12月12日,发表在的JCO杂志上一项最新研究"Congenital Anomalies in the Children of Cancer Survivors: A Report From the Childhood Cancer Survivor Study"显示,年轻癌症患者接受放化疗后,不会增加今后孩子出生缺陷的风险。
研究者Lisa Signorello讲到,我们知道儿童接受的一些治疗确实对生殖系统有损害,很多孩子接受重度治疗后会出现不孕。我们现在知道主要取决于治疗类型,从而会出现高流产率或低出生体重率。
对于儿童癌症幸存者,担忧会持续到他们的下一代。这项新研究中,研究者随访了美国和加拿大的近2800名儿童期癌症幸存者,定期对他们调查包括询问怀孕和生育的问题。
治疗至少5年后,幸存者生产的4700名婴儿中,129名(不到3%)有至少一个出生缺陷,包括唇腭裂,21三体和心血管缺陷。睾丸和卵巢区域接受过放疗,或者服用过化疗药物的人群和那些没有这些暴露的人群,其出生缺陷率是相同的。
对于女性幸存者的孩子,放化疗后孩子出生缺陷率为3%,没有接受那些治疗的母亲为3.5%,对于男性,分别为1.9%和1.7%。化疗和放疗对于出生缺陷的风险没有剂量反应关系。
作者指出,癌症幸存者的结果中没有包括那些和家族史相关的出生缺陷,而且该研究没有包括一个父母均无癌症的对照组。
这样的研究对为癌症儿童和接受过治疗的儿童提供咨询上是非常重要的,虽然以前也有研究发现癌症治疗不会造成额外的出生缺风险,但是本研究参考了癌症治疗的医疗记录,结果更加可信。(生物谷Bioon.com)
doi:10.1200/JCO.2011.37.2938
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Congenital Anomalies in the Children of Cancer Survivors: A Report From the Childhood Cancer Survivor Study.
Signorello LB, Mulvihill JJ, Green DM, Munro HM, Stovall M, Weathers RE, Mertens AC, Whitton JA, Robison LL, Boice JD Jr.
PURPOSEChildren with cancer receive mutagenic treatments, which raises concern about the potential transmissibility of germline damage to their offspring. This question has been inadequately studied to date because of a lack of detailed individual treatment exposure assessment such as gonadal radiation doses. METHODSWithin the Childhood Cancer Survivor Study, we performed a retrospective cohort analysis of validated cases of congenital anomalies among 4,699 children of 1,128 male and 1,627 female childhood cancer survivors. We quantified chemotherapy with alkylating agents and radiotherapy doses to the testes and ovaries and related these exposures to risk of congenital anomalies using logistic regression.ResultsOne hundred twenty-nine children had at least one anomaly (prevalence = 2.7%). For children whose mothers were exposed to radiation or alkylating agents versus neither, the prevalence of anomalies was 3.0% versus 3.5% (P = .51); corresponding figures were 1.9% versus 1.7% (P = .79) for the children of male survivors. Neither ovarian radiation dose (mean, 1.19 Gy; odds ratio [OR] = 0.59; 95% CI, 0.20 to 1.75 for 2.50+ Gy) nor testicular radiation dose (mean, 0.48 Gy; OR = 1.01; 95% CI, 0.36 to 2.83 for 0.50+ Gy) was related to risk of congenital anomalies. Treatment with alkylating agents also was not significantly associated with anomalies in the children of male or female survivors. CONCLUSIONOur findings offer strong evidence that the children of cancer survivors are not at significantly increased risk for congenital anomalies stemming from their parent's exposure to mutagenic cancer treatments. This information is important for counseling cancer survivors planning to have children.