Reproductive problems and birth defects in survivors of Wilms' tumor and their relatives

Abstract

In a retrospective cohort study of 47 Wilms' tumor survivors and their 77 sibling controls, female survivors had a fourfold excess risk (risk ratio, 4.1; 95% confidence interval, 1.7-10.1) for any adverse livebirth outcome, including birth defects, compared with their sibling controls. Wives of male survivors had no apparent excess risk for problem pregnancies. The families had a number of severe reproductive problems and major birth defects, such as primary amenorrhea in two survivors, bicornuate uterus in two survivors and one control, and mental retardation in one male survivor and a male control. The son of a female survivor died after bilateral Wilms' tumors. Birth defects in the offspring of female survivors are compatible either with intrauterine constraint, possibly due to radiation-induced fibrosis or with the complex of malformations associated with Wilms' tumor. Female survivors of Wilms' tumor appear to be at increased risk for a variety of reproductive problems, from sterility to fetal loss, early delivery, and birth defects in offspring. Furthermore, relatives of survivors of Wilms' tumor may be at risk of having associated birth defects, with clinically significant consequences.

Factors affecting gonadal function after bone marrow transplantation during childhood

“…4 All the pregnancies of the five who were given TBI ended in spontaneous abortion. Low birth weight is more frequent in women given abdominal irradiation for Wilms' tumor during childhood 15 and in those given TBI after puberty. 4 This is attributable to fibrosis and to alterations in the vascularization of the myometrium.…”

“…None of them had any central nervous system involvement at diagnosis, nor had they been given irradiation other than total body irradiation (TBI). Chronic graft-versus-host disease occurred in 28 cases (cases 9,11,12,17,18,21,[23][24][25]27, 29 and 31 in girls and cases 5,9,11,12,15,18,19,21,26,29,30, 33, 35-37 and 39 in boys) and had been treated with corticosteroids and cyclosporine. All were in remission without complications.…”

Impact of Cancer Therapy on the Reproductive Axis

“…However, long-term survivors of Wilms’ tumour who have received abdominal irradiation may have an adverse pregnancy outcome and the offspring appear to have an increased risk of reproductive tract malformations [60, 61, 62]. …”

Ultrasound B-mode changes in the uterus and ovaries and Doppler changes in the uterus after total body irradiation and allogeneic bone marrow transplantation in childhood

“…In patients treated for solid tumours abdominal irradiation with 20-30 Gy have caused irreversible damage to uterine musculature and blood flow 21 and a high risk of adverse pregnancy outcome, eg low birth weight and increased perinatal mortality, have been reported. [22][23][24][25] Recent reports have documented abortions, pre-term births and delivery of low birth weight infants after BMT and TBI. 13,17,18,26 A reduction in uterine and ovarian size was found in five patients shortly after TBI and BMT.…”