Fetal Effects During Cyclophosphamide and Irradiation Therapy

A 23-year-old pregnant white woman with stage IIIB Hodgkin's disease was treated with cyclophosphamide and exposed to diagnostic roentgenography, which resulted in a dose to her uterus estimated at 5 to 25 R. The cyclophosphamide and radiation were received during the first trimester of pregnancy. Her baby was delivered at 6 months' gestation, and fetal autopsy showed absence of all toes and a single coronary artery. This is the second reported case of toe and cardiac anomalies associated with cyclophosphamide therapy. To the best of our knowledge, cardiac anomalies secondary to cyclophosphamide administration have not been described in humans. Irradiation-induced cardiac anomalies have been reported in experimental animals and humans. Irradiation-induced musculoskeletal anomalies in humans have been documented. Cancer chemotherapeutic drug-induced and X-irradiationinduced fetal anomalies are discussed.