Jacobs C, Donaldson S S, Rosenberg S A, Kaplan H S
Ann Intern Med. 1981 Dec;95(6):669-75. doi: 10.7326/0003-4819-95-6-669.
Fifteen pregnant women with Hodgkin's disease were followed. Five patients had irradiation, 1000 to 3000 rad to the neck, mediastinum, or both, during the second or third trimester with normal outcome of pregnancy. One patient had a spontaneous abortion in the first trimester after radiotherapy of 4400 rad to the breast, an estimated fetal dose of 9 rad. One patient who received chlorambucil throughout pregnancy delivered a normal infant. Six patients had therapeutic abortions; one had early induction of labor. In one patient previously treated for supradiaphragmatic Hodgkin's disease, detection of a supradiaphragmatic relapse was delayed because of pregnancy. We recommend abortion for patients who develop Hodgkin's disease early in pregnancy or who have received chemotherapy or irradiation during the first trimester. During the latter half of pregnancy, asymptomatic disease may be closely followed but early delivery is recommended. Supradiaphragmatic, symptomatic disease can be treated with modified irradiation. For subdiaphragmatic, symptomatic, or extranodal disease, single-agent chemotherapy may be preferable. Treatment requires individualization to insure that the patient will be cured and the fetus protected.
对15名患有霍奇金病的孕妇进行了随访。5名患者在妊娠中期或晚期接受了颈部、纵隔或两者的照射，剂量为1000至3000拉德，妊娠结局正常。1名患者在对乳房进行4400拉德放疗后于孕早期自然流产，估计胎儿剂量为9拉德。1名在整个孕期接受苯丁酸氮芥治疗的患者分娩了一名正常婴儿。6名患者进行了治疗性流产；1名进行了早期引产。1名曾接受膈上霍奇金病治疗的患者，由于怀孕，膈上复发的检测被延迟。我们建议，对于在孕早期患霍奇金病或在孕早期接受过化疗或放疗的患者进行流产。在妊娠后半期，对于无症状疾病可密切随访，但建议提前分娩。对于膈上有症状的疾病，可采用改良照射进行治疗。对于膈下、有症状或结外疾病，单药化疗可能更可取。治疗需要个体化，以确保患者得到治愈且胎儿受到保护。
