Disease Description

The National Cancer Institute (NCI) has updated its cancer information delivery services. In the future, please use the Cancer.gov web site (Http: //cancer.gov/) to meet your cancer information needs. CancerMail users in the United States can obtain cancer information by telephone at 1-800-4-CANCER (1-800-422-6237).

The NCI will no longer support CancerMail after November 2002. If you have comments about the NCI's cancer information delivery services, contact us by e-mail at cancer.govstaff@mail.nih.gov or call 301-496-9096.

###########################################################################

DISEASE DESCRIPTION

Since Hodgkin's disease affects primarily young adults, most oncologists will eventually face the dilemma of how to provide therapy to a pregnant woman while minimizing the risk to the fetus. Treatment choice must be individualized, taking into consideration the mother's wishes, the severity and pace of the Hodgkin's disease, and the length of the remaining pregnancy. Since general guidelines can never substitute for clinical judgment, oncologists should be prepared to alter the initial plans when necessary. Magnetic resonance imaging is the preferred tool for staging evaluation to avoid exposure to ionizing radiation.[1]

Oncologists usually counsel therapeutic abortion for women with Hodgkin's disease who are in the first trimester. If the Hodgkin's disease presents in early stage above the diaphragm and appears to be growing slowly, patients can be followed carefully with plans to induce delivery early and proceed with definitive therapy. Alternatively, these patients can receive radiation therapy with proper shielding.[2] Investigators at M.D. Anderson reported no congenital abnormalities in 16 babies delivered after the mothers had received supradiaphragmatic radiation while shielding the uterus with five half-value layers of lead.[3] Chemotherapy administered in the first trimester is associated with congenital abnormalities in up to one-third of infants.[4] However, in one series, there were no adverse effects in 14 children of mothers who received mechlorethamine + vincristine + procarbazine + prednisone or doxorubicin + bleomycin + vinblastine + dacarbazine (ABVD) during gestation, 5 of whom began treatment during the first trimester.[5] Consequently, some women may opt to continue the pregnancy and agree to radiation therapy or chemotherapy if immediate treatment is required.

In the second half of pregnancy, most patients can be followed carefully, postponing therapy until induction of delivery at 32 to 36 weeks.[6,7] If chemotherapy is mandatory prior to delivery, such as for patients with symptomatic advanced stage disease, vinblastine alone (given at 6 milligrams per square meter intravenously every two weeks until induction of delivery) may be considered as it has never been associated with fetal abnormalities in the second half of pregnancy.[6,7] Steroids are also employed both for their antitumor effect as well as for hastening fetal pulmonary maturity. As an alternative, a short course of radiation can also be used prior to delivery in cases of respiratory compromise due to a rapidly enlarging mediastinal mass. Combination chemotherapy with ABVD appears to be safe in the second half of pregnancy.[5] If chemotherapy is required after the first trimester, many clinicians prefer the combination of drugs over single agent drugs or radiation therapy.

In one study, the 20-year survival of pregnant women with Hodgkin's disease was not different from nonpregnant women matched for similar stage of disease, age at diagnosis, and calendric year of treatment.[8] The long-term effects on progeny after chemotherapy in utero are unknown, although present evidence tends to be reassuring.[4-8]

References:

1. Nicklas AH, Baker ME: Imaging strategies in the pregnant cancer patient. Seminars in Oncology 27(6): 623-632, 2000.
2. Greskovich JF Jr., Macklis RM: Radiation therapy in pregnancy: risk calculation and risk minimization. Seminars in Oncology 27(6): 633-645, 2000.
3. Woo SY, Fuller LM, Cundiff JH, et al.: Radiotherapy during pregnancy for clinical stages IA-IIA Hodgkin's disease. International Journal of Radiation Oncology, Biology, Physics 23(2): 407-412, 1992.
4. Thomas PR, Peckham MJ: The investigation and management of Hodgkin's disease in the pregnant patient. Cancer 38(3): 1443-1451, 1976.
5. Aviles A, Diaz-Maqueo JC, Talavera A, et al.: Growth and development of children of mothers treated with chemotherapy during pregnancy: current status of 43 children. American Journal of Hematology 36: 243-248, 1991.
6. Jacobs C, Donaldson SS, Rosenberg SA, et al.: Management of the pregnant patient with Hodgkin's disease. Annals of Internal Medicine 95(6): 669-675, 1981.
7. Nisce LZ, Tome MA, He S, et al.: Management of coexisting Hodgkin's disease and pregnancy. American Journal of Clinical Oncology 9(2): 146-151, 1986.
8. Lishner M, Zemlickis D, Degendorfer P, et al.: Maternal and foetal outcome following Hodgkin's disease in pregnancy. British Journal of Cancer 65: 114-117, 1992.

Browse and Submit Oncology Conferences

Sponsors: Health on the Net Foundation (Geneva) Landesregierung NRW (im Rahmen von HSP III) FAST Multimedia AG  Schnittpunkt

<A HREF ="deutsch/CancernetDSL.ram">Play clip using the stand-alone RealPlayer!</A><A HREF ="http://www.real.com/products/player/d1.html">Click here to download the latest RealPlayer!</A> small video clip about our work (200 Kbit/s)

Back to the Cancernet contents overview Questions? Mail them to us!

This site complies with the HONcode standard for trustworthy health information: verify here.

We subscribe to the HONcode principles of the Health On the Net Foundation

This page was last modified on Sunday, 02-Nov-2003 15:52:10 CET