Children who are exposed to chemotherapy or radiotherapy while in the womb suffer no negative impacts on mental or cardiac development, as shown by international studies presented at the European Society for Medical Oncology (ESMO) 2014 Congress in Madrid, Spain.
“When chemotherapy is administered after the first trimester of pregnancy, we cannot discern any problems in the children,” said lead author Frederic Amant, MD, PhD, KU Leuven and University Hospitals Leuven, in Belgium. “Fear about the risks of chemotherapy administration should not be a reason to terminate a pregnancy, delay cancer treatment for the mother, or to deliver a baby prematurely.”
Concerns about the potential impact of cancer treatments on unborn children have caused some oncologists to hesitate to administer treatments to pregnant patients with cancer, said Amant, whose group presented results of three new studies that address these concerns.
In the first study, 38 children prenatally exposed to chemotherapy were recruited from the International Network for Cancer, Infertility, and Pregnancy (INCIP) registry and assessed for mental development and cardiac health. Their outcomes were compared with 38 control children who were not exposed to chemotherapy.
Mental development at a median age of almost 2 years, as measured by the Mental Development Index, was in the normal range for both groups of children and was not significantly different. Cardiac dimensions and functions were within normal ranges for both groups.
In a second study, Amant and colleagues explored the impact of radiotherapy on the children of women with cancer.
The study included 16 children and 10 adults who had been exposed to radiotherapy in utero. This is the first long-term follow-up study of children prenatally exposed to medical radiation, and the study results showed that neuropsychological, behavioral, and general health outcomes in those exposed to radiotherapy were within normal ranges. One child revealed a severe cognitive delay; however, the researchers report that other pregnancy-related complications were confounding factors.
A third study found that using sentinel node biopsy to check for the spread of early breast cancer, rather than complete dissection of the node, in pregnant women is safe and effective.
This study is the largest series to date to assess this question. The researchers examined 97 women with breast cancer who underwent sentinel node biopsy. Their aim was to assess whether the sentinel lymph node procedure is safe from an oncologic point of view for the mother.
These results show that sentinel lymph node biopsy during pregnancy has a low axillary recurrence rate, they wrote. “This staging method can be considered during pregnancy instead of standard axillary lymph node dissection for early stage, clinically node-negative breast cancer.”
The third study from Amant’s group shows the importance of thinking about contraception during cancer diagnosis and cancer treatment. Overall, 3.23% (29/897) of the patients in the database used in the study became pregnant after their cancer diagnosis or during treatment. Of those 29 patients, three pregnancies were identified during diagnostic examinations for suspected malignancy but before definite diagnosis, 18 during treatment, and seven after cancer diagnosis but before treatment was started.
“The core message from our results is that it is vital for doctors and patients to discuss contraception during cancer diagnosis and cancer treatment. Although fertility issues are not the focus of attention at this time, it is necessary to provide advice about contraception.”