Expert: Claes-Gustaf Nordquist, M.D. - 3/24/2009

Question
I am a 29 yr. old female dx'd w/ anaplastic astrocytoma grade 3 about 9 months ago.  I underwent fertility preservation before starting chemo (Temozolomide).  My medical oncologist says that my treatment plan is to do chemo for a year and if all goes well, continue.  But I may be able to take a break to get pregnant and have a baby.  He said to wait a year before trying to get pregnant.  It is my understanding that anaplastic astrocytoma usually occur in men 50 yr. and above, thus I question the information available on this type of tumor in women of childbearing age and pregnancy.  I was wondering where I could find more information this and what is your take on suspending chemo to go through a pregnancy?  Also, is this type of tumor hormone-sensitive?  Are there cases out there of women who have done this?

Answer
You have asked my personal opinion and a straight question deserves a straight and honest answer. I will right now beg your pardon for my perhaps even brutal bluntness and frankness but I'm an old military physician and police surgeon and medical examiner where bluntness was a tool of the trade. It is my FIRM personal opinion that you should abstain from any pauses in your treatment especially in order to get pregnant and having a baby. The reason is simple. You have a malignant brain tumor. Regardless of if that normally strikes middle aged to older men or not it has struck YOU! That is a reality. It is there in your brain growing all the time unless stopped to do so by treatment. That is the way malignant tumors normally behave regardless of the age and sex of the patients. And a grade 3 anaplastic astrocytoma IS malignant without any doubt - that is in fact the meaning of the word anaplastic. To get pregnant and to bring a baby into this world is a business of around 9 months. Due to your pregnancy you would be without useful treatment for 9 months since all possible treatments (with chemotherapy and/or radiation therapy) are incompatible with a pregnancy! So your plan is unfortunately UNTHINKABLE and IMPOSSIBLE! I BEG you to follow the advice of your medical oncologist with treatment for at least a year before any more discussion on this subject is continued. The ONLY pregnancy at the moment I can approve of is with an in vitro fertilization with eggs from you and sperm from your husband and then a hired host mother until the end of the pregnancy. That way your treatment could continue for as long as necessary. It would still be YOUR baby in spite of the host mother. That is a possibility, as far as I can see here and now the only other available alternative is no pregnancy at all for the time being. Please do listen to my advice! Your tumor is an at least potentially deadly disease! You can not afford to do what you want to do! These tumors are not hormone sensitive.