Congenital anomalies in children of patients who received chemotherapy for cancer in childhood and adolescence.
Congenital anomalies in children of patients who received chemotherapy for cancer in childhood and adolescence.
复制标题
儿童期和青少年期接受癌症化疗的患者的孩子出现先天性异常。
DOI：
10.1056/nejm199107183250301
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Hall,B
中科院分区：
文献类型：
--
作者：
Green,DM;Zevon,MA;Lowrie,G;Seigelstein,N;Hall,B
背景许多已经用含有一种或多种诱变化疗剂的方案成功治疗儿童癌症的患者担心他们自己在儿童或青春期的治疗可能对他们的孩子产生不利影响。我们回顾了306名接受过儿科癌症治疗的男性和女性的记录，他们回答了我们的问卷。306例患者中有100例报告了202例妊娠。在接受化疗作为癌症治疗一部分的患者中，60名患者或患者的妻子有一次或多次怀孕20周或以上。前60例患者共有100活产和2死产儿。结果先天性畸形的频率为8.1%（5 62）之间的活产儿的妇女和7.9%（3 38）之间的活产儿的男子。结构性先天性心脏缺陷在10.0%（20例中有2例）接受更生霉素治疗的妇女的子女中被确定，而在一项多中心胎儿畸形调查中，这一比例为0.6%（24,153例中有144例）（P = 0.0126）。我们没有发现收到的诱变剂的数量或累积剂量的任何代理收到和先天性异常的频率在children.ConclusionsThese数据表明，治疗的儿童和青少年与诱变化疗药物，在我们检查的剂量范围内，不增加先天性异常的频率在随后出生的儿童前患者。然而，更生霉素对此类患者的子女可能产生的不良影响需要进一步研究。（N Engl J Med 1991;325：141-6.）
BackgroundMany patients who have been treated successfully for childhood cancer with regimens that contain one or more mutagenic chemotherapeutic agents are concerned that their own treatment during childhood or adolescence may adversely affect their children.MethodsTo determine the effect of chemotherapy for cancer during childhood and adolescence on the outcome of subsequent pregnancies, we reviewed the records of 306 men and women who had been treated for pediatric cancer and who responded to our questionnaire. One hundred of the 306 patients reported 202 pregnancies. Among the patients who had received chemotherapy as part of their treatment for cancer, 60 patients or wives of patients had had one or more pregnancies of 20 or more weeks' gestation. The 60 former patients had a total of 100 live-born and 2 stillborn children.ResultsThe frequency of congenital anomalies was 8.1 percent (5 of 62) among the live-born children of the women and 7.9 percent (3 of 38) among the live-born children of the men. Structural congenital cardiac defects were identified in 10.0 percent (2 of 20) of the children of women who had been treated with dactinomycin, as compared with 0.6 percent (144 of 24,153) among the children in a multicenter survey of fetal anomalies (P = 0.0126). We found no relation between the number of mutagens received or the cumulative dose of any agent received and the frequency of congenital anomalies in the children.ConclusionsThese data suggest that treatment of children and adolescents with mutagenic chemotherapeutic agents, in the dose ranges we examined, does not increase the frequency of congenital anomalies in the children subsequently born to the former patients. However, the possible adverse effect of dactinomycin on the children of such patients requires further study. (N Engl J Med 1991;325:141–6.)