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Impact of Chemotherapy and Radiotherapy on the Uterus

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Fertility Preservation

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Abstract

Survivorship issues surrounding conception and gestational outcome have gained recognition as the management and outcome of childhood malignancies has become increasingly successful. Issues surrounding future fertility are likely multifactorial including both direct and indirect effects of therapy on the pituitary system as well as the end organs. Radiation therapy impairs normal function of both the ovaries and the uterus. The magnitude of risk is related to the age and menarchal status at the time of treatment. Although all treatment for malignant disease is a balance between successful therapeutic outcome and minimized toxicity, it appears that the threshold for radiation is considerably lower than initially perceived. As cancer treatment and cures improve, assisted reproductive technology strives to keep pace. Oocyte cryopreservation, in vitro maturation, ovarian tissue cryopreservation, and uterus and ovary transplantation are all evolving to treat secondary infertility in cancer patients. Because of the rapidly changing field, it has become of paramount importance to educate both the parents and the patient with pediatric malignancy as to the impact their treatment may have on fertility and pregnancy outcome.

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References

  1. American Cancer Society: Cancer Facts and Figures, 2010.

    Google Scholar 

  2. Robison LL, Green DM, Hudson M, et al. Long-term outcomes of adult survivors of childhood cancer. Cancer. 2005;104(11 Suppl):2557–64.

    Article  PubMed  Google Scholar 

  3. Rowland JH, Baker F. Resilience of cancer survivors across the lifespan. Cancer. 2005;104(11 Suppl): 2543–8.

    Article  PubMed  Google Scholar 

  4. Knopman JM, Papadopoulos EB, Grifo JA, et al. Surviving childhood and reproductive–age malignancy: effects on fertility and future parenthood. Lancet Oncol. 2010;11:490–8.

    Article  PubMed  Google Scholar 

  5. Copeland LJ, editor. Textbook of gynecology. 2nd ed. Philadelphia: W.B. Saunders; 2000. p. 8–9.

    Google Scholar 

  6. Holm K, Mosfeldt L, Brocks V, et al. Pubertal maturation of the internal genitalia: an ultrasound evaluation of 166 healthy girls. Ultrasound Obstet Gynecol. 1995;6:175–81.

    Article  PubMed  CAS  Google Scholar 

  7. Bridges NA, Cooke A, Healy MJR, et al. Growth of the uterus. Arch Dis Child. 1996;75(4):330–1.

    Article  PubMed  CAS  Google Scholar 

  8. Mosfeldt Laursen E, Holm K, Brocks V, et al. Doppler assessment of flow veocity in the uterine artery during pubertal maturation. Ultrasound Obstet Gynecol. 1996;8:341–5.

    Article  Google Scholar 

  9. Sieunarine K, Boyle DCM, Corless DJ, Noakes DE, Ungar L, Marr CE, et al. Pelvic vascular prospects for uterine transplantation. Int Surg. 2006;91(4):217–22.

    PubMed  Google Scholar 

  10. Arrive L, Chang YGF, Hricak H, et al. Radiation-induced uterine changes: MR imaging. Radiology. 1989;170:55–8.

    PubMed  CAS  Google Scholar 

  11. Critchley HO, Wallace WH. Impact of cancer treatment on uterine function. J Natl Cancer Inst Monogr. 2005;34:64–8.

    Article  PubMed  Google Scholar 

  12. Larsen EC et al. Radiotherapy at a young age reduces uterine volume of childhood cancer survivors. Acta Obstet Gynecol Scand. 2004;83(1):96–102.

    PubMed  Google Scholar 

  13. Holm K et al. Ultrasound B-mode changes in the uterus and ovaries and Doppler Changes in the uterus after total body irradiation and allogenic bone marrow transplantation in childhood. Bone Marrow Transplant. 1999;23(3):259–63.

    Article  PubMed  CAS  Google Scholar 

  14. Laursen EM et al. Doppler assessment of flow velocity in the uterine artery during pubertal maturation. Ultrasound Obstet Gynecol. 1996;8(5):341–5.

    Article  PubMed  CAS  Google Scholar 

  15. Wo JY, Viswanathan AK. Impact of radiotherapy on fertility, pregnancy and neonatal outcomes in female cancer patients. Int J Radiat Oncol Biol Phys. 2009;5:1304–12.

    Article  Google Scholar 

  16. Critchley HO et al. Abdominal irradiation in childhood; the potential for pregnancy. Br J Obstet Gynaecol. 1992;99(5):392–4.

    Article  PubMed  CAS  Google Scholar 

  17. Bath LE et al. Ovarian and uterine characteristics after total body irradiation in childhood and adolescence: response to sex steroid replacement. Br J Obstet Gynaecol. 1999;106(12):1265–72.

    Article  PubMed  CAS  Google Scholar 

  18. Sudour H et al. Fertility and pregnancy outcome after abdominal irradiation that included or excluded the pelvis in childhood tumor survivors. Int J Radiat Oncol Biol Phys. 2010;76(3):867–73.

    Article  PubMed  Google Scholar 

  19. Norwitz ER, et al. Placenta percreta and uterine rupture associated with prior whole body radiation therapy. Obstet Gynecol. 2001;98(5 Pt 2):929–31. [PubMed: 10084257].

    Google Scholar 

  20. Pridjian G, Rich NE, Montag AG. Pregnancy hemoperitoneum and placenta percreta in a patient with previous pelvic irradiation and ovarian failure. Am J Obstet Gynecol. 1990;162(5):1205–6.

    PubMed  CAS  Google Scholar 

  21. Green DM, Whitton JA, Stovall M, et al. Pregnancy outcome of female survivors of childhood cancer: a report from the childhood cancer survivor study. Am J Obstet Gynecol. 2002;187(4):1070–80.

    Article  PubMed  Google Scholar 

  22. Ventura SJ, Martin JA, Curtin SC, et al. Births: final data for 1999. Natl Vital Stat Rep. 2001;49:1–100.

    Google Scholar 

  23. Stovall M et al. Dose reconstruction for therapeutic and diagnostic radiation exposures: use in epidemiologic studies. Radiat Res. 2006;166:141–57.

    Article  PubMed  CAS  Google Scholar 

  24. Green DM et al. Pregnancy outcome after treatment for Wilms tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol. 2002;20(10): 2506–13.

    Article  PubMed  Google Scholar 

  25. Chiarelli AM, Marrett LD, Darlington GA. Pregnancy outcomes in females after treatment for childhood cancer. Epidemiology. 2000;11(2):161–6.

    Article  PubMed  CAS  Google Scholar 

  26. Signorello LB et al. Female survivors of childhood cancer: preterm birth and low birth weight among their children. J Natl Cancer Inst. 2006;98(20):1453–61.

    Article  PubMed  Google Scholar 

  27. Li FP et al. Outcome of pregnancy in survivors of Wilms tumor. JAMA. 1987;257:216–9.

    Article  PubMed  CAS  Google Scholar 

  28. Byrne J et al. Reproductive problems and birth defects in survivors of Wilms tumor and their relatives. Med Pediatr Oncol. 1988;16:233–40.

    Article  PubMed  CAS  Google Scholar 

  29. Borenstein R et al. Tamoxifen treatment in women with failure of clomiphne citrate therapy. Aust N Z J Obstet Gynecol. 1989;29:173–5.

    Article  CAS  Google Scholar 

  30. Suginami H et al. A clomiphene citrate and tamoxifen citrate combination therapy: a novel therapy for ovulation induction. Fertil Steril. 1993;59:976–9.

    PubMed  CAS  Google Scholar 

  31. Reynolds K et al. Comparison of the effect of tamoxifen on endometrial thickness in women with thin endometrium (<7mm) undergoing ovulation induction with clompiphene citrate. Fertil Steril. 2010;93: 2091–3.

    Article  PubMed  Google Scholar 

  32. Del Priore G, Stega J, Sieunarine K, Ungar L, Smith JR. Human uterus retrieval from a multi-organ donor. Obstet Gynecol. 2007;109:101–4.

    Article  PubMed  Google Scholar 

  33. Signorello LB et al. Stillbirth and neonatal death in relation to radiation exposure before conception: a retrospective cohort study. Lancet. 2010;376:624–30.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Washington Hospital Center, Washington, DC, USA

    Abbie L. Fields MD (Medical Director)

  2. Department of Radiation Oncology, Basavatarakam Indo-American Cancer Institute and Research Center, Hyderabad, Andhra Pradesh, India

    Deleep Kumar Gudipudi MBBS, DNB (Resident)

  3. Division of Gynecologic Oncology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA

    Giuseppe Del Priore MD, MPH (Director)

Authors
  1. Abbie L. Fields MD
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  2. Deleep Kumar Gudipudi MBBS, DNB
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  3. Giuseppe Del Priore MD, MPH
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Editor information

Editors and Affiliations

  1. School of Medicine, Department of Obstetrics, Gynecology, Yale University, Cedar St. 333, New Haven, 06510, Connecticut, USA

    Emre Seli

  2. , Director, Center for Reproductive, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, Ohio, USA

    Ashok Agarwal

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Fields, A.L., Gudipudi, D.K., Del Priore, G. (2012). Impact of Chemotherapy and Radiotherapy on the Uterus. In: Seli, E., Agarwal, A. (eds) Fertility Preservation. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1783-6_5

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  • DOI: https://doi.org/10.1007/978-1-4419-1783-6_5

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1782-9

  • Online ISBN: 978-1-4419-1783-6

  • eBook Packages: MedicineMedicine (R0)

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