title: Safe and successful birth following pelvic radiotherapy for rectal mucosa-associated lymphoid tissue lymphoma: a case report.
abstract: BACKGROUND
  Mucosa-associated lymphoid tissue lymphomas can occur in various parts of the body, and half of mucosa-associated lymphoid tissue lymphomas occur in the gastrointestinal tract. Gastric mucosa-associated lymphoid tissue lymphoma is the most common lymphoma of the gastrointestinal tract and primary rectal mucosa-associated lymphoid tissue lymphoma is very rare. Because of the high radiosensitivity of mucosa-associated lymphoid tissue lymphomas, this condition can be controlled with radiotherapy of approximately 30 Gy alone. However, ovarian dysfunction as an adverse event of radiotherapy for pelvic lesions can become a problem in girls and women. We report a case of a 28-year-old woman with rectal mucosa-associated lymphoid tissue lymphoma who safely gave birth to a baby following 30.6 Gy radiotherapy to her whole rectum.
  
  
  METHODS
  A 28-year-old Japanese woman became aware of bloody stools and was diagnosed as having Lugano I rectal mucosa-associated lymphoid tissue lymphoma. She was referred to our institute and initiated on radiotherapy. However, she expressed a desire to bear children. We used horizontally opposed pair fields for radiotherapy to minimize the irradiation to her endometrium and ovary. A total dose of 30.6 Gy was given in 17 fractions of 1.8 Gy by 10-Megavolt X-ray linear accelerator. As a result, one-third of her uterus and half of her ovary were outside the irradiation field. After approximately 1 year of treatment, positive pregnancy was confirmed and finally she safely gave birth to a baby girl without congenital abnormalities.
  
  
  CONCLUSIONS
  This report provides hope for girls and women who have undergone irradiation for pelvic mucosa-associated lymphoid tissue lymphomas and who desire to bear children.
authors.affiliation: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan. yonoki2005@gmail.com.
authors.forename: Yoshiomi
authors.initials: Y
authors.lastname: Hatayama
authors.affiliation: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Aoki
authors.affiliation: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Kawaguchi
authors.affiliation: Southern Tohoku BNCT Research Center, Koriyama, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Hirose
authors.affiliation: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Akimoto
authors.affiliation: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Mitsuki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Ichitaro
authors.initials: I
authors.lastname: Fujioka
authors.affiliation: Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ono
authors.affiliation: Southern Tohoku BNCT Research Center, Koriyama, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takai
mesh_terms: D000328:Adult; D005260:Female; D059247:Fertility Preservation; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000473:pathology / Q000532:radiotherapy*; D059351:Organ Sparing Treatments; D011247:Pregnancy; D011256:Pregnancy Outcome; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy*
keywords: Natural pregnancy; Ovarian function; Radiotherapy; Rectal MALT lymphoma; Safe birth