Doll D C, Ringenberg Q S, Yarbro J W
Department of Medicine, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65201.
Arch Intern Med. 1988 Sep;148(9):2058-64.
Although cancer during pregnancy is infrequent, its management is difficult for patients, their families, and their physicians. When termination of the pregnancy is unacceptable, decisions regarding the use of irradiation and chemotherapy are complicated by the well-known high risks of abortion and fetal malformation. This risk is concentrated in the first trimester and varies with the choice of chemotherapeutic agents or combinations of agents. There is only minimal evidence of increased risk of malformation or abortion in the second or third trimester. Recent progress in cancer therapy has made cure a reasonable goal, and for some malignant neoplasms, cure is still possible even when initial therapy is modified or delayed. When cure is a reasonable goal, curative therapy should not be compromised by modification or delay. When treatment for cure or significant palliation is not possible, however, the goal should shift to protection of the fetus from damage by the injudicious use of teratogenic cancer therapy. This report will review the available data that may assist in these difficult decisions.
尽管孕期患癌并不常见，但对患者及其家属和医生来说，其治疗却很困难。当终止妊娠不可接受时，关于放疗和化疗的使用决策会因众所周知的流产和胎儿畸形高风险而变得复杂。这种风险集中在孕早期，并且因化疗药物或药物组合的选择而异。在孕中期或孕晚期，只有极少的证据表明畸形或流产风险增加。癌症治疗的最新进展使治愈成为一个合理的目标，对于某些恶性肿瘤，即使初始治疗被调整或延迟，治愈仍然是可能的。当治愈是一个合理的目标时，根治性治疗不应因调整或延迟而受到影响。然而，当无法进行治愈性治疗或显著缓解病情时，目标应转向保护胎儿免受致畸性癌症治疗的不当损害。本报告将回顾可能有助于做出这些艰难决策的现有数据。
