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Woon W, Samuel J, Wahab K, Zaini F, Hamadi F, Ck AL, Ramamurthy V, Bohari S. A phantom study investigating effective strategies for reducing fetal dose in pregnant patients with head and neck cancer. J Med Imaging Radiat Sci 2024; 55:264-271. [PMID: 38553300 DOI: 10.1016/j.jmir.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE To measure the out-of-field doses for various treatment planning techniques and assess the impact on fetal dose with and without the use of custom shielding. MATERIALS AND METHODS A total of six treatment plans were generated with different treatment techniques such as 3-dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT), utilizing both 6 MV flattened beams and flattening filter-free (FFF) beams. The measurements were carried out both out-of-field at the surface and at depth to assess the dose reduction achieved by removing the flattening filter and incorporating shielding. RESULTS The custom-made frame shielding can effectively reduce the surface dose with a maximum reduction of 15.2% observed in VMAT plans and achieve a maximum reduction of 100% for cone beam computed tomography (CBCT) imaging. Out-of-field dose measurements conducted at depth, positioned 58 cm inferior to the target isocenter, reveal that the shielding effectiveness consistently remains the greatest for 3DCRT technique. A maximum reduction of 21% is observed when utilizing a flattening filter-free beam. CONCLUSION The results of this study indicate that the 3DCRT technique exhibits the least amount of scatter radiation both near and far from the treatment isocenter, which is the most suitable approach for radiation therapy of pregnant patients. In cases where meeting dose constraints for critical organs becomes challenging, VMAT technique emerges as the most suitable treatment technique for reducing out-of-field doses. Additionally, a flattening filter-free beam significantly reduces out-of-field doses due to lower contributions from head scatter.
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Affiliation(s)
- WuiAnn Woon
- Department of Radiation Oncology, The Brunei Cancer Center, Bandar Seri Begawan, BG3122, Brunei Darussalam.
| | - Jacob Samuel
- Department of Radiation Oncology, The Brunei Cancer Center, Bandar Seri Begawan, BG3122, Brunei Darussalam
| | - Khairina Wahab
- Department of Radiation Oncology, The Brunei Cancer Center, Bandar Seri Begawan, BG3122, Brunei Darussalam
| | - Farhan Zaini
- Department of Radiation Oncology, The Brunei Cancer Center, Bandar Seri Begawan, BG3122, Brunei Darussalam
| | - Fatin Hamadi
- Department of Radiation Oncology, The Brunei Cancer Center, Bandar Seri Begawan, BG3122, Brunei Darussalam
| | - Andrew Lee Ck
- Department of Radiation Oncology, The Brunei Cancer Center, Bandar Seri Begawan, BG3122, Brunei Darussalam
| | - Vedapriya Ramamurthy
- Department of Radiation Oncology, The Brunei Cancer Center, Bandar Seri Begawan, BG3122, Brunei Darussalam
| | - Shahidda Bohari
- Department of Radiation Oncology, The Brunei Cancer Center, Bandar Seri Begawan, BG3122, Brunei Darussalam
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Blommaert J, De Saint‐Hubert M, Depuydt T, Oldehinkel E, Poortmans P, Amant F, Lambrecht M. Challenges and opportunities for proton therapy during pregnancy. Acta Obstet Gynecol Scand 2024; 103:767-774. [PMID: 37491770 PMCID: PMC10993337 DOI: 10.1111/aogs.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
During pregnancy, the use of radiation therapy for cancer treatment is often considered impossible due to the assumed associated fetal risks. However, suboptimal treatment of pregnant cancer patients and unjustifiable delay in radiation therapy until after delivery can be harmful for both patient and child. In non-pregnant patients, proton-radiation therapy is increasingly administered because of its favorable dosimetric properties compared with photon-radiation therapy. Although data on the use of pencil beam scanning proton-radiation therapy during pregnancy are scarce, different case reports and dosimetric studies have indicated a more than 10-fold reduction in fetal radiation exposure compared with photon-radiation therapy. Nonetheless, the implementation of proton-radiation therapy during pregnancy requires complex fetal dosimetry for the neutron-dominated out-of-field radiation dose and faces a lack of clinical guidelines. Further exploration and standardization of proton-radiation therapy during pregnancy will be necessary to improve radiotherapeutic management of pregnant women with cancer and further reduce risks for their offspring.
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Affiliation(s)
| | | | - Tom Depuydt
- Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Edwin Oldehinkel
- Department of Radiation OncologyUniversity Medical Center Groningen, University of GroningenGroningenthe Netherlands
| | - Philip Poortmans
- Radiation OncologyIridium Netwerk & University of AntwerpWilrijkBelgium
| | - Frederic Amant
- Department of OncologyKU LeuvenLeuvenBelgium
- Gynecologic Oncology, Antoni van LeeuwenhoekNetherlands Cancer InstituteAmsterdamThe Netherlands
- Division Gynecologic OncologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Maarten Lambrecht
- Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
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Fagerstrom JM. Radiation oncology department policy development for patients who may become pregnant. J Appl Clin Med Phys 2024; 25:e14256. [PMID: 38175957 PMCID: PMC10860450 DOI: 10.1002/acm2.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
In the context of radiation oncology, radiation exposure from radiation therapy simulation, image guidance, and radiation therapy procedures can have severe adverse biological effects on a developing embryo or fetus. Patients who may be pregnant are screened for the possibility of pregnancy to prevent unnecessary or excessive exposure of radiation in utero. Some radiation therapy patients for whom a pregnancy test is indicated may elect to decline the test. In addition, some patients who are found upon screening to be pregnant may decide, with their attending radiation oncologist, to continue with treatment. A radiation oncology department policy was developed to provide guidelines regarding screening and consent. The policy was designed to prevent unnecessary exposure to patients who may be pregnant, and to limit dose to the embryo or fetus in patients for whom treatment is medically indicated. The policy is presented as an example for physicists intending to develop or revise their own practice's policy regarding patients who may become pregnant.
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Affiliation(s)
- Jessica M. Fagerstrom
- Department of Radiation OncologyUniversity of WashingtonSeattleWashingtonUSA
- Department of Radiation OncologyKaiser PermanenteSeattleWashingtonUSA
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Benameur Y, Tahiri M, Mkimel M, El Baydaoui R, Najeh M, Sahraoui S, Benchekroun N, Bougteb M, El Hariri B, Mesradi MR, Hilali A, Saad EM. FETAL DOSE ESTIMATION DURING PREGNANCY USING GATE MONTE CARLO SIMULATION: APPLICATION OF HODGKIN'S LYMPHOMA RADIOTHERAPY. RADIATION PROTECTION DOSIMETRY 2023; 199:581-587. [PMID: 36918210 DOI: 10.1093/rpd/ncad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 05/05/2023]
Abstract
The aim of this study is to estimate the fetal radiation dose for a pregnant patient treated for Hodgkin's lymphoma. Due to the supradiaphragmatic extensions, two plans are used for this treatment, one for supra-clavicular and the other for cervical lymph nodes, with beam energies of 18 and 6 MV, respectively. We model the ELEKTA accelerator (Versa HD Ltd, Crawly, UK) and the pregnant patient using GATE code. The accelerator is modelled based on the vendor-supplied data and the pregnant patient is modeled with a voxelized pregnant woman phantom (Katja, 29 years old) at the 24th week of pregnancy. In each plan, we estimate the absorbed dose of each fetus organ by delivering a 2 Gy for one fraction and then multiplying the result by 15 fractions to get the total prescribed dose, then we calculate the mean fetal absorbed dose. The results indicate that the mean absorbed fetal dose was 26.18 mGy.
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Affiliation(s)
- Yassine Benameur
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
- Medical Radiophysics Units (MRU), Mohammed VI Oncology Centre for Cancer Ibn Rochd University Hospital, Casablanca, Morocco
| | - Maroine Tahiri
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Mounir Mkimel
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Redouane El Baydaoui
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Mohammed Najeh
- Medical Radiophysics Units (MRU), Mohammed VI Oncology Centre for Cancer Ibn Rochd University Hospital, Casablanca, Morocco
- Laboratory of Genetics and Molecular Pathology (LGMP), Faculty of Medicine and Pharmacy, Hassan 2, Morocco
| | - Souha Sahraoui
- Laboratory of Genetics and Molecular Pathology (LGMP), Faculty of Medicine and Pharmacy, Hassan 2, Morocco
- Department of Radiotherapy Mohammed VI Oncology Centre for Cancer Treatment, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Nadia Benchekroun
- Laboratory of Genetics and Molecular Pathology (LGMP), Faculty of Medicine and Pharmacy, Hassan 2, Morocco
- Department of Radiotherapy Mohammed VI Oncology Centre for Cancer Treatment, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Mustapha Bougteb
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Bouazza El Hariri
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Mohammed Reda Mesradi
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Abderraouf Hilali
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - El Madani Saad
- Laboratory Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
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Yadav A, Goyal S, Madan R, Singh R, Chitkara A, Khosla D. Challenges with Adjuvant Radiation for Intracranial Chondrosarcoma in Pregnancy. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2023. [DOI: 10.1055/s-0042-1758225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background Managing a brain tumor during pregnancy is a highly confusing and challenging situation, complicated by several technical, medical, ethical, and sociocultural concerns. The interests of the mother and child are often pitted against each other, for which legal opinion may occasionally be needed.
Case Report We present the report of a young lady with intracranial well-differentiated chondrosarcoma who was determined to be pregnant in the immediate postoperative period. We discuss the management of challenges and dilemmas in devising optimum therapy, and the modifications and care required at each step to help safeguard maternal and fetal health. Risks with therapeutic radiation and measures to assess and pre-empt fetal doses that may assist decision-making are also discussed.
Conclusion Radiation therapy during pregnancy is challenging and requires multidisciplinary involvement and psychosocial support for the patient and family.
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Affiliation(s)
- Arun Yadav
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjit Singh
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aarti Chitkara
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Somma T, Bove I, Vitulli F, Cappabianca P, Pessina F, Alviggi C, Santi L, Della Pepa GM, Sabatino G, Olivi A, Ius T. Management and treatment of brain tumors during pregnancy: an Italian survey. J Neurooncol 2023; 161:13-22. [PMID: 36580221 DOI: 10.1007/s11060-022-04215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The management of brain tumors during pregnancy is challenging. The clinical rarity and prognostic heterogeneity of such condition makes it difficult to develop standardized guidelines of treatment. The aim of this study was to assess the treatment options used in pregnant women with brain tumors that are currently used in Italy, considering the management of these patients reported in current literature in this field. METHODS A survey addressing the treatments options and management of brain tumors during pregnancy was designed on behalf of an ad-hoc task-force Neuro-Oncology committee of the Società Italiana di Neurochirurgia (SINch) to analyze the management of pregnant patients with brain tumors. We conducted a search of the literature published between January 2011 and September 2021, using MEDLINE (PubMed) in accordance to PRISMA guidelines. Data were discussed to obtain recommendations after evaluation of the selected articles and discussion among the experts. RESULTS A total of 18 Neurosurgical centers participated in the survey. A total of 31 pregnant women were included in this retrospective study. Meningiomas and gliomas were the two most common types of brain tumors diagnosed during pregnancy. An emergency surgical procedure was required in 12.9% of cases. CONCLUSION A multidisciplinary and tailored approach is fundamental. In women showing clinical stability, neurosurgical options should preferably be delayed if possible, and considered during the second trimester or after delivery. In patients with acute neurological symptoms or tumor progression, medical abortion in the first trimester or a C-section in the second and third trimester need to be considered.
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Affiliation(s)
- Teresa Somma
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Ilaria Bove
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.
| | - Francesca Vitulli
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy
| | - Laura Santi
- Neurosurgical Unit of Sondrio ASST - Valtellina e alto Lario, Sondrio, Italy
| | - Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100, Rome, Italy
| | | | - Alessandro Olivi
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, Udine, Italy
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Fetal dose estimation for Virtual Tangential-fields Arc Therapy whole breast irradiation by optically stimulated luminescence dosimeters. Phys Med 2022; 101:44-49. [PMID: 35944444 DOI: 10.1016/j.ejmp.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/14/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is the most frequently diagnosed tumor in pregnant women and radiation therapy should carefully be weighted up because of the dose to the fetus. The aim of this study was to investigate fetal dose in a patient treated with Virtual Tangential-fields Arc Therapy (ViTAT), an innovative technique for whole breast irradiation. Optically stimulated luminescence detectors (OSLDs) were calibrated on a Varian TrueBeam linac, with both a 6X and 6XFFF beam quality, and used for out-of-field measurements. Fetal dose related with ViTAT technique was compared to the standard 3D conformal radiation therapy technique (3DCRT). The fetal dose delivered with a ViTAT technique planned with 6XFFF beam was also investigated. Measurements were taken on a phantom composed of Rando Alderson Phantom slices and solid water slabs. OSLDs were placed in a region identified by the height of the fundus from conception to the twentieth week using a custom made PMMA grid. Due to the higher number of monitor units, the peripheral dose of ViTAT delivered with 6X beams is higher than that of 3DCRT. However, nanoDots measurements prove that ViTAT can be used in place of 3DCRT while maintaining similar fetal dose levels if 6XFFF beams are used.
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Tillery H, Moore M, Gallagher KJ, Taddei PJ, Leuro E, Argento DC, Moffitt GB, Kranz M, Carey M, Heymsfield S, Newhauser WD. Personalized 3D-printed anthropomorphic whole-body phantom irradiated by protons, photons, and neutrons. Biomed Phys Eng Express 2022; 8. [PMID: 35045408 DOI: 10.1088/2057-1976/ac4d04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/19/2022] [Indexed: 11/12/2022]
Abstract
The objective of this study was to confirm the feasibility of three-dimensionally-printed (3D-printed), personalized whole-body anthropomorphic phantoms for radiation dose measurements in a variety of charged and uncharged particle radiation fields. We 3D-printed a personalized whole-body phantom of an adult female with a height of 154.8 cm, mass of 90.7 kg, and body mass index of 37.8 kg/m2. The phantom comprised of a hollow plastic shell filled with water and included a watertight access conduit for positioning dosimeters. It is compatible with a wide variety of radiation dosimeters, including ionization chambers that are suitable for uncharged and charged particles. Its mass was 6.8 kg empty and 98 kg when filled with water. Watertightness and mechanical robustness were confirmed after multiple experiments and transportations between institutions. The phantom was irradiated to the cranium with therapeutic beams of 170-MeV protons, 6-MV photons, and fast neutrons. Radiation absorbed dose was measured from the cranium to the pelvis along the longitudinal central axis of the phantom. The dose measurements were made using established dosimetry protocols and well-characterized instruments. For the therapeutic environments considered in this study, stray radiation from intracranial treatment beams was the lowest for proton therapy, intermediate for photon therapy, and highest for neutron therapy. An illustrative example set of measurements at the location of the thyroid for a square field of 5.3 cm per side resulted in 0.09, 0.59, and 1.93 cGy/Gy from proton, photon, and neutron beams, respectively. In this study, we found that 3D-printed personalized phantoms are feasible, inherently reproducible, and well-suited for therapeutic radiation measurements. The measurement methodologies we developed enabled the direct comparison of radiation exposures from neutron, proton, and photon beam irradiations.
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Affiliation(s)
- Hunter Tillery
- Radiation Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, Oregon, 97239-3098, UNITED STATES
| | - Meagan Moore
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Kyle Joseph Gallagher
- Radiation Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, Oregon, 97239-3098, UNITED STATES
| | - Phillip J Taddei
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, UNITED STATES
| | - Eric Leuro
- Seattle Cancer Care Alliance, 1570 N 115th St, Seattle, Washington, 98133, UNITED STATES
| | - David C Argento
- Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Gregory B Moffitt
- Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Marissa Kranz
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Margaret Carey
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Steven Heymsfield
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Wayne David Newhauser
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
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Assessment of Fetal Dose and Health Effect to the Fetus from Breast Cancer Radiotherapy during Pregnancy. Life (Basel) 2022; 12:life12010084. [PMID: 35054476 PMCID: PMC8780279 DOI: 10.3390/life12010084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 01/26/2023] Open
Abstract
Decision for radiotherapy during the first trimester of pregnancy may occur, as patients may not realize their pregnancy at the very early stage. Since radiation dose can affect fetal development, the aim of this study was to evaluate fetal dose and associated deterministic effects and risks to the fetus from breast cancer radiotherapy of an 8-week pregnant patient. PHITS (Particle and Heavy Ion Transport code System) Monte Carlo simulation and the J-45 computational pregnancy phantom were used to simulate breast cancer radiotherapy from a 6 MV TrueBeam linear accelerator using the three dimensional-conformal radiotherapy (3D-CRT) technique with a prescribed dose to the planning target volume (PTV) of 50 Gy. Once the fetal dose was evaluated, the occurrence of the deterministic effects and risks for developing stochastic effects in the fetus were assessed using the recommendations of NCRP Report No. 174, AAPM Report No. 50, and ICRP Publication 84. The fetal dose was evaluated to be 3.37 ± 2.66 mGy, suggesting that the fetus was expected to have no additional deterministic effects, while the risks for developing cancer and malfunctions were similar to that expected from exposure to background radiation. The comparison with the other studies showed that accurate consideration of fetal position and size was important for dose determination in the fetus, especially at the early pregnancy stage when the fetus is very small.
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Goyal S, Yadav A, Madan R, Chitkara A, Singh R, Khosla D, Kumar N. Managing brain tumors in pregnancy: The oncologist's struggle with maternal-fetal conflict. J Cancer Res Ther 2022; 18:5-18. [DOI: 10.4103/jcrt.jcrt_1343_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Applegate KE, Findlay Ú, Fraser L, Kinsella Y, Ainsbury L, Bouffler S. Radiation exposures in pregnancy, health effects and risks to the embryo/foetus-information to inform the medical management of the pregnant patient. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:S522-S539. [PMID: 34380129 DOI: 10.1088/1361-6498/ac1c95] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
Generally, intentional exposure of pregnant women is avoided as far as possible in both medical and occupational situations. This paper aims to summarise available information on sources of radiation exposure of the embryo/foetus primarily in medical settings. Accidental and unintended exposure is also considered. Knowledge on the effects of radiation exposure on the developing embryo/foetus remains incomplete-drawn largely from animal studies and two human cohorts but a summary is provided in relation to the key health endpoints of concern, severe foetal malformations/death, future cancer risk, and future impact on cognitive function. Both the specific education and training and also the literature regarding medical management of pregnant females is in general sparse, and consequently the justification and optimisation approaches may need to be considered on a case by case basis. In collating and reviewing this information, several suggestions for future basic science research, education and training, and radiation protection practice are identified.
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Affiliation(s)
- Kimberly E Applegate
- Department of Radiology (retired), University of Kentucky College of Medicine, 800 Rose St, Lexington, KY 40536, United States of America
| | - Úna Findlay
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Chilton, Didcot, Oxon OX11 0RQ, United Kingdom
| | - Louise Fraser
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Chilton, Didcot, Oxon OX11 0RQ, United Kingdom
| | - Yvonne Kinsella
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Chilton, Didcot, Oxon OX11 0RQ, United Kingdom
| | - Liz Ainsbury
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Chilton, Didcot, Oxon OX11 0RQ, United Kingdom
| | - Simon Bouffler
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Chilton, Didcot, Oxon OX11 0RQ, United Kingdom
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Kang S, Kim KH, Kang SW, Shin DS, Lee S, Chung JB. Evaluation of a new foetal shielding device for pregnant brain tumour patients. Radiat Oncol 2021; 16:109. [PMID: 34120633 PMCID: PMC8201726 DOI: 10.1186/s13014-021-01836-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background The present study aimed to propose a new foetal shielding device for pregnant cancer patients to reduce the foetal dose associated with treatment techniques using multiple gantry angles, such as intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT). Methods Three shielding structures were designed to minimise the scattered and leaked radiation from various gantry angles and radiation scattering within the patient. The base-plate part that can be placed on the treatment couch was designed to reduce the scattered and leaked radiation generated at gantry angles located near 180°. A body shielding part that can cover the lower chest and abdomen was designed, and a neck-shielding structure was added to reduce the internal and external radiation scattering from the treatment area. Evaluation plans were generated to assess the foetal dose reduction by the foetal shielding device in terms of the shielding material thickness, distance from the field edge, and shielding component using the flattened 6 MV photon beam (6MV) and flattening filter-free 6 MV photon beam (6MV-FFF). In addition, the effectiveness of the foetal shielding device was evaluated in a pregnant brain tumour patient. Results The shielding material consisting of three parts was placed on frames composed of four arch shapes with a vertical curved structure, connection bar at the top position, and base plate. Each shielding part resulted in reductions in the radiation dose according to the treatment technique, as the thickness of the shielding material increased and the foetal dose decreased. In addition, a foetal dose reduction of approximately 50% was confirmed at 50 cm from the field edge by using the designed shielding device in most delivery techniques. In patients, the newly designed shielding structures can effectively eliminate up to about 49% of the foetal dose generated from various gantry angles used in VMAT or IMRT. Conclusions We designed a foetal shielding device consisting of three parts to effectively reduce the dose delivered to the foetus, and evaluated the device with various treatment techniques for a pregnant patient with brain tumour. The foetal shielding device shielded the scattered/leaked radiation from the treatment machine, and also effectively reduced internal scattering from the treatment area in the patient.
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Affiliation(s)
- Seonghee Kang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyeong-Hyeon Kim
- Department of Biomedical Engineering, Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Won Kang
- Department of Biomedical Engineering, Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Seok Shin
- Department of Biomedical Engineering, Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seungwan Lee
- Department of Radiological Science, Konyang University, Daejeon, Korea
| | - Jin-Beom Chung
- Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Korea.
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13
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Rodrigues AJ, Waldrop AR, Suharwardy S, Druzin ML, Iv M, Ansari JR, Stone SA, Jaffe RA, Jin MC, Li G, Hayden-Gephart M. Management of brain tumors presenting in pregnancy: a case series and systematic review. Am J Obstet Gynecol MFM 2021; 3:100256. [PMID: 33451609 DOI: 10.1016/j.ajogmf.2020.100256] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022]
Abstract
Patients who present with brain tumors during pregnancy require unique imaging and neurosurgical, obstetrical, and anesthetic considerations. Here, we review the literature and discuss the management of patients who present with brain tumors during pregnancy. Between 2009 and 2019, 9 patients were diagnosed at our institution with brain tumors during pregnancy. Clinical information was extracted from the electronic medical records. The median age at presentation was 29 years (range, 25-38 years). The most common symptoms at presentation included headache (n=5), visual changes (n=4), hemiparesis (n=3), and seizures (n=3). The median gestational age at presentation was 20.5 weeks (range, 11-37 weeks). Of note, 8 patients (89%) delivered healthy newborns, and 1 patient terminated her pregnancy. In addition, 5 patients (56%) required neurosurgical procedures during pregnancy (gestational ages, 14-37 weeks) because of disease progression (n=2) or neurologic instability (n=3). There was 1 episode of postneurosurgery morbidity (pulmonary embolism [PE]) and no surgical maternal mortality. The median length of follow-up was 15 months (range, 6-45 months). In cases demonstrating unstable or progressive neurosurgical status past the point of fetal viability, neurosurgical intervention should be considered. The physiological and pharmacodynamic changes of pregnancy substantially affect anesthetic management. Pregnancy termination should be discussed and offered to the patient when aggressive disease necessitates immediate treatment and the fetal gestational age remains previable, although neurologically stable patients may be able to continue the pregnancy to term. Ultimately, pregnant patients with brain tumors require an individualized approach to their care under the guidance of a multidisciplinary team.
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Affiliation(s)
- Adrian J Rodrigues
- Departments of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Anne R Waldrop
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Sanaa Suharwardy
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Maurice L Druzin
- Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Michael Iv
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Jessica R Ansari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Sarah A Stone
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Richard A Jaffe
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Michael C Jin
- Departments of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Gordon Li
- Departments of Neurosurgery, Stanford University School of Medicine, Stanford, CA
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