Elsevier

Gynecologic Oncology

Volume 95, Issue 1, October 2004, Pages 252-255
Gynecologic Oncology

Case Report
Combined chemotherapy and radiotherapy during conception and first two trimesters of gestation in a woman with metastatic breast cancer

https://doi.org/10.1016/j.ygyno.2004.06.037Get rights and content

Abstract

A 33-year-old woman with T4cN3 breast cancer with metastases in the skeleton (M1) received five cycles of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC regimen) before conception and during the first trimester. Salvage radiotherapy (28 Gy) was delivered during the 17th week. Tamoxifen and zolendronic acid were also administered throughout the second and third trimesters. The patient was not aware of her pregnancy until the 28th week. A female phenotypically normal infant was delivered in the 35th week of gestation by cesarean section. The child is functioning normally 12 months after delivery. The literature of anthracycline treatment during conception and the first trimester is reviewed. The effects of tamoxifen and biphosphonate therapy on the fetus during pregnancy are also discussed.

Introduction

Diagnosis of breast cancer during pregnancy is quite common. Seven percent of patients with breast cancer are younger than 40 years old, and an estimated 10% of all women aged between 25 and 40 years old are pregnant at any point [1]. Recent reports indicate that 0.75% to 3.1% of patients with breast cancer are pregnant or lactating at the time of diagnosis [2]. It is estimated that there is one case of breast cancer per 3000 pregnancies, and with the increasing trend for women to delay childbearing, the incidence rate tends to increase [3].

Use of chemotherapy during the first trimester increases the risk of spontaneous abortion, fetal death, and major malformations [4]. Chemotherapy should be avoided during the highly sensitive period of organogenesis, but according to present literature, it may be used during the second and third trimesters [4], [5]. Radiotherapy should also be avoided during pregnancy because of fetal congenital defects observed [6].

The experience with chemotherapy toxicity during conception and first trimester is limited. We present a case of a woman with metastatic breast cancer, who conceived during chemotherapy and underwent analgesic radiotherapy of the thoracic and lumbar spine during the 17th week of her pregnancy.

Section snippets

Case report

A 33-year-old woman came to our department with a locally advanced malignant neoplasm of her left breast. She was otherwise asymptomatic. On examination, her left breast was painless, hard, and irregular, with a retracted nipple and “peau d'orange” skin. A fixation of the bulky breast in the thoracic wall was observed. A block 3 × 5 cm of lymph nodes in the ipsilateral axilla and a supraclavicular lymph node were found. The mammography and the ultrasound examination confirmed the presence of a

Discussion

It is obvious that the patient conceived after the second chemotherapeutic cycle. Both the patient and her medical staff did not know about the pregnancy, so they did not discuss and debate this particular difficult situation. An anthracycline-based regimen rather than hormonal therapy was preferred as the first therapeutic approach because of the inflammatory nature of the primary breast tumor and because of the high bony spread of the metastatic disease. Cumulative doses of the cytotoxics

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