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Dosimetric evaluation of ovaries and pelvic bones associated with clinical outcomes in patients receiving total body irradiation with ovarian shielding

Authors :
Yuta Takahashi
Shinichi Kako
Masahiro Ashizawa
Yoshinobu Kanda
Shun-ichi Kimura
Noriko Oyama-Manabe
Keiko Akahane
Masahiro Kawahara
Satoru Takahashi
Shogo Hatanaka
Katsuyuki Shirai
Masaru Wakatsuki
Kazunari Ogawa
Masato Suzuki
Source :
Journal of Radiation Research
Publication Year :
2021
Publisher :
Oxford University Press, 2021.

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.

Details

Language :
English
ISSN :
13499157 and 04493060
Volume :
62
Issue :
5
Database :
OpenAIRE
Journal :
Journal of Radiation Research
Accession number :
edsair.doi.dedup.....6be8bc4b2012bba987c33251c597ee1b