PMC6304601_01
The gastrointestinal endoscopic finding at 16 weeks of gestation. Arrowheads indicate the recurrent lesion of esophageal cancer in the residual esophagus.
CRIOG2018-1280582.001.jpg
PMC6304601_01_CRIOG2018-1280582.001.jpg
fig1
At 16 weeks of gestation, the scheduled gastrointestinal endoscopy and biopsy revealed relapse of esophageal cancer in the residual esophagus (Figure 1).
The simulation study of radiotherapy using a phantom. (a) The irradiation plan was created based on the recurrent lesion. The distance between the inferior margin of irradiation and the uterine fundus was 38 cm. (b) Five dosimeters (arrows) were put on the phantom's abdomen. (c) The radiation dosage measured by five dosimeters in one irradiation fraction.
CRIOG2018-1280582.002.jpg
PMC6304601_01_CRIOG2018-1280582.002.jpg
fig2
We created the irradiation plan for the patient (Figure 2(a)) and delivered doses to the phantom (Figure 2(b)). According to the radiation dosage measured by five dosimeters, which ranged from 0.052 to 0.176 mGy in one irradiation fraction (Figure 2(c)), the fetal dose was estimated as 1.56 to 5.28 mGy, even after 60 Gy in 30 fractions of radiotherapy.
The time course of treatment. The horizontal axis indicates gestational weeks. CF, cisplatin 60 mg/m2, 5-fluorouracil 750 mg/m2; CS, cesarean section.
CRIOG2018-1280582.003.jpg
PMC6304601_01_CRIOG2018-1280582.003.jpg
fig3
The CRT consisted of 50.4 Gy in 28 fractions of radiation and four courses of chemotherapy (CDDP 60 mg/m2 on day 1, 5-FU 750 mg/m2 on days 1 to 4).  Figure 3 shows the course of treatment over time.