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Uterine function, pregnancy complications, and pregnancy outcomes among female childhood cancer survivors

      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.
      Función uterina, complicaciones del embarazo y resultados del embarazo en mujeres supervivientes de cáncer infantil

      Objetivo

      Evaluar si la radioterapia abdominal-pélvica para el cáncer infantil afecta la función uterina y aumenta el riesgo de resultados adversos y complicaciones del embarazo.

      Diseño

      Estudio de cohorte anidado.

      Entorno

      Este es un subestudio del estudio DCOG LATER-VEVO, un estudio retrospectivo de cohorte a nivel nacional que evalúa la fertilidad en mujeres supervivientes de cáncer infantil (SCI) en los Países Bajos. Los datos se recogieron mediante cuestionario, toma de muestras de sangre y ecografía transvaginal.

      Paciente (s)

      Supervivientes de cáncer infantil previamente expuestas a radioterapia abdominal-pélvica (SCI expuestas a RT) como parte de su tratamiento para el cáncer infantil.

      Intervención (es)

      Las SCI expuestas a radioterapia (n = 55) se ajustaron por edad y paridad a las SCI no irradiadas (SCI no expuestas a RT; n =110) y a los controles de la población general (n = 110).

      Principales medidas de resultados

      volumen uterino, complicaciones del embarazo y resultados del embarazo.

      Resultado (s)

      Entre las participantes nuligrávidas, el volumen uterino mediano (rango intercuartil) fue de 41.4 (18.6–52.8) mL para SCI expuestas a RT, 48.1 (35.7–61.8) mL para SCI no expuestas a RT, y 61.3 (49.1– 75.5) mL para controles de población general. Las SCI expuestas a radioterapia tenían un mayor riesgo de un volumen uterino reducido (<44.3 ml) en comparación con los controles de población (odds ratio [OR] 5,31 [intervalo de confianza del 95%: 1,98 a 14,23]). Sorprendentemente, lo mismo sucedió con las SCI no expuestas a RT (OR 2.61 [1.16–5.91]).
      Entre las participantes grávidas, las SCI expuestas a la RT tuvieron un mayor riesgo de complicaciones del embarazo, parto prematuro y un bebé con bajo peso al nacer en comparación con los controles de la población (OR 12.70 [2.55–63.40], O 9.74 [1.49–63.60] y OR 15.66 [1.43 –171.35], respectivamente). En comparación con las SCI no expuestas a la RT, las SCI expuestas a la RT tenían un mayor riesgo de tener un bebé con bajo peso al nacer (OR 6.86 [1.08-43.75]).

      Conclusión (es)

      La exposición uterina a la radioterapia durante la infancia reduce el volumen uterino en adultos y aumenta el riesgo de complicaciones del embarazo y resultados adversos del embarazo. El asesoramiento preconcepcional y el control obstétrico adecuado está justificado.

      Key Words

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