Concerns about the potential impact of cancer treatment on unborn children has until recently left oncologists hesitant to administer treatments to pregnant cancer patients. However, three studies presented during the 2014 ESMO meeting demonstrate that children who are exposed to chemotherapy or radiotherapy while in the womb suffer no negative impact on mental or cardiac development. In fact, when chemotherapy is administered after the first trimester of pregnancy, no problems were seen 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.
The reluctance to administer chemotherapy to pregnant cancer patients is mainly due to unknown long term consequences for the child. To address these concerns, Professor Frederic Amant (University Hospital Leuven, Belgium) and colleagues set up two new studies.
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 to 38 control children who were not exposed to chemotherapy. At a median age of almost two years, mental development as measured by the Mental Development Index was in the normal range for both groups of children and were not significantly different (Mean MDI for exposed children: M=99.13 and M=101.47 for non-exposed children). In addition to this, cardiac dimensions and functions were within normal ranges for both groups.1
This was the first study on the developmental outcome of children exposed in utero to chemotherapy. These results confirm that chemotherapy administration during pregnancy does not alter neurodevelopment after birth, nor causes cardiac alterations.
In a second study, Amant and colleagues explored the impact of radiotherapy on the children of women with cancer. This 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 showed that neuropsychological, behavioral and general health outcomes for those exposed to radiotherapy were within normal ranges. No linear relationship was found between fetal dose of radiation and cognitive outcome. One child revealed a severe cognitive delay, however this child was exposed to a relatively low dose of radiotherapy (34 mGy) in addition to other confounding pregnancy complications.2
In conclusion, the overall long-term cardiac, neuropsychological, behavioral and general health outcomes after prenatal exposure to radiotherapy appear to be within normal ranges. Larger series are needed to reconfirm these findings.
1. Amant F, Vandenbroucke T, Verheecke M, et al. Cancer during pregnancy: A case-control analysis of mental development and cardiac functioning of 38 children prenatally exposed to chemotherapy. Presented at ESMO 2014; abstract 267PD.
2. Amant F, Vandenbroucke T, Verheecke M, et al. Long-term neuropsychological and cardiac follow-up of children and adults who were ante-natal exposed to radiotherapy. Presented at ESMO 2014; Abstract 49LBA.