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Weidema M, Kaal S, de Jong L, van Erp N, Jansen R, Schreuder B, Heidema W, van der Graaf W, Desar I. Bone sarcoma during pregnancy: an example of personalized multidisciplinary care. Acta Oncol 2019; 58:128-131. [PMID: 30264644 DOI: 10.1080/0284186x.2018.1512754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marije Weidema
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Suzanne Kaal
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Loek de Jong
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nielka van Erp
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rosemarie Jansen
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bart Schreuder
- Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wieteke Heidema
- Department of Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Winette van der Graaf
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ingrid Desar
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Successful Spontaneous Pregnancy after Treatment for Ewing Sarcoma including Sacrectomy. Case Rep Obstet Gynecol 2018; 2018:2484036. [PMID: 29854509 PMCID: PMC5952498 DOI: 10.1155/2018/2484036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/25/2018] [Indexed: 01/08/2023] Open
Abstract
Ewing sarcomas are highly malignant bone tumors and usually occur in childhood. Radiation therapy, chemotherapy, and surgical methods increase the survival rate of the affected patient, but infertility and reduced reproductive capacity are common late effects of pediatric cancer treatment.
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Puvanesarajah V, Spiker AM, Shannon BA, Grundy M, Levin AS, Morris CD. Evaluation and management of the pregnant patient with suspected primary musculoskeletal tumor or metastatic carcinoma to bone. Surg Oncol 2016; 25:212-22. [PMID: 27566025 DOI: 10.1016/j.suronc.2016.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/20/2016] [Indexed: 01/26/2023]
Abstract
Primary musculoskeletal cancer and metastatic disease to bone in pregnant patients presents major treatment challenges. Although uncommon, musculoskeletal malignancies in pregnant women have been reported. When diagnosing and treating these patients, the mother's health must be managed appropriately while ensuring that fetal development is not deleteriously affected. Extensive radiographic imaging and more advanced techniques are often necessary to fully characterize the extent of disease. When possible, magnetic resonance imaging should be used instead of computed tomography to limit exposure of the conceptus to radiation. If treatment is needed, therapeutic radiation, chemotherapy, and surgery should be considered. Surgical resection is the foundation of treatment of early-stage primary bone tumors and soft-tissue sarcomas during pregnancy. With surgery, anesthesia and thromboprophylaxis are important considerations. If chemotherapy is required, administration should be avoided in the first trimester to limit harm to the fetus. Therapeutic radiation should similarly be avoided during the first trimester and often can be postponed until after delivery.
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Affiliation(s)
- Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrea M Spiker
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Brett A Shannon
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Maureen Grundy
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carol D Morris
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Séjourné A, Paupière S, Bonnaire B, Ikoli JF, Chauffert B, Goëb V. [A peripartum lumbosciatica revealing an Ewing sarcoma of the pelvis]. ACTA ACUST UNITED AC 2013; 43:474-7. [PMID: 24315736 DOI: 10.1016/j.jgyn.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/30/2013] [Accepted: 11/07/2013] [Indexed: 10/25/2022]
Affiliation(s)
- A Séjourné
- Service de rhumatologie, hôpital Nord, CHU d'Amiens, université Picardie Jules-Verne, 1, place Victor-Pauchet, 80000 Amiens, France.
| | - S Paupière
- Service de rhumatologie, hôpital Nord, CHU d'Amiens, université Picardie Jules-Verne, 1, place Victor-Pauchet, 80000 Amiens, France
| | - B Bonnaire
- Service de radiologie, CHU d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France
| | - J-F Ikoli
- Service d'anatomie et cytologie pathologiques, CHU d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France
| | - B Chauffert
- Service d'oncologie médicale, CHU d'Amiens, 1, place Victor-Pauchet, 80000 Amiens, France
| | - V Goëb
- Service de rhumatologie, hôpital Nord, CHU d'Amiens, université Picardie Jules-Verne, 1, place Victor-Pauchet, 80000 Amiens, France; Équipe Inserm EA 4666, université Picardie Jules-Verne, 1, place Victor-Pauchet, 80000 Amiens, France
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Schur S, Wild J, Amann G, Köstler W, Langer M, Brodowicz T. Sarcoma of the ewing family in pregnancy: a case report of intrauterine fetal death after induction of chemotherapy. Case Rep Oncol 2012; 5:633-8. [PMID: 23275778 PMCID: PMC3531939 DOI: 10.1159/000345568] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Ewing's sarcoma is an ultra-orphan disease (2/1,000,000/year) which requires a multimodal therapy approach in high-volume centers. Treatment consists of pre-operative therapy followed by surgery and post-operative combination of chemo-radiotherapy. Experience with diagnosis and therapy of Ewing's sarcoma in pregnancy is very limited. We herein report the case of an atypical Ewing's sarcoma detected in the second trimester of gestation. Neoadjuvant chemotherapy was initiated and resulted in substantial tumor shrinkage and intrauterine fetal death. The rare nature of this condition underlines once more the need for a multidisciplinary team to improve the quality of care for this highly special patient collective.
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Affiliation(s)
- S Schur
- Comprehensive Cancer Center - Musculoskeletal Tumors, GIST, Bone and Soft Tissue Sarcoma Program, Clinical Division of Oncology, Department of Internal Medicine I, Sarcoma Platform Austria, Vienna, Austria
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Selig BP, Furr JR, Huey RW, Moran C, Alluri VN, Medders GR, Mumm CD, Hallford HG, Mulvihill JJ. Cancer chemotherapeutic agents as human teratogens. ACTA ACUST UNITED AC 2012; 94:626-50. [DOI: 10.1002/bdra.23063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/29/2012] [Accepted: 07/04/2012] [Indexed: 12/11/2022]
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Nulman I, Edell H. Paediatric outcomes following in utero exposure to the diagnosis and treatment of maternal malignancy. Eur J Cancer 2011; 47 Suppl 3:S217-29. [DOI: 10.1016/s0959-8049(11)70168-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Azim HA, Peccatori FA, Pavlidis N. Treatment of the pregnant mother with cancer: a systematic review on the use of cytotoxic, endocrine, targeted agents and immunotherapy during pregnancy. Part I: Solid tumors. Cancer Treat Rev 2009; 36:101-9. [PMID: 20015593 DOI: 10.1016/j.ctrv.2009.11.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 11/05/2009] [Accepted: 11/15/2009] [Indexed: 01/14/2023]
Abstract
The association of cancer and pregnancy is increasingly encountered nowadays in clinical practice. Due to the relative rarity of the situation, it lacks a systematized approach. Different systemic therapies are used in managing cancer with uncertainty regarding the potential hazards they could pose on the pregnancy and/or the fetus. We have performed a systematic review of literature to identify all reports addressing cancer patients who were exposed to any of the known systemic therapies during the course of the pregnancy. The results were discussed in two parts; part I addresses pregnant patients with solid tumors while part I for those with hematological malignancies. In part I, we identified different solid tumors diagnosed and treated during the course of pregnancy. Breast cancer was the most commonly treated followed by ovarian cancer. Other tumors were treated as well including lung cancer, cervical cancer, sarcoma and melanomas. It is important to acknowledge the intent of therapy (palliative vs. curative) and the patients has to be properly counseled to reach an informed decision. We aim to provide a more robust consensus on how to approach these cases and provide a higher degree of evidence to support the safety of applying certain management strategies over the other.
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Affiliation(s)
- Hatem A Azim
- Department of Medical Oncology, National Cancer Institute, Cairo University, 55 Abdel Monem Riad Street, Mohandeseen, Cairo, Egypt.
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Ateser G, Yildiz O, Leblebici C, Mandel NM, Unal F, Turna H, Arikan I, Colcaki D. Metastatic primitive neuroectodermal tumor of the ovary in pregnancy. Int J Gynecol Cancer 2007; 17:266-9. [PMID: 17291265 DOI: 10.1111/j.1525-1438.2006.00761.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primitive neuroectodermal tumor (PNET) is a small round tumor belonging to the PNET/Ewing's sarcoma family. We hereby report a case of PNET of the ovary, which was detected at the second trimester of pregnancy. Chemotherapy was administered and a healthy baby was delivered by cesarean section. After the pregnancy, the mother was found to have metastatic disease. Chemotherapy was continued, but she died due to progressive disease 13 months after the initial diagnosis. In this case report, we discuss chemotherapy options during pregnancy and the importance of multidisciplinary approach to unusual presentations of rare tumors
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Affiliation(s)
- G Ateser
- Department of Obstetrics and Gynecology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
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Abstract
Chemotherapy may be indicated for the treatment of cancer during pregnancy. The decision to use chemotherapy significantly impacts the pregnancy, and in turn the pregnancy may affect the treatment options available to patients with cancer. This review provides information about the effects of chemotherapeutic agents in pregnancy, taking into account both the mother and the fetus. For convenience, the agents are divided into categories based upon class and mechanism of action. These include alkylating agents, antimetabolites, nucleoside analogs, topoisomerase I inhibitors, topisomerase II inhibitors, vinca alkaloids, taxanes, and biologics such as signaling and growth factor blocking agents.
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Affiliation(s)
- Kimberly K Leslie
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, 2211 Lomas Boulevard NE, Albuquerque NM 87131-0001, USA.
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Nakajima W, Ishida A, Takahashi M, Hirayama M, Washino N, Ogawa M, Takahashi S, Okada K. Good outcome for infant of mother treated with chemotherapy for ewing sarcoma at 25 to 30 weeks' gestation. J Pediatr Hematol Oncol 2004; 26:308-11. [PMID: 15111784 DOI: 10.1097/00043426-200405000-00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There have been only three previous reports of women with Ewing sarcoma who received chemotherapy while pregnant. A 17-year-old woman with Ewing sarcoma was treated with a combination of doxorubicin (Adriamycin) and ifosfamide during the 25th to 30th week of gestation, and the baby was delivered at the 32nd week. The baby was developing normally at follow-up at 8 months of age. This case report supports the idea that in this situation, the pregnancy can be continued to await fetal growth, and second-trimester chemotherapy may not have a deleterious effect on the fetus.
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Affiliation(s)
- Wako Nakajima
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan.
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MESH Headings
- Antibiotics, Antineoplastic/pharmacology
- Antibiotics, Antineoplastic/therapeutic use
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antimetabolites, Antineoplastic/pharmacology
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Alkylating/pharmacology
- Antineoplastic Agents, Alkylating/therapeutic use
- Cytarabine/pharmacology
- Daunorubicin/pharmacology
- Daunorubicin/therapeutic use
- Doxorubicin/pharmacology
- Doxorubicin/therapeutic use
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- Etoposide/pharmacology
- Etoposide/therapeutic use
- Female
- Fetus/drug effects
- Humans
- Nucleic Acid Synthesis Inhibitors/pharmacology
- Nucleic Acid Synthesis Inhibitors/therapeutic use
- Paclitaxel/pharmacology
- Paclitaxel/therapeutic use
- Pregnancy
- Pregnancy Complications, Neoplastic/drug therapy
- Topotecan/pharmacology
- Topotecan/therapeutic use
- Trastuzumab
- Vinblastine/pharmacology
- Vinblastine/therapeutic use
- Vincristine/pharmacology
- Vincristine/therapeutic use
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Affiliation(s)
- Kimberly K Leslie
- Department of Obstetrics and Gynecology, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA.
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Abstract
Two cases of pregnancy associated with myxoid liposarcoma are presented. Both patients were treated with hyperthermoradiotherapy after the induced delivery of healthy infants and by surgical excision of the tumor 5 to 7 weeks after delivery. No local recurrence or distant metastasis occurred; the children have progressed normally for 4 and 5 years, respectively, after surgery. Because coexistence of pregnancy and sarcoma is rare, it is difficult for the clinician to develop an appropriate approach to the management of bone and soft tissue sarcoma during pregnancy. The literature was reviewed regarding the effect that pregnancy may have on the clinical behavior of sarcoma and the effect treatment for sarcoma may have on the fetus.
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Affiliation(s)
- S Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
The occurrence of cancer in a pregnant woman is a relatively infrequent event. The influence of pregnancy on the initiation, promotion and development of sarcomas is yet unclear. The medical approach is strongly influenced by the type and site of the primary tumor, its growth rate and associated symptoms, and by the need to treat the woman while minimizing fetal toxicity. The medical files of seven pregnant women in whom sarcomas were diagnosed during gestation or 3-4 months after delivery were reviewed. Three had bone sarcomas, and four had soft tissue sarcomas. In five cases there were various reasons for the delayed diagnosis and treatment, including lack of any signs or symptoms during gestation, clinical misdiagnosis, religious attitude and refusal of the patients. Ancillary tests such as magnetic resonance imaging (MRI) and ultrasound, and biopsy, are safe during gestation. Adriamycin, ifosfamide and granisetron were administered in one case during the third trimester, without remarkable toxicity. Whenever a pregnant woman is diagnosed as having a malignant tumor, serious medical, ethical, emotional, religious and philosophical dilemmas arise. The mother's well-being and the risk to the fetus by introducing early diagnostic tests and treatment should be weighed against the risk to the mother and the well-being of the fetus in carrying on an uninterrupted gestation.
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Affiliation(s)
- O Merimsky
- Department of Medicine, Institut Gustave Roussy, Villejuif, France
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Merimsky O, Le Chevalier T, Missenard G, Lepechoux C, Cojean-Zelek I, Mesurolle B, Le Cesne A. Management of cancer in pregnancy: a case of Ewing's sarcoma of the pelvis in the third trimester. Ann Oncol 1999; 10:345-50. [PMID: 10355581 DOI: 10.1023/a:1008235023749] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ewing's sarcoma of the pelvic bones was diagnosed in a 21-year childbearing woman, raising major medical and ethical problems. The diagnostic and therapeutic approaches during the sixth month of gestation were tailored in order to cure the patient and avoid unnecessary toxicity to the fetus. Ancillary tests included ultrasound and MRI studies of the pelvis. Ifosfamide and adriamycin, premedicated by granisetron, were administered during gestation, and were found to be safe. Cesarean section was the preferred way of delivery since the tumor involved the pelvic bones. The outcome was a disease-free patient and a small healthy baby who is now two years of age.
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Affiliation(s)
- O Merimsky
- Unit of Bone and Soft Tissue Sarcoma, Institut Gustave Roussy, Villejuif, France
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Abstract
The use of antineoplastic agents in pregnant women poses obvious risks to both the patient and the developing fetus, particularly during organogenesis. While the use of antineoplastics during pregnancy is often unavoidable, the physician may limit the risks by having a clear knowledge of the pharmacology and teratogenic potential of individual agents. Specific physiologic changes in the pregnant patient, such as enhanced renal excretion of drugs, increased or decreased hepatic function, altered gastrointestinal absorption and enterohepatic circulation, altered plasma protein binding, an increase in plasma volume (50%), and creation of a fluid filled 3rd compartment (amniotic fluid) for water soluble drugs may all significantly influence the pharmacology of antineoplastic agents. These physiological changes may effect the pregnant patients ability to absorb orally administered drugs, metabolize drugs to either active or inactive metabolites, and eliminate cytotoxically active drugs. A resulting reduction in concentration x time (C x T) for drug exposure to the maternal system may reduce the efficacy of the antineoplastic agents, while an increase in C x T may expose the patient and her fetus to undue toxicity. The timing of drug administration to gestational age is also a critical factor for some drugs. While many drugs result in adverse effects on the fetus regardless of gestational age, others appear to pose less of a threat if administered beyond the first trimester. This review addresses the pharmacology, pharmacokinetics and the teratogenic potential of individual antineoplastic agents that are commonly used in pregnant patients. The aim of this review is to help the physician select, on a patient specific basis, antineoplastic agents that avoid at least some of the fetal risk involved while maintaining efficacy in the treatment of the patient.
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Affiliation(s)
- V J Wiebe
- Department of Medicine, University of Texas Health Science Center, San Antonio
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Medikamentöse Tumortherapie in der Schwangerschaft: Wann und Wie? Arch Gynecol Obstet 1993. [DOI: 10.1007/bf02266149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Willemse PH, van der Sijde R, Sleijfer DT. Combination chemotherapy and radiation for stage IV breast cancer during pregnancy. Gynecol Oncol 1990; 36:281-4. [PMID: 2298417 DOI: 10.1016/0090-8258(90)90188-q] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 42-year-old woman presented with a 25-week pregnancy and stage IV breast cancer with metastases in the skeleton and liver and a T-4 primary tumor. She was treated with two cycles of doxorubicin, methotrexate, and vincristine. Spontaneous labor resulted in a normal female infant, who was successfully treated for sepsis and mild respiratory distress. The placenta showed diffuse chorioamnionitis. There was no doxorubicin demonstrated in the placenta, blood, or fetal lymphocytes 3 weeks after the last treatment. Maternal and fetal chromosomal analyses were unremarkable. The child is functioning normally 2 years after delivery. The literature on anthracycline treatment during pregnancy is reviewed. Adriamycin has been shown to cross the blood-placenta barrier, but has not led to specific fetal abnormalities when given during the second or third trimester. Experience during the first trimester is still limited.
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Affiliation(s)
- P H Willemse
- Department of Medicine, University of Groningen, The Netherlands
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Abstract
This article reports two cases and reviews the literature regarding chemotherapy using anthracyclines during pregnancy. Twenty-six additional cases using this class of agents to treat malignancy during pregnancy are summarized from 18 reports for a total of 28 pregnancies. Final outcome of pregnancy is analyzed with regard to the following factors: diagnosis, gestational age at start of therapy, total dose of anthracycline, number and type of agents used, neonatal pathologic findings and months of follow-up of infants. Final outcome of 28 pregnancies resulted in 24 normal infants including a set of twins in the current report. Limited pharmacokinetic information is inconclusive with regard to the appearance of anthracyclines and their known metabolites in placental or fetal tissue.
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Affiliation(s)
- J J Turchi
- Division of Medical Oncology, Mercy Catholic Medical Center, Darby, PA 19023
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Abstract
Acute leukemia was diagnosed in five pregnant patients who received chemotherapy during the course of pregnancy. Three were undergoing chemotherapy at conception. One patient died in the fifth month of pregnancy and the anatomic study of the fetus was normal. Four babies had low birth weights at birth. Of the four one was born prematurely, but without malformations. Later development was normal. The results are reviewed and compared with data from the literature, leading to the conclusion that pregnancy is not an absolute contraindication for cytostatic treatment, except in the first trimester, in which cytostatic treatment should be avoided.
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Affiliation(s)
- J Feliu
- Department of Internal Medicine, Cuidad Sanitaria La Paz, University Autonoma of Madrid, Spain
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