LBA49_PR - Long-term neuropsychological and cardiac follow-up of children and adults who were antenatal exposed to radiotherapy

Date 27 September 2014
Event ESMO 2014
Session Pregnancy, fertility and cancer
Topics Complications of Treatment
Supportive Care
Cancer in Special Situations
Surgery and/or Radiotherapy of Cancer
Presenter Frédéric Amant
Citation Annals of Oncology (2014) 25 (5): 1-41. 10.1093/annonc/mdu438
Authors F. Amant1, T. Vandenbroucke1, M. Verheecke1, M.M. Gziri2, S.N. Han1, F. van den Heuvel3, L. Lagae4, M.A. Willemsen5, L. Kapusta6, P.B. Ottevanger7, L. Mertens8, L. Claes9, K. van Calsteren10
  • 1Gynecological Oncology, KU Leuven, 3000 - Leuven/BE
  • 2Obstetrics & Gynecology, Université Catholique de Louvain, Louvain-la-Neuve/BE
  • 3Oncology, University of Oxford, Oxford/GB
  • 4Pediatrics, KU Leuven, 3000 - Leuven/BE
  • 5Pediatric Neurology, Radboud University Nijmegen Medical Centre, Nijmegen/NL
  • 6Pediatric Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen/NL
  • 7Medical Oncology, Radboud University Medical Centre Nijmegen, NL-6500 HB - Nijmegen/NL
  • 8Pediatrics, University of Toronto, Toronto/CA
  • 9Faculty Of Psychology And Educational Sciences, KU Leuven, 3000 - Leuven/BE
  • 10Obstetrics & Gynecology, KU Leuven, 3000 - Leuven/BE

 

Abstract

Aim

The use of radiation in medical diagnostics and treatment is standard of care. Apart from deductions from atom bomb and nuclear plant disaster survivors, there are scarce data on the long-term outcome after antenatal exposure to medical radiation. We aimed to assess the general health, cardiac and neuropsychological outcome of children in utero exposed to radiotherapy.

Methods

Women treated with radiotherapy during pregnancy were retro- and prospectively registered by the International Network on Cancer, Infertility and Pregnancy (INCIP). Children were assessed at 1.5, 3.0, 6.0 or 9.0 years of age, by echocardiography, a clinical neurological examination, cognitive tests and questionnaires regarding health and behavior. Adults were examined by echocardiography and questionnaires regarding health and behavior. Echocardiographic data were compared to an age- and gender-matched control group and neurocognitive data to test specific age-appropriate norms.

Results

Sixteen children (median age: 6.0 years, range 1.5–9.6) and ten adults (median age: 33.0 years, range 22.0–49.0) antenatal exposed to radiotherapy from Belgium, The Netherlands and Italy were enrolled. Median maternal and estimated fetal irradiation were 48 Gy (range, 12–70) and 91 mGy (range, 0–1690), respectively. Conventional and advanced cardiac function measurements were normal. Overall neuropsychological, behavioral and general health outcomes were within normal ranges. No linear relationship was found between fetal dose of radiation and cognitive outcome. One child revealed a severe cognitive delay, however this child was exposed to a relatively low dose of radiotherapy (34 mGy) in addition to other confounding pregnancy complications. The mother suffered from an aggressive non-hodgkin tumor of the brain with impact on her general state (maternal somnolence, hemiplegia and intravenous nutrition) followed by preterm delivery.

Conclusions

The overall long-term cardiac, neuropsychological, behavioral and general health outcomes after prenatal exposure to radiotherapy appear to be within normal ranges. Larger series are needed to strengthen these findings.

Disclosure

All authors have declared no conflicts of interest.