Successful pregnancy and normal delivery after whole craniospinal irradiation in two patients.
BACKGROUND
Two cases of normal pregnancies and deliveries after whole craniospinal irradiation (WCSI) are described, and whether the ovaries can be left out of the WCSI field by identifying ovarian position using magnetic resonance imaging (MRI) is determined.


METHODS
The distance between the upper edge of the pubic symphysis and the central part of the ovary was measured on MRI in 17 women.


RESULTS
The right ovary was located 20.3-68.4 mm to the right of and 33.7-113.5 mm above the upper edge of the pubic symphysis; the left ovary was located 26.2-72.5 mm to the left and 25.8-106.6 mm above this edge. The lower border of the spinal field in WCSI should be the caudal border of the thecal sac, i.e., S2-S4. The line of this location, which nearly approximates normal ovarian position, should be employed in radiotherapy planning to avoid irradiating at least one ovary with its thecal sac. Omitting this area from the WCSI field in women of childbearing age with a good long-term prognosis, preserves potential fertility.


CONCLUSIONS
It appears that the ovaries might be excluded from the WCSI field, using appropriate techniques, so as to preserve female fertility.
Shigematsu
Naoyuki
N
Department of Radiology, School of Medicine, Keio University, Tokyo, Japan. shige@rad.med.keio.ac.jp
Shinmoto
Hiroshi
H
Ito
Nobutake
N
Kunieda
Etsuo
E
Takeda
Atsuya
A
Ohashi
Toshio
T
Kawaguchi
Osamu
O
Kawata
Tetsuya
T
Ito
Hisao
H
Kuribayashi
Sachio
S
Kubo
Atsushi
A
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000532:radiotherapy*; D004806:Ependymoma / Q000532:radiotherapy; D005260:Female; D005298:Fertility / Q000528:radiation effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010053:Ovary / Q000502:physiology / Q000528:radiation effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011835:Radiation Protection / Q000379:methods*; D013120:Spinal Cord Neoplasms / Q000532:radiotherapy*