Successful pregnancy after radiation therapy for carcinoma of the cervix

Abstract

Radiosensitivity of the ovary is considered, and the possibility of recovery of ovarian function following pelvic radiotherapy is evaluated with reference to previously reported cases and a new case. In the standard radiation program of combined Ra and x-ray therapy currently employed for the control of carcinoma of the cervix, thc amount of radiation delivered to the gonads makes preservation of ovarian function nearly impossible. Even after Ra therapy alone for cervical cancer, continued ovarian activity as evidenced by regular menstruation is infrequent, and successful pregnancy after Ra treatment for a malignant growth on the cervix is an extremely rare occurrence. Data are tabulated for nine previous cases in which pregnancy occurred after radiotherapy for cervical carcinoma. In the present case, a 21-yr-old women was treated with 5000 mg-hr and became pregnant twice, four and six yrs later. No external x-ray therapy was given. The patient experienced vaginal bleeding consistent with a menstrual period in each of the first two months after Ra insertion but had total amenorrhea for the next year. Rectal bleeding and diarrhea six months later because of radiation proctitis. A cervical biopsy performed three yr later showed a severe radiation reaction. Regular menses commenced four monthsmore » after this procedure. Both pregnancies terminated prematurely but in both instances an apparently normal infant was born, and no subsequent abnormalities in their growth, development, or behaviour were noted. In the reviewed group of cases, preservation of ovarian function was attributed in great measure to the increased distance of the ovaries from the Ra source because of an intrauterine gestation (five cases), recent parturition (one case), recent miscarriage (one case), and a large exophytic tumor (one case). The existence of an amenorrheic state for nine months in one earlier case and for 12 months in the present case indicates that the radiosensitive gonads were significantly affected by the action of radiation. The relative youth of these two patients may have played a role in the capacity of their ovaries to reestablish ovulation. The effect of radiation on the function of cervical dilatation in parturition was also discussed after a study of these cases. Because of radioinduced scarring of the cervix, cesarean section is usually necessary for delivery in such cases. Among the 10 children who were born of these mothers whose ovaries had received a subliminal castration dose of radiation there was no evidence of any gross congenital defect, but the follow-up on all of these children is incomplete and the possibility of a genetic defect in a future generation cannot be ruled out if children should be born to any of these individuals.« less