Brain radiotherapy during pregnancy: an analysis of conceptus dose using anthropomorphic phantoms

The aims of this study were: (a) to determine conceptus dose resulting from brain radiotherapy; (b) to investigate the necessity of using shielding devices over patient's abdomen during treatment; and (c) to estimate the components of conceptus dose. Radiation doses received by conceptus were measured using anthropomorphic phantoms simulating pregnancy at 4, 12 and 24 weeks gestation and thermoluminescent dosemeters. All irradiations were performed with two lateral and opposed fields approximating the minimum, medium and maximum field size used during treatment of brain malignancies. For a treatment course delivering 65 Gy to tumour without using shielding equipment, conceptus dose never exceeded 100 mGy. Appropriate positioning of 5.1 cm of lead over the phantom's abdomen provided reduction of conceptus dose from 26% to 71%, depending upon gestational age, field size and distance from the field isocentre. The contribution of scatter arising from within the phantom to the conceptus dose was small compared with that from head leakage and collimator scatter. Our dosimetric results indicate that the construction of special shielding equipment is not a prerequisite for treating brain malignancies during pregnancy. However, based on the concept that exposures in women of childbearing age should be kept as low as reasonably achievable, we suggest that shielding devices should be used whenever possible.