Pregnancy after Cytotoxic Chemotherapy for Gestational Trophoblastic Tumours

Abstract

Cytotoxic chemotherapy is a potential cause of sterility in young women and of malformations in the offspring of patients who conceive after treatment. The present authors, with the aim of identifying drug regimens that are compatible with fertility and not teratogenic, studied the obstetrical histories of women who entered remission after receiving cytotoxic chemotherapy for gestational trophoblastic tumors. Up-to-date obstetrical records on 445 women were available. Of the 217 who wished to conceive, 187 (86 per cent) succeeded in having at least one live birth each. Twenty-three (11 per cent) conceived but did not achieve a live birth, and seven (3 per cent) failed to conceive. The mean duration of chemotherapy was 4 months. The average age on completion of treatment was 24.9 years for those who had live births, 24.4 years for those who conceived but had no live birth, and 24.4 years for those who did not conceive at all. The average age of the women who did not want a pregnancy was 31.5 years. For each of the four groups of women, Table 1 shows the mean and maximum amounts of cytotoxic drug received. Methotrexate was given to all but two patients, neither of whom had tried to conceive. Analysis of each drug individually showed no significant difference between the mean amounts given to the women who achieved live births and those who did not. Live births occurred after all of the agents used, apart from cisplatin and etoposide. There was little difference, in the maximum doses given, between the group who had live births and the groups who had none. Combination chemotherapy was given to 43 per cent of the women who had live births, to 57 per cent of those who conceived but had no live births, and to 71 per cent of those who failed to conceive. These differences were not significant, but there was a distinct difference when the number of drugs received was considered. Women who were given three or more drugs in combination were less likely to have live births or to conceive at all than those given methotrexate alone or in combination with only one other drug (P < 0.001). Those who received actinomycin D or vincristine were less likely to have live births than the women who did not receive either drug (P < 0.01 and P < 0.05, respectively). None of the other drugs used in combination showed this significance, and none, including actinomycin and vincristine, showed any dose-response relation.