Children of Survivors of Childhood Cancer

ABSTRACT & COMMENTARY

Synopsis: A survey of 280 pregnancies that had occurred in patients successfully treated during childhood for a variety of malignancies showed no increase over the expected incidence of congenital malformations and no cases of childhood cancer in the offspring.

Source: Green DM, et al. Birth defects and childhood cancer in offspring of survivors of childhood cancer. Arch Pediatr Adolesc Med 1997;151:379-383.

Potentially mutagenic agents, including radiotherapy and chemotherapeutic agents, are often employed in the treatment of childhood malignancies. These agents may have the potential to damage germ cells, which might increase the risk of birth defects and malignancies of the offspring of patients who received such treatment. A self-administered questionnaire was completed by 148 cancer patients who were 18 years or older and who were at least five years beyond their initial diagnosis of cancer. These patients reported 280 pregnancies. Sixty-two percent (91/148) of these patients had received one or more cancer chemotherapeutic agents as part of their treatment. Infants born to both men and women patients had a 3.3% frequency of congenital anomalies that does not differ significantly from normal populations. No cases of childhood cancer have been diagnosed in the offspring of these patients.

COMMENT BY HOWARD A. PEARSON, MD, FAAP

The dramatic increase in survival of children with a variety of childhood malignancies has resulted in increasing numbers of these patients entering the reproductive age. Not surprisingly, because many of these patients are treated with potentially mutagenic cancer chemotherapeutic drugs, there have been concerns about possible effects of the treatment on future offspring. Although there have been several studies of the outcome of pregnancies in which one of the parents has been treated for cancer, in general the kind and dose of therapy has not been specified.1,2 This study by Green and associates at the Roswell Park Cancer Institute includes the largest number of reported, fertile patients who were exposed to alkylating agents. This class of drugs, being radiomimetic, would be expected to have the greatest potential for chromosomal damage. (It may be difficult to accumulate large numbers of such patients because alkylating agents, especially cyclophosphamide, often cause infertility.) The observed 3.3% prevalence of congenital abnormalities observed in the offspring of these cancer survivors does not differ significantly from reported frequencies in normal populations. This reassuring report, combined with previous studies, supports the view that current standard chemotherapy programs do not result in increased numbers of birth defects in the offspring of children and adolescents successfully treated for cancer. Although no cases of secondary cancer were seen in the children born to survivors of pediatric cancer, the numbers are too small to confidently state that there is no increased risk.

References

1. Li FP, et al. Offspring of patients treated for cancer in childhood. J Natl Cancer Inst 1979;62:1193-1197.

2. Green DM, et al. Congenital anomalies in children of patients who received chemotherapy for cancer in childhood and adolescence. N Engl J Med 1991;325:141-145.