Uterine function and reproductive outcomes in the female survivors of childhood and adolescent cancers: review

Abstract

Uterine functions may adversely be affected by radiation treatments for childhood cancer. The uterine vasculature exposed to radiation therapy may not respond normally to cytotrophob-last, the resulting decrease in fetoplacental blood flow may lead to impaired fetal growth in case of a probable pregnancy. Also as a result of the negative impact of radiotherapy to myometrial layer, uterin elasticity and volume may be reduced. In particular, this effect is more pronounced in patients receiving radiotherapy before puberty. Radiotherapy may injure the endometrium layer and result in disorders of placental attachment, such as placenta accreta or increata. Obstetrical consequences include an increased risk of hypertension, fetal malposition, spontaneous abortion, pregnancy loss, preterm birth, low birthweight. In addition, an increased risk of spontaneous abortion is observed in patients treated with high dose cranial or craniospinal radiation. Other than complications due to radiotherapy, low birth weight can ocur in patients undergoing chemotherapy treatment such as doxorubicin or daunorubicin. When comparing patients treated with chemotherapy with those who did not, no significant difference in terms of low birth weight infants, or spontaneous abortion was observed. There was no significant difference considering risk of developing minor anomalies, cytogenetic syndrome or single gene defect in patients with a history of radiotherapy or chemotherapy. In this review, we aim to examine effects of chemotherapy and radiation therapies for childhood cancer on uterine functions.