NEW YORK - Pregnant women who survived childhood cancers, primarily those
treated with radiation to the pelvic area, are more likely to deliver early,
according to data from the Childhood Cancer Survivor Study.
In the Journal of the National Cancer Institute, Dr. Lisa B. Signorello, from the
International Epidemiology Institute in Rockville, Maryland, and associates report
their analysis of 1,264 female childhood cancer survivors reporting 2201 single-infant
live births. These women were compared with a "control" group of 601
of their sisters without cancer reporting 1175 single-infant live births.
Childhood cancer survivors' children were nearly twice as likely to have been
delivered earlier than 37 weeks than children in the control group.
In general, survivors' children were also more likely to have been born at
less than about 5.3 pounds, but this difference was not statistically
significant after of other contributing factors. Similarly, these infants were
no more likely to be born preterm or before complete maturation.
Radiation therapy near the uterus had a significant impact on birth outcomes.
Compared with survivors who were not treated with radiation, the risk rose
according to dosage among the women who underwent radiation. Infants born to
mothers treated with more than 500 cGy to the uterus were also more likely to be
born small for gestational age and to have a low birth weight.
In contrast, the investigators observed no significant associations between
preterm birth and radiation exposure to the ovaries or pituitary gland.
Chemotherapy also appeared to have little effect on preterm birth, low
birthweight, and small for gestational age births.
In a related editorial, Dr. Leslie R. Schover, at the University of Texas M.
D. Anderson Cancer Center in Houston, comments that the research by Signorello's
group fails to analyze other pregnancy complications caused by cancer treatment,
such as an increased rate of miscarriage and medical terminations.
"Given the complex terrain our young survivors need to
traverse (with regard to fertility), we should design patient and professional
educational materials that map out the paths to making informed decisions,"
Schover concludes.
