Session Item

A retrospective study was conducted to analyze fertility outcomes in adult medulloblastoma (MB) pts of childbearing age treated with helical Tomotherapy craniospinal irradiation (HT-CSI) at the Pediatric Radiotherapy Unit of the Centro di Riferimento Oncologico di Aviano (CRO) IRCCS in Aviano, Italy.

From September 2006 to May 2021, 12 women of childbearing age (range 20-36 years, median 31) with MB underwent HT-CSI. The prescribed HT-CSI dose was 32.4 Gy (1.8 Gy/fr) for non-metastatic pts, and 36 Gy (1.8 Gy/fr) for metastatic pts, with a boost to the tumor bed and metastases. Administered chemotherapy (CT), performed fertility preservation techniques, menstrual activity, anti-Müllerian hormone (AMH) levels, and radiation doses to the ovaries were recorded. Successful pregnancies resulting in live births after HT-CSI were examined.

At the time of the study, all women were alive with a median fup of 4.4 years (range 0.8-10.4). A 31-year-old patient reported a 2-year history of secondary amenorrhea when diagnosed with MB and was excluded. Eight out of the remaining 11 pts were alive with NED with a median fup of 4.4 years (range 1.1-10.4) and were included in the analysis for fertility outcomes. Six non-metastatic pts received 32.4 Gy/18 fr HT-CSI; a subsequent whole spinal boost of 3.6 Gy/2 fr (to a total dose of 36 Gy/20 fr) was delivered to a platinum unsuitable patient; 2 metastatic pts received 36 Gy/20 fr HT-CSI, with one receiving a simultaneous integrated boost up to 45 Gy (2.25 Gy/fr) to the cauda equina region. Platinum/etoposide adjuvant CT was administered to 6 pts, together with gonadotropin-releasing hormone agonist (GnRH); 2 had no CT. Two pts underwent ovarian tissue cryopreservation prior to HT-CSI. Before starting RT, 5 pts had regular menstrual cycles, 2 were taking oral contraceptives, and 1 reported postpartum amenorrhea (4-month-old baby). Pre-RT AMH level was available for 3 pts, resulting <0.1 ng/ml for the postpartum amenorrheic woman (36 years old), and within normal range for the 2 women using oral contraceptives. Data on menstrual activity after finishing oncological treatments were available for 6 pts: 3 recovered regular cycles after 0.8-4 years, 2 still had irregular cycles at their last fup (at 10.1 and 2.5 years after therapy completion), and 1 was still amenorrhoic at the time of the study (5 months after suspension of adjuvant CT and GnRH). Median maximum radiation dose to the ovaries was 5.2 Gy (range 1.0-9.5 Gy). Only 2 women had actively tried to conceive after successful MB treatment. Both became spontaneously pregnant and gave birth to full-term healthy children. Patient and treatment characteristics and fertility outcomes of these 2 women are presented in Figure 1 and 2.

In this retrospective study of adult MB women of childbearing age, HT-CSI has not precluded 2 long-term survivors from becoming spontaneously pregnant and giving birth to healthy children.