Hahn Karin M E, Johnson Peter H, Gordon Nancy, Kuerer Henry, Middleton Lavinia, Ramirez Mildred, Yang Wei, Perkins George, Hortobagyi Gabriel N, Theriault Richard L
Department of Breast Medical Oncology and Epidemiology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230-1439, USA.
Cancer. 2006 Sep 15;107(6):1219-26. doi: 10.1002/cncr.22081.
As women in the US delay childbearing, it has been hypothesized that the incidence of breast cancer diagnosed during pregnancy will increase. There are very little prospective data on the treatment of pregnant women with breast cancer with chemotherapy and even less data on the outcomes of their children who were exposed to chemotherapy in utero.
Fifty-seven pregnant breast cancer patients were treated on a single-arm, multidisciplinary, institutional review board-approved protocol with FAC (5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant (n = 32) or neoadjuvant (n = 25) setting. Parents/guardians were surveyed by mail or telephone regarding outcomes of children exposed to chemotherapy in utero.
Of the 57 women, 40 are alive and disease-free, 3 have recurrent breast cancer, 12 died from breast cancer, 1 died from other causes, and 1 was lost to follow-up. Of the 25 patients who received neoadjuvant FAC, 6 had a pathologic complete response, whereas 4 had no tumor response to chemotherapy and eventually died from their disease. All women who delivered had live births. One child has Down syndrome and 2 have congenital anomalies (club foot; congenital bilateral ureteral reflux). The children are healthy and those in school are doing well, although 2 have special educational needs.
Breast cancer can be treated with FAC chemotherapy during the second and third trimesters without significant short-term complications for the majority of children exposed to chemotherapy in utero. Longer follow-up of the children is needed to evaluate possible late side effects such as impaired cardiac function and fertility.
由于美国女性生育推迟，有人推测孕期诊断出的乳腺癌发病率将会上升。关于乳腺癌孕妇接受化疗治疗的前瞻性数据非常少，而关于其子宫内接触化疗的孩子的结局的数据更少。
57例乳腺癌孕妇按照一项经机构审查委员会批准的单臂多学科方案接受FAC（5-氟尿嘧啶、阿霉素、环磷酰胺）治疗，其中32例为辅助治疗，25例为新辅助治疗。通过邮件或电话对父母/监护人进行调查，了解子宫内接触化疗的孩子的结局。
57例女性中，40例存活且无疾病，3例乳腺癌复发，12例死于乳腺癌，1例死于其他原因，1例失访。在接受新辅助FAC治疗的25例患者中，6例达到病理完全缓解，而4例对化疗无肿瘤反应，最终死于疾病。所有分娩的女性均顺利产下活婴。1名儿童患有唐氏综合征，2名儿童有先天性异常（马蹄内翻足；先天性双侧输尿管反流）。孩子们都很健康，上学的孩子表现良好，不过有2名孩子有特殊教育需求。
在孕中期和孕晚期，乳腺癌可用FAC化疗进行治疗，对于大多数子宫内接触化疗的孩子来说，不会出现显著的短期并发症。需要对这些孩子进行更长时间的随访，以评估可能的晚期副作用，如心功能受损和生育能力问题。
