Acute effects of pelvic irradiation on the adult uterus revealed by dynamic contrast-enhanced MRI Journal Article

Authors: Milgrom, S. A.; Vargas, H. A.; Sala, E.; Kelvin, J. F.; Hricak, H.; Goodman, K. A.
Article Title: Acute effects of pelvic irradiation on the adult uterus revealed by dynamic contrast-enhanced MRI
Abstract: Objective: Pelvic radiation therapy (RT) can influence fertility in female rectal cancer survivors. Data regarding its effects on the adult uterus are scant. This study aims to evaluate the uterus before and after RT, using dynamic contrast-enhanced MRI. Methods: Eligible patients (n510) received RT for rectal cancer, had an intact uterus and underwent dynamic contrast-enhanced MRI before and after RT. Seven patients were pre-menopausal. Results: Patients received pelvic RT (median, 50.2Gy) with concurrent 5-fluorouracil. Five patients were treated with intensity modulated RT (IMRT) and five with a three-field technique. The median D95 of the uterus was 30Gy; D05 was 48Gy; and V95was 97%. The median cervical D95 was 45Gy; D05, 50Gy; and V95, 100%. Cervical dose was higher with IMRT than with three-field plans (p≤0.038). On T2 MRI, the junctional zone was visible in nine patients before and in one after RT (p=0.001). Median cervical length (2.3 vs 3.0 cm) and endometrial thickness (2.6 vs 5.9mm) were reduced after RT (p≤0.008). In pre-menopausal patients, the volume transfer constant, Ktrans, (0.069 vs 0.195, p=0.006) and the extracellular extravascular volume fraction, Ve, (0.217 ve 0.520, p=0.053) decreased. Conclusion: Pelvic RT significantly affected uterine anatomy and perfusion. Cervical dose was higher with IMRT than three-field plans, but no attempt was made to constrain the dose. Advances in knowledge: Pelvic RT significantly affects the adult uterus. These findings are crucial to understand the potential consequences of RT on fertility, and they lay the groundwork for further prospective studies. © 2013 The Authors.
Journal Title: British Journal of Radiology
Volume: 86
Issue: 1031
ISSN: 0007-1285
Publisher: British Institute of Radiology  
Date Published: 2013-11-01
Start Page: 20130334
Language: English
DOI: 10.1259/bjr.20130334
PROVIDER: scopus
PMCID: PMC3830434
PUBMED: 24052311
Notes: --- - "Export Date: 2 December 2013" - "CODEN: BJRAA" - "Source: Scopus"
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MSK Authors
  1. Evis Sala
    95 Sala
  2. Karyn A Goodman
    245 Goodman
  3. Sarah Allison Milgrom
    22 Milgrom
  4. Hedvig Hricak
    333 Hricak
  5. Joanne F Kelvin
    63 Kelvin