropriate obstetric monitoring is warranted.
KW - Childhood cancer survivors
KW - pregnancy complications
KW - pregnancy outcomes
KW - radiotherapy
KW - uterine volume
KW - Neoplasms/pathology
KW - Reproductive Health
KW - Humans
KW - Young Adult
KW - Time Factors
KW - Radiotherapy/adverse effects
KW - Adult
KW - Female
KW - Retrospective Studies
KW - Parity
KW - Risk Assessment
KW - Risk Factors
KW - Survivors
KW - Radiation Injuries/diagnosis
KW - Treatment Outcome
KW - Pregnancy
KW - Pregnancy Complications/diagnosis
KW - Uterus/diagnostic imaging
KW - Age of Onset
KW - Pregnancy Outcome
UR - http://www.scopus.com/inward/record.url?scp=85060488285&partnerID=8YFLogxK
U2 - 10.1016/j.fertnstert.2018.10.016
DO - 10.1016/j.fertnstert.2018.10.016
M3 - Article
C2 - 30691634
AN - SCOPUS:85060488285
SN - 0015-0282
VL - 111
SP - 372
EP - 380
JO - Fertility and Sterility
JF - Fertility and Sterility
IS - 2
ER -