Children who are subjected to chemotherapy or radiotherapy whilst in the womb suffer no negative impacts on mental or cardiac development, international studies presented at the ESMO 2014 Congress in Madrid have shown.
“When chemotherapy is run after the first trimester of being pregnant, we can’t discern any problems within the children,” says lead author Dr. Frederic Amant, KU Leuven and University Hospitals Leuven in Belgium. “Fear concerning the perils of chemotherapy administration should not be any reason to terminate getting pregnant, delay cancer treatment for the mother, in order to generate a baby prematurely.”
Concerns concerning the potential impact of cancer treatment on unborn children has until recently left some oncologists reluctant to administer treatments to pregnant cancer patients, says Amant. To address these concerns, his group has led three new studies presented at ESMO 2014.
In the very 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 to 38 control children who weren’t exposed to chemotherapy.
At an average age of almost two years old, mental development as measured by the Mental Development Index was at the normal range for groups of children, and weren’t significantly different. Cardiac dimensions and functions were within normal ranges for groups.
This is the first case control study on the developmental results of children exposed in utero to chemotherapy. It shows that chemotherapy while pregnant can be considered safe for mental development and cardiac functioning of the child, the authors say.
Commenting around the results, Dr. Fedro Alessandro Peccatori, Director of the Fertility & Procreation Unit at the European Institute of Oncology’s Division of Gynaecologic Oncology, who had been not involved in the study, asserted these results make sure chemotherapy administration during pregnancy doesn’t alter neurodevelopment after birth, nor cause cardiac alterations.
“This paper points to the very important issue of long-term safety of prenatal exposure to chemotherapy and reinforces the notion that chemotherapy during gestation doesn’t endanger the fetus and his or her subsequent development. To help ameliorate neonatal outcome, a unique effort should be designed to prolong pregnancy duration, and stringent long-term follow-up should be pursued to confirm these bits of information. Meanwhile, specific measures to aid prematurely delivered babies as well as their families ought to be implemented.
Future studies will explore the effects of specific chemotherapy types at length, and longer term follow-up, to fine tune the findings.
In a second study, Amant and colleagues explored the impact of radiotherapy on the kids of women with cancer.
The study included 16 children and 10 adults who had been subjected to radiotherapy in utero. This is the first long-term follow-up study of kids prenatally exposed to medical radiation, and the study demonstrated that neuropsychological, behavioral and general health outcomes for those exposed to radiotherapy were within normal ranges. One child revealed a serious cognitive delay, however other pregnancy-related complications are confounding factors, they report.
Amant hopes the new results will give you clinicians with the evidence they have to ensure pregnant women with cancer receive the best quality care. “It’s a good feeling to know that research data could be implemented immediately in to the clinic. Our data will state physicians and patients and enable them to take decisions in a difficult situation.”
Commenting, Peccatori noted that the long-term follow-up of children and adults whose mothers happen to be treated with radiotherapy during gestation is an important topic.
“The main message is the fact that neuropsychological, behavioral and overall health outcomes were within the normal range in all, but Three of the 16 children studied. This is actually the first long-term follow-up study of children and adults subjected to radiotherapy in utero. Pregnancy, particularly advanced pregnancy, has been traditionally considered a contra-indication to radiotherapy. New radiation techniques and much more sophisticated simulations from the received fetal dose may change this scenario, but caution remains mandatory when giving radiotherapy to a pregnant woman, especially in the third trimester.”
It is protected and effective to check for the spread of early cancer of the breast in pregnant women using sentinel node biopsy rather than completely dissecting the node, researchers from the International Network of Cancer, Infertility and Pregnancy and also the German Breast Group have shown in another study presented at ESMO 2014 in Madrid.
Sentinel lymph node biopsies have been the main topic of intensive research over the last 20 years, and have replaced the older and much more invasive approach to axillary lymph node dissection for ladies patients without clinically suspicious axillary lymph nodes.
This method removes the first (or ‘sentinel’) lymph node receiving lymphatic drainage in the tumor, therefore most likely to contain metastatic cells. When the SLN does not contain metastatic disease, the rest of the lymph nodes do not have to be removed, thereby sparing the patient the associated side-effects for example lymphedema and reduced movement.
The latest guidelines for doctors still propose that they perform axillary lymph node dissection and steer clear of sentinel lymph node biopsy during pregnancy, because of insufficient safety data, explains Sileny Han of University Hospitals Leuven, Belgium, who is presenting the results of a new attend ESMO 2014. “We try to increase the body of evidence that sentinel node biopsy is possible while pregnant and really should be considered an option.”
This study may be the largest series up to now to evaluate this question. They studied 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 that mother.
After a median follow-up of 35 months, eight patients had experienced a loco-regional relapse, meaning their cancer recurred within the same or other breast, the chest area wall, including two who developed tumors within their lymph nodes. Four patients developed distant metastases, who three died of breast cancer.
These results show that sentinel lymph node biopsy while pregnant includes a low axillary recurrence rate, they write. “This staging method can be viewed as while pregnant rather than standard axillary lymph node dissection for initial phase, clinically node negative cancer of the breast.”
Adds Peccatori, co-author about this study: “Axillary staging in early breast cancer is a changing paradigm. Data from different institutions in Europe and US have demonstrated that in non-pregnant patients, sentinel node biopsy is an efficient staging procedure that holds equivalent leads to axillary lymph node dissection even just in patients with up to three positive sentinel nodes, if post operative systemic treatment methods are adequate. Furthermore, hand sentinel node biopsy is assigned to improved arm motility, decreased armpit pain and numbness and shorter stay in hospital. Why must we deny this process to pregnant breast cancer patients?”
Another study from Amant’s group shows the significance of considering contraception during cancer diagnosis and cancer treatment. Sarah van Peer and colleagues checked the database of the International Network for Cancer Infertility and Pregnancy for ladies who became pregnant during cancer diagnosis or during treatment.
The INCIP database currently includes 1011 patients from 21 countries (at that time it included 897 patients).
Overall, 3.23% (29/897) of the sufferers in the database became pregnant after 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 7 after cancer diagnosis but before treatment was started.
“The core message from your results is that it is vital for doctors and patients to discuss contraception during cancer diagnosis and cancer treatment. Although fertility issues aren’t the main focus of attention at this time, it is necessary to provide assistance with contraception. And although we all know it’s easy to treat patients with chemotherapy/radiotherapy during pregnancy when necessary, it’s still better to avoid this case, if at all possible.”
Says Peccatori, “Discussion about effective contraception remains a higher priority for oncologists coping with young patients with cancer. The incidence of unplanned pregnancy during cancer treatment probably remains an uncommon event. Nonetheless, our prime emotional impact of an unplanned pregnancy and the possible maternal consequences in terms of treatment modification should prompt more efficient interventions in this subject.”