Safety of cytotoxic chemotherapy during pregnancy

To To present an experience and results of treatment of pregnant cancer patients with cytotoxic chemotherapy from second trimester of pregnancy.

Eighteen consecutive pregnant patients treated at Khyber Teaching Hospital, Peshawar between December 2000 and August 2006 for different types of malignancies are reported. Six patients (33%) had breast cancer, four (22%) had chronic myeloid leukaemia, two (11%) had Hodgkin's disease, two (11%) had acute myeloid leukaemia and one each had recurrent ovarian carcinoma (5.7%), soft-tissue sarcoma (5.7%), acute lymphoblastic leukaemia (5.7%) and non-Hodgkin's lymphoma (5.7%). Various chemotherapeutic protocols were administered from second trimester of pregnancy onwards. Detailed obstetrical examinations and high risk foetal ultrasound monitoring were performed regularly.

Two patients were lost to follow-up after one course of chemotherapy while two patients chose to have therapeutic abortion. Out of the remaining 14 patients, one patient had spontaneous abortion while one patient had an intra-uterine death of foetus during chemotherapy. Remaining 12/14 (86%) patients gave birth to live, healthy babies and no foetal malformations were observed. Six out of 140 breast cancer patients (4.3%) during the study period had concomitant pregnancy. Four patients with breast cancer had modified radical mastectomy with axillary dissection during pregnancy (median gestational age 22 weeks) and no operative or post-operative complications were noted. Three out of four breast cancer patients (75%) had hormone receptor negative tumours.

Chemotherapy during the second and third trimester of pregnancy can be safe if proper obstetric and radiologic monitoring is performed. Long term side-effects in these children need to be studied with extended periods of follow-up.