Written by Medicover Team and Medically
Reviewed by
Dr. Kavitha Uppala, Consultant Radiation Oncology
High-Grade Glioma During Pregnancy: Why IGRT is the Best Treatment Option?
Brain tumors during pregnancy are rare (occurring in about 1 in 13,000 to 17,000 cases), and treatment requires a delicate balance between stopping the mother's tumor progression and ensuring the absolute safety of the fetus.
That's because treating high-grade glioma (HGG) during pregnancy is one of the most complex challenges in modern oncology. It requires a delicate balance between aggressive maternal treatment and strict fetal protection. IGRT achieves this by delivering radiation specifically to the tumor with sub-millimeter precision using real-time imaging, which allows oncologists to postpone systemic treatments such as chemotherapy that would pose significant risks to the developing fetus.
The 2026 landmark case at Medicover Cancer Institute is the first of its kind in India and shows why image-guided radiation therapy (IGRT) has become the clinical gold standard for managing these complex scenarios.
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Clinical Evidence: India’s First Successful IGRT for a Pregnant Patient
In February 2026, a 48-year-old patient was treated for a left thalamic high-grade glioma at 20 weeks of gestation. After neurosurgery in late 2025 showed tumor progression, the multidisciplinary team at Medicover Cancer Institute opted for IGRT.
After a detailed risk assessment, systemic treatments such as chemotherapy had to be postponed to protect the developing fetus from toxic chemicals crossing the placenta.
Instead, the oncology team utilized the pinpoint accuracy of IGRT. By combining the machine's real-time targeting with physical lead fetal shielding and precise beam trajectory calculations, doctors were able to aggressively treat the mother's brain tumor while ensuring that the scattered radiation remained within internationally accepted safety limits. The mother was stabilized, and the fetus continued to develop normally. This result is entirely possible thanks to the sub-millimeter precision of IGRT technology.
What is IGRT (Image-Guided Radiation Therapy)?
Image-guided radiation therapy (IGRT) is a high-precision radiotherapy technique that uses integrated imaging (such as cone beam CT or X-rays) immediately before each treatment session.
In traditional radiation therapy, doctors identify the location of a tumor days or weeks before starting treatment. However, human anatomy is not static. Tumors can shrink as they respond to treatment, and internal organs can naturally move as breathing, digestion, or bladder filling occur. IGRT solves this problem by combining a linear accelerator (a machine that delivers radiation) with advanced imaging capabilities such as CT, MRI, or X-ray scanners.
This allows for:
Real-time localization: Adjusting for minute patient movements.
Adaptive planning: Accounting for maternal physiological changes (weight/posture) during the second and third trimesters.
Why IGRT is the Best Option for HGG in Pregnant Patients?
In cases of High-Grade Glioma, particularly in sensitive areas like the thalamus, IGRT offers distinct advantages over conventional radiotherapy:
Strict Dose Conformation: It focuses the maximum radiation dose on the tumor volume while ensuring a rapid "dose fall-off" to protect healthy brain tissue.
Reduction of Internal Scatter: By using highly collimated beams, IGRT minimizes the "stray" radiation that could potentially reach the abdomen.
Fetal Dose Mitigation: When combined with specialized physical shielding, IGRT ensures the fetus remains well below the internationally recognized safety threshold of 100 mGy.
Maximized Tumor Control: Because doctors are confident the beam is hitting the target accurately, they can safely escalate the radiation dose, resulting in higher cancer-kill rates.
Protection of Healthy Tissue: The radiation beam is tightly conformed to the tumor's shape, drastically reducing "scatter radiation". This minimizes damage to adjacent healthy organs and significantly reduces treatment side effects.
Fewer Treatment Sessions: Higher precision often enables hypofractionation, in which the total required dose is delivered in fewer, shorter sessions.
What Types of Cancers are Treated with IGRT?
Image-Guided Radiation Therapy (IGRT) is versatile but is primarily indicated for tumors near vital organs or in areas of the body prone to movement (e.g., respiration, digestion, or bladder filling).
Neurological Cancers: High-grade gliomas, glioblastomas, and brain metastases, where millimeter precision is required to spare healthy brain tissue.
Thoracic Cancers:Lung cancer, where tumors shift significantly with every breath.
Pelvic Cancers: Prostate, cervical, and bladder cancers, which move based on the filling of surrounding organs.
Gastrointestinal Cancers: Liver and pancreatic tumors, which are often located near sensitive structures like the spinal cord or kidneys.
Head and Neck Cancers: Tumors in the throat or oral cavity that may shift as a patient loses weight or experiences reduced swelling during treatment.
Breast Cancer: Particularly left-sided cases, to ensure the heart is excluded from the radiation field.
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In the management of high-grade glioma (HGG) during pregnancy, clinicians often face a choice between local control (Radiation/IGRT) and systemic control (Chemotherapy).
Feature
Image-Guided Radiation (IGRT)
Chemotherapy (e.g., Temozolomide)
Primary Goal
Targeted local tumor destruction.
Systemic control of cancer cells.
Fetal Risk
Low. Cranial radiation is distant from the fetus; scatter is blocked by lead shielding.
High. Most agents cross the placenta, increasing the risk of malformations or growth restriction.
Best Trimester
Preferred in 2nd or 3rd Trimester (post-organogenesis).
Generally avoided; used only if maternal survival is immediately threatened.
Precision
High. Daily imaging is used to monitor maternal body changes and tumor shifts.
N/A. Systemic distribution affects the entire body, including the fetus.
Clinical Decision
Often the first-line choice for pregnant patients requiring immediate tumor control.
Frequently deferred until postpartum to prioritize fetal safety.
Side Effects
Site-specific (e.g., hair loss, fatigue, local skin irritation).
Systemic (e.g., nausea, myelosuppression, risk of fetal toxicity).
Conclusion
High-grade glioma diagnosed during pregnancy represents one of the most complex intersections of oncology and obstetrics. When immediate intervention is required, Image-Guided Radiation Therapy (IGRT) provides a highly precise and controlled radiation delivery method that may allow treatment while maintaining fetal safety parameters.
The documented 2026 case demonstrates how advanced imaging, shielding protocols, and multidisciplinary oversight can enable oncologic management without exceeding accepted safety thresholds.
Frequently Asked Questions
Yes, but only under strict conditions. While standard, unshielded radiation is dangerous to a fetus, advanced localized therapies like IGRT can be administered safely for brain tumors when customized lead shielding and precise beam angling are utilized.
It depends on the trimester and the specific drug. While some chemotherapies are carefully used in the second and third trimesters, doctors often defer them in highly sensitive cases to completely avoid the risk of systemic toxicity crossing the placenta.
High-grade gliomas are aggressive. Leaving them untreated allows the tumor to grow rapidly, which can cause severe neurological deficits, seizures, and life-threatening complications for the mother, which in turn directly threaten the survival of the fetus.
No. IGRT is a completely non-invasive, painless outpatient procedure. Unless the patient has a condition that prevents them from lying perfectly still, general anesthesia is not required, which further increases safety for the pregnant mother.
Yes, if performed with IGRT. While radiation to the pelvic area is contraindicated, radiation to the brain (cranial) is possible because the distance from the brain to the uterus significantly reduces the dose. IGRT further enhances this safety by ensuring the beam does not stray.
Untreated HGG can lead to increased intracranial pressure, neurological deficits, and maternal mortality. Rapid tumor progression (as seen in the 2026 case study) often makes deferring treatment until after birth impossible.
Many chemotherapy agents for HGG, such as Temozolomide, carry risks of teratogenicity (birth defects). In the Medicover milestone case, chemotherapy was deferred specifically to prioritize fetal safety while using IGRT to control the tumor locally.
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