Abstract P059

Safe Radiotherapy for Pregnant Women with Hodgkin's Lymphoma: Myth or Reality?

Introduction: Cancer during pregnancy occurs in about 0.1% of pregnancies. Hodgkin's lymphoma is the most frequently diagnosed lymphoma in pregnant women. Diagnostic and therapeutic interventions involving ionizing radiation must ensure the best treatment for the mother while minimizing fetal risks, necessitating a multidisciplinary team. Administering radiotherapy during pregnancy involves evaluating potential fetal risks and optimizing procedures for safe treatment.

Material and Method: From 1990 to 2020, 162 pregnant patients with Hodgkin's lymphoma were treated at the Oncology Institute in Warsaw. This presentation highlights 23 patients (14.2%) who underwent radiotherapy during pregnancy. Two patients (8.7%) received radiotherapy in the first trimester, while 21 patients (91.3%) were treated in the second trimester. In the third trimester, none of the patients received irradiation. Gestational age and the primary location of affected areas were considered when planning the irradiation field (involved vs. mantle fields). Radiotherapy planning used 2D and 3D systems with computed tomography. Gamma radiation was administered using Cobalt 60 machines and linear accelerators with energy levels ranging from 1.25 to 4-6 MV and 15 MV. Individualized shields for the uterus and fetus, along with lead aprons, were utilized. Dosimeter positioning was monitored, with corrections based on weekly ultrasound exams of fetal and uterine fundus positions.

Results: Fetal doses during maternal irradiation ranged from 0 to 10 cGy with no observed fetal complications at higher doses. From 2018 to 2020, medical physicists conducted radiotherapeutic surveillance, verifying fetal doses multiple times. Toxicity of prenatal and postnatal radiation therapy was within grades 1-2, including skin and oral mucosal reactions, esophageal inflammation, hematologic, and cardiac disturbances. Four cases of Lhermitte's syndrome were reported. No complications required treatment interruptions or additional hospitalization.

Conclusions: Although modern principles of radiotherapy planning, techniques, equipment, and dosimetry are well-developed, the use of radiotherapy during pregnancy remains limited. Indications for radiotherapy may include significant nodal changes located above the diaphragm. Properly conducted radiotherapy is safe during pregnancy but must be applied only when appropriate planning, treatment delivery, and monitoring of fetal and uterine exposure doses are possible.

Authors

Elżbieta Wojciechowska-Lampka, Magdalena Rosińska, Jacek Lampka, Włodzimierz Osiadacz, Joanna Tajer, Agnieszka Kuchcińska