Survival rates of patients with choriocarcinoma treated with chemotherapy without hysterectomy: effects of anticancer agents on subsequent births.

OBJECTIVES

The outcomes of patients with choriocarcinoma treated with fertility-preserving techniques and the children born to patients subjected to combined chemotherapy were examined retrospectively.

METHODS

We treated 191 patients with choriocarcinoma from 1965 through 2001. Of these, 62 were treated with fertility-preserving techniques (50 were cured and 12 died) and 129 with hysterectomy (88 were cured and 41 died).

RESULTS

Between 1965 and 1972, survival in the hysterectomy group increased. Thereafter, no significant differences between the two groups were observed. Subsequently, the number of cases with uterus preservation increased and occupied about two thirds of all cases. There were no significant differences in patient survival between the two groups by FIGO stage, although the data tended to support uterus preservation. Of the 50 patients who underwent fertility-preserving treatment for choriocarcinoma, 23 conceived for a total of 43 pregnancies. Thirty-four children were born without congenital malformations. However, two babies were born with ventricular septal defect (VSD) and one with tetralogy of Fallot (TOF) (3/34; 8.8%). The three children were the second child born after combination chemotherapy. The total dose of Methotrexate (MTX) was higher in patients who delivered a child with a heart anomaly (P < 0.02).

CONCLUSIONS

Patients treated with fertility-preserving modalities had comparable survival rates to those undergoing hysterectomy at more recent time points. The incidence of congenital heart abnormalities was higher for patients undergoing combined chemotherapy than in the general population. The influence of anti-cancer agents on oocytes should be incorporated into any treatment plans for patients wishing to bear children.