Combined chemotherapy and radiotherapy during conception and first two trimesters of gestation in a woman with metastatic breast cancer

A 33-year-old woman with T4cN3 breast cancer with metastases in the skeleton (M-1) received five cycles of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC regimen) before conception and during the first trimester. Salvage radiotherapy (28 Gy) was delivered during the 17th week. Tamoxifen and zolendronic acid were also administered throughout the second and third trimesters. The patient was not aware of her pregnancy until the 28th week. A female phenotypically normal infant was delivered in the 35th week of gestation by cesarean section. The child is functioning normally 12 months after delivery. The literature of anthracycline treatment during conception and the first trimester is reviewed. The effects of tamoxifen and biphosphonate therapy on the fetus during pregnancy are also discussed. (C) 2004 Elsevier Inc. All rights reserved.