Radiation therapy for ovarian cancer could decrease fertility
In female cancer patients of reproductive age, a mutlidsciplinary approach to ovarian radiation treatment should be taken due to the direct relationship between certain types of radiation therapy and fertility problems, according to a review in the April 1 issue of the International Journal of Radiation Oncology*Biology*Physics.
Researchers at the Harvard Medical School radiation oncology program and the department of radiation oncology at Brigham and Women's Hospital and Dana-Farber Cancer Institute, all in Boston, sought to review the impact of radiation therapy on fertility, pregnancy and neonatal outcomes among female patients and the effectiveness of ovarian transposition, or moving the ovaries out of the field of radiation, as a means of preserving fertility.
The researchers reviewed the outcomes of past studies that reported fertility, pregnancy and neonatal outcomes as a result of cranio-spinal, abdominal and pelvic radiation and determined that cranio-spinal irradiation caused hormonal changes that affected a woman's ability to become pregnant later in life. Women who received abdominal or pelvic radiation had an increased risk of uterine dysfunction that can lead to miscarriage, pre-term labor, low birth weight and placental abnormalities.
The study also determined that women who received low doses of ovarian radiation can suffer early menopause.
Ovarian transposition was proven to be an effective method of reducing the rates of ovarian dysfunction, but even if the ovaries are outside of the field of radiation, scatter dose can cause significant damage, according to the authors.
"Female patients who are not past their reproductive years would be best served by a multidisciplinary team of caregivers, including a radiation oncologist, pediatric oncologist, medical oncologist, a reproductive endocrinologist or gynecologist, and a maternal fetal medicine specialist," said the study's senior author Akila Viswanathan, MD, a radiation oncologist at the Brigham and Dana Farber. "Only through a multidisciplinary approach will patients receive optimal care of their cancer and the best options for fertility preservation."
Researchers at the Harvard Medical School radiation oncology program and the department of radiation oncology at Brigham and Women's Hospital and Dana-Farber Cancer Institute, all in Boston, sought to review the impact of radiation therapy on fertility, pregnancy and neonatal outcomes among female patients and the effectiveness of ovarian transposition, or moving the ovaries out of the field of radiation, as a means of preserving fertility.
The researchers reviewed the outcomes of past studies that reported fertility, pregnancy and neonatal outcomes as a result of cranio-spinal, abdominal and pelvic radiation and determined that cranio-spinal irradiation caused hormonal changes that affected a woman's ability to become pregnant later in life. Women who received abdominal or pelvic radiation had an increased risk of uterine dysfunction that can lead to miscarriage, pre-term labor, low birth weight and placental abnormalities.
The study also determined that women who received low doses of ovarian radiation can suffer early menopause.
Ovarian transposition was proven to be an effective method of reducing the rates of ovarian dysfunction, but even if the ovaries are outside of the field of radiation, scatter dose can cause significant damage, according to the authors.
"Female patients who are not past their reproductive years would be best served by a multidisciplinary team of caregivers, including a radiation oncologist, pediatric oncologist, medical oncologist, a reproductive endocrinologist or gynecologist, and a maternal fetal medicine specialist," said the study's senior author Akila Viswanathan, MD, a radiation oncologist at the Brigham and Dana Farber. "Only through a multidisciplinary approach will patients receive optimal care of their cancer and the best options for fertility preservation."