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Maxwell C, Alavifard S, Warner E, Barrera M, Brezden-Masley C, Colapinto N, Kassirian S, Madarnas Y, Srikala S, Tozer R, Yu J, Nulman I. Neurocognitive outcomes following fetal exposure to chemotherapy for gestational breast cancer: A Canadian multi-center cohort study. Breast 2021; 58:34-41. [PMID: 33901920 PMCID: PMC8099599 DOI: 10.1016/j.breast.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background Limited knowledge exists on outcomes of children exposed prenatally to chemotherapy for breast cancer (BC). The purpose of this study was to compare long-term neurocognitive, behavioral, developmental, growth, and health outcomes of children exposed in-utero to chemotherapy for BC. Methods This is a multi-center matched cross-sectional cohort study involving seven cancer centers across the region of Southern Ontario (Canada), and the Hospital for Sick Children (Toronto, Ontario). Using standardized psychological and behavioral tests, we compared cognitive and behavioral outcomes in children exposed to chemotherapy during pregnancy for BC to age-matched pairs exposed to known non-teratogens. Results We recruited 17 parent-child pairs and their matched controls. There were more preterm deliveries in the chemotherapy-exposed group compared to controls (p < 0.05). Full Scale IQ of children in the chemotherapy group was significantly confounded by maternal IQ and prematurity. Exposed children born at term were not different in cognitive outcomes. Children from both groups were similar in their developmental milestones, pediatric anthropometric measurements and health problems. There were no cases of autoimmune cytopenia. Conclusions This is the first Canadian prospective comparative study designed to assess pediatric cognition following prenatal exposure to chemotherapy for BC. Chemotherapy was not found to be neurotoxic in this cohort and did not affect pediatric health. The decision to plan a preterm birth for initiating or continuing chemotherapy treatment must be taken into consideration in context of pediatric implications. While these results may assist in such decision making, replication with a larger sample is needed for more conclusive findings. Limited knowledge exists on outcomes of children exposed prenatally to chemotherapy for breast cancer (BC). We compared cognitive and behavioral outcomes in children exposed to chemotherapy during pregnancy for BC to controls. FSIQ of children in the chemotherapy group was significantly confounded by prematurity. Chemotherapy was not found to be neurotoxic and did not affect pediatric health. Pediatric implications of planned preterm birth for further treatment should be considered.
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Affiliation(s)
- Cynthia Maxwell
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada.
| | - Sepand Alavifard
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Ellen Warner
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
| | - Christine Brezden-Masley
- Medical Oncology, Mount Sinai Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Shima Kassirian
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Yolanda Madarnas
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Sridhar Srikala
- Medical Oncology, Princess Margaret Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Richard Tozer
- Department of Medicine, Juravinski Cancer Centre, Hamilton Health Sciences Centre, Hamilton, ON, Canada.
| | - Joanne Yu
- Medical Oncology, North York General Hospital, Toronto, ON, Canada.
| | - Irena Nulman
- CHES, Research Institute, The Hospital for Sick Children, Toronto, Toronto, ON, Canada.
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Cordeiro Mitchell CN, Murdock T, Fader AN, Stone RL. Advanced ovarian cancer treated in pregnancy and detected by cell-free DNA aneuploidy screening. Gynecol Oncol Rep 2018; 24:48-50. [PMID: 29915798 DOI: 10.1016/j.gore.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/12/2018] [Accepted: 03/17/2018] [Indexed: 02/06/2023] Open
Abstract
Abnormal cell free DNA results may indicate occult maternal malignancy. Cesarean-cytoreductive surgery is feasible even with significant disease burden. Carboplatin/paclitaxel is first line for epithelial ovarian cancer in pregnancy.
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