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Low-Dose Head Radiotherapy Can Cut Fertility

March 13, 2011
Written by: , Filed in: Pediatric Radiology
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Women who receive radiotherapy to the head as children, even in low doses, are at risk of fertility problems later in life, according to a new study.

Scientists had already known that high doses, above 30-35 Gray, apparently destroy cells in the hypothalamus and pituitary gland that produce hormones controlling sexual development and pregnancy. But even relatively low doses of about 22-27 Gy also slightly increase the chances of infertility later in life.

Of course, “relatively” is a key term. A dose of 22 Gy is roughly equivalent to the dosage of 220,000 chest X-rays.

The new study, published earlier this month in Fertility and Sterility, looked at 3,619 female childhood cancer survivors who received dosages of 22-27 Gy to the head but no direct radiation to the ovaries. It compared their pregnancy rates to those of 2,081 female siblings.

Even the women with the lowest doses reported one-third fewer pregnancies than their untreated sisters.

Most of the cancer survivors had received radiotherapy for a brain tumor or leukemia. Others had been treated for cancers of the lymph nodes, bones, or muscles.

Such therapy for leukemia is less common now than it was a decade or more ago, but many women who received the treatment in the past still may be at risk for fertility problems, the researchers said.

Daniel M. Green, MD, an oncologist at St. Jude Children’s Research Hospital in Memphis, Tennessee, led the study. At the American Society of Clinical Oncology’s annual meeting in Chicago last June, Dr. Green did a poster presentation based on his research.

During that presentation, he theorized that high-dose and low-dose hypothalamic/pituitary radiation exposure interfere with fertility via different mechanisms. High-dose exposure may result in failure to stimulate ovulation, he said, while low-dose exposure may cause luteal phase deficiency (disruption of the second half of the menstrual cycle, which is believed to interfere with implantation of embryos).

Related seminar: Pediatric Radiology Review

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