Chemotherapy for breast carcinoma during pregnancy - A French national survey

BACKGROUND. During pregnancy, the need for maternal chemotherapy for breast carcinoma must be balanced against the fetal risk because modification of cancer therapy to assure the birth of a healthy infant may affect maternal prognosis adversely. To the authors' knowledge few studies have documented the oncologic and obstetric management of this association. METHODS. A retrospective nationwide survey was used to identify women treat ed with chemotherapy for breast carcinoma during pregnancy. Each member of the Societe Francaise d'Oncologie Gynecologique and the Societe Francaise d e Senologie et de Pathologie Mammaire completed a postal questionnaire rega rding cancer staging, oncologic treatment, obstetric details, pregnancy out come, fetal behavior, and postdelivery follow-up. Twenty women were accrued to the study. RESULTS. The mean gestational age at the first cycle of treatment was 26 we eks. A total of 38 cycles were administered during pregnancy, with a median of 2 cycles. Delivery was performed at a mean of 34.7 weeks. Two pregnanci es that were exposed to chemotherapy during the first trimester resulted in spontaneous abortion. One pregnancy exposed in the second trimester result ed in intrauterine death. The remaining 17 pregnancies resulted in live bir ths, although 3 women had complications related to chemotherapy (anemia, le ukopenia, and fetal growth retardation) and 1 newborn died 8 days after bir th without apparent etiology. Two newborns had complications related to pre maturity (transient respiratory distress). At a mean follow-up of 42.3 mont hs, all live infants were reported to have reached normal developmental mil estones. CONCLUSIONS. The current study found that even when chemotherapy was initia ted after the first trimester, 95% of the pregnancies resulted in live birt hs with low related morbidity in the newborns. (C) 1999 American Cancer Soc iety.