Several studies were presented at the 2014 European Society for Medical Oncology (ESMO) affirming that chemotherapy and radiotherapy are safe for unborn babies.
The impact of in-utero exposure to chemo and radiotherapy, lymph node biopsy in pregnancy and the results of unplanned pregnancy during cancer treatment were the main issues of these presentations that might alter how physicians deal with pregnant patients who also suffer with cancer.
Frederic Amant, University Hospitals Leuven in Belgium, lead author of the first study, explained in an ESMO press release “when chemotherapy is administered after the first trimester of pregnancy, we cannot discern any problems in the children. 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”.
According to Dr. Amant’s study, children exposed to these therapies, while in the womb, do not suffer negative impacts on mental or cardiac development. His study considered 38 children prenatally exposed to chemotherapy and 38 control children who were not; both groups of children were assessed for mental development and cardiac health. Not only mental development was in the normal and expectable range for both groups but also cardiac dimensions and functions were within normal ranges too.
Fedro Alessandro Peccatori, Director of the Fertility & Procreation Unit at the European Institute of Oncology’s Division of Gynaecologic Oncology, not involved in Amant’s study, said that these results are reliable but recalls the importance of long-term follow-up to confirm it. Peccatori concludes saying “meanwhile, specific measures to support prematurely delivered babies and their families should be implemented” (press release).
In a second study, also lead by Dr. Amant, radiotheraphy effects on children of women with cancer were studied. Sixteen children and 10 adults who had been exposed to radiotheraphy while in the womb were analyzed, with results demonstrating that neuropsychological, behavioral and general health outcomes were within normal ranges. “It’s a good feeling to know that research data can be implemented immediately into the clinic. Our data will inform physicians and patients and help them to take decisions in a difficult situation,” said Amant in the press release, hoping that pregnant women will receive the best care possible. Advanced pregnancy was being considered a contra-indication to radiotherapy treatments and even if it remains a sensitive question, it may change the scenario and open new doors to treat patients.
Researchers from the International Network of Cancer, Infertility and Pregnancy and the German Breast Group presented another study showing that sentinel node biopsy is effective to check if an early breast cancer is spread in pregnant women. Sentinel lymph node (SLN) biopsy is a less invasive method that can replace the older method of axillary lymph node dissection. This method removes the first lymph node, more likely to have metastatic cells, through lymphatic drainage; if the SLN does not have metastases the remaining lymph nodes will not be removed and the patient can be spared of an invasive surgical intervention.
Ninety-seven women suffering with breast cancer were studied and, after a follow-up of 35 months, 8 patients had loco-regional cancer relapse, of whom 2 developed tumours in the lymph nodes; 4 other patients developed distant metastases and 3 of them died.
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Sileny Han of University Hospitals Leuven, Belgium, author of the study, explained that doctors avoid performing axillary lymph node dissection during pregnancy due to the lack of data about the SLN biopsy. “We aim to add to the body of evidence that sentinel node biopsy is feasible during pregnancy and should be considered an option. This staging method can be considered during pregnancy instead of standard axillary lymph node dissection for early stage, clinically node negative breast cancer,” Dr. Han added in the press release.
Another study from Amant’s research team focused on the relevance of contraception during cancer diagnosis and treatment. Sarah van Peer consulted the International Network for Cancer Infertility and Pregnancy to check for women who became pregnant in these particular situations, counting 29 patients (3.23 percent). Therefore, as Peccatori clearly explained in the press release, “discussion about effective contraception remains a high priority for oncologists dealing with young patients with cancer. The incidence of unplanned pregnancy during cancer treatment probably remains a rare event. Nonetheless, the high emotional impact of an unplanned pregnancy and the possible maternal consequences in terms of treatment modification should prompt more effective interventions in this field.”
