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Strahlentherapie in der Schwangerschaft

Radiation therapy during pregnancy

  • Leitthema
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Zusammenfassung

Die Risiken einer Strahlentherapie während einer Schwangerschaft für den Embryo/Fetus werden in Abhängigkeit von der Strahlendosis und der embryonalen Entwicklungsphasen dargestellt. Eine Strahlentherapie ist bei verschiedenen Tumorentitäten bei supradiaphragmalem Tumorsitz mit einer Dosisbelastung unterhalb von 0,1 Gy für den Embryo bei einer Vielzahl von Patientinnen möglich. Durch Verwendung von Zusatzabschirmungen, die optimierte Wahl der Strahlungsart und Energie, der Bestrahlungstechnik, der Einstrahlrichtungen und Feldkollimationen sowie der therapierten Volumina kann die individuelle Strahlenbelastung gesenkt werden. Ist eine Strahlentherapie während der Schwangerschaft zur Kontrolle der Tumorerkrankung unter Abwägung aller Behandlungsalternativen bei der Mutter sinnvoll, kann sie bei Unterschreiten von Schwellendosen im Embryo von 0,1 Gy in Hinsicht auf Fehlbildungen mit geringen Risiken durchgeführt werden. Das absolute Tumorrisiko für das Ungeborene wird durch Dosen unterhalb von 0,1 Gy nur gering erhöht, sodass auch vor diesem Hintergrund eine Strahlentherapie der Mutter vertretbar ist, wenn keine risikoärmere, ähnlich effektive Therapie zur Verfügung steht. Es wird eine Übersicht der therapeutischen Situationen bei den während der Schwangerschaft häufigeren Tumoren gegeben.

Abstract

The risks of radiation exposure during pregnancy for the embryo are reviewed depending on the radiation dose and the embryonic/fetal developmental phase. A full course of radiotherapy is possible in many patients for supradiaphragmal maternal tumor locations with a dose exposure of the embryo below 0.1 Gy. The individual radiation exposure of the embryo/fetus can be lowered by the use of additional shielding over the abdomen of the mother and optimization of the beam energy, beam direction and beam collimation as well as selection of the extent of treated margins around the macroscopic tumor. If radiotherapy is indicated for treatment of the maternal cancer after consideration of all therapeutic alternatives, it can be performed at a low risk of malformation at doses below a threshold dose of 0.1 Gy to the embryo. The absolute tumor risk for the unborn child is only slightly increased by doses below 0.1 Gy so that even in this context radiotherapy of the mother is justified if no other therapy of similar effectiveness and involving a lower risk is available. An overview will be given on therapeutic decisions for more common tumors during pregnancy.

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  1. Strahlenklinik, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    M. Stuschke

  2. Institut für Medizinische Strahlenbiologie, Universitätsklinikum Essen, Essen, Deutschland

    W.-U. Müller

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  1. M. Stuschke
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  2. W.-U. Müller
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Stuschke, M., Müller, WU. Strahlentherapie in der Schwangerschaft. Onkologe 18, 316–329 (2012). https://doi.org/10.1007/s00761-012-2220-3

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