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Akahane K, Shirai K, Wakatsuki M, Suzuki M, Hatanaka S, Takahashi Y, Kawahara M, Ogawa K, Takahashi S, Oyama-Manabe N, Ashizawa M, Kimura SI, Kako S, Kanda Y. Dosimetric evaluation of ovaries and pelvic bones associated with clinical outcomes in patients receiving total body irradiation with ovarian shielding. JOURNAL OF RADIATION RESEARCH 2021; 62:918-925. [PMID: 34350969 PMCID: PMC8438484 DOI: 10.1093/jrr/rrab066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/11/2021] [Indexed: 05/11/2023]
Abstract
Total body irradiation (TBI) with ovarian shielding is expected to preserve fertility among hematopoietic stem cell transplant (HSCT) patients with myeloablative TBI-based regimens. However, the radiation dose to the ovaries that preserves ovarian function in TBI remains poorly understood. Furthermore, it is uncertain whether the dose to the shielded organs is associated with relapse risk. Here, we retrospectively evaluated the relationship between fertility and the dose to the ovaries, and between relapse risk and the dose to the pelvic bones. A total of 20 patients (median age, 23 years) with standard-risk hematologic diseases were included. Median follow-up duration was 31.9 months. The TBI prescribed dose was 12 Gy in six fractions for three days. Patients' ovaries were shielded with cylinder-type lead blocks. The dose-volume parameters (D98% and Dmean) in the ovaries and the pelvic bones were extracted from the dose-volume histogram (DVH). The mean ovary Dmean for all patients was 2.4 Gy, and 18 patients recovered menstruation (90%). The mean ovary Dmean for patients with menstrual recovery and without recovery were 2.4 Gy and 2.4 Gy, respectively, with no significant difference (P = 0.998). Hematological relapse was observed in five patients. The mean pelvis Dmean and pelvis D98% for relapse and non-relapse patients were 11.6 Gy and 11.7 Gy and 5.6 Gy and 5.3 Gy, respectively. Both parameters showed no significant difference (P = 0.827, 0.807). In conclusion, TBI with ovarian shielding reduced the radiation dose to the ovaries to 2.4 Gy, and preserved fertility without increasing the risk of relapse.
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Affiliation(s)
- Keiko Akahane
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Katsuyuki Shirai
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
- Department of Radiology, Jichi Medical University, Tochigi 329-0498, Japan
- Correspondence. Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan, E-mail:
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Masato Suzuki
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Shogo Hatanaka
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama 350-8550, Japan
| | - Yuta Takahashi
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Masahiro Kawahara
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Kazunari Ogawa
- Department of Radiology, Jichi Medical University, Tochigi 329-0498, Japan
| | - Satoru Takahashi
- Department of Radiology, Jichi Medical University, Tochigi 329-0498, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 350-8550, Japan
| | - Shun-ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi 350-8550, Japan
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
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