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Late Effects

Fertility

 

Female Genito-urinary Tract

 

The Uterus

Uterine development can be damaged by radiation therapy (RT).

The effect is especially severe if patients are young (pre-pubertal) at the time of therapy and are given high dose therapy.

RT causes:

  • Decreased uterine growth with reduced:
    • Uterine length
    • Uterine blood flow
  • Estrogen replacement therapy does not lead to any increase in endometrial thickness
  • Scarring and reduced elasticity of the uterine wall

All these changes reduce the chances of successful completion of pregnancy with an increased risk of:

  • Early pregnancy loss
  • Premature labour
  • Low birth weight babies

In a study looking at patients treated for Wilms tumor6, the conclusion was that fertility could be preserved in children with Wilms tumor after upper abdominal RT (10-20 Gy) that did not include the entire pelvis. In rare instances, fertility can be preserved after low-dose whole-abdominal RT (10.5 Gy). Childhood Wilms tumor survivors should be considered to be at a high risk for infertility and pregnancy-related complications during their reproductive years. Prompt obstetric evaluation was recommended for optimal prenatal, antenatal, and postnatal care.

 

The Vagina

Very high dose RT can cause:

  • Abnormal vaginal development in a young child
  • Fibrosis of the vagina
  • Soft tissue necrosis of the vaginal wall
  • Fistula formation (rectovaginal, vesicovaginal, urethrovaginal)

Scarring from the RT combined with early menopause can cause dyspareunia and a negative impact on sexual function secondary to painful intercourse and vaginal dryness

 

 

 

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