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Tang X, Zhang X, Ding Y, Zhang Y, Zhang N, Qiu J, Hua K. A long-term retrospective analysis of management of cervical cancer during pregnancy. Int J Gynaecol Obstet 2024; 165:1189-1198. [PMID: 38149695 DOI: 10.1002/ijgo.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE This study aims to describe cervical cancer during pregnancy (CCP) and investigate factors associated with survival outcomes. METHODS This retrospective matched study included CCP patients from May 2007 to August 2021 and matched non-pregnant cervical cancer patients (1:2) based on age (±5 years), year at diagnosis (±2 years), histological type and stage (2018 FIGO). The Kaplan-Meier method and multivariate Cox regression analyses were used to assess the impact of pregnancy and clinicopathologic factors on prognosis. RESULTS Thirty-eight CCP patients (stage IA to IIIC) and 76 non-pregnant patients were included. Most CCP patients were diagnosed in the first (31.6%) or second (47.4%) trimester. CCP patients had a longer waiting time than non-pregnant patients. Pregnancy continued in 42.1% (continuation of pregnancy [COP] group) and was terminated in 57.9% (termination of pregnancy [TOP] group) of patients. Survival analysis showed no significant differences in recurrence-free survival (RFS) or overall survival (OS) between pregnant and non-pregnant patients or between the COP and TOP groups. At the end of the follow-up period (range 12-178 months), 23 children born to CCP patients exhibited normal development. CONCLUSION Pregnancy does not impact cervical cancer prognosis. The oncologic outcomes of the TOP and COP groups were comparable. A pregnancy-preserving strategy could be considered for managing CCP patients.
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Affiliation(s)
- Xiaoyan Tang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Xuyin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Yan Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Yunqiang Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Ning Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Junjun Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies. Cancers (Basel) 2024; 16:1341. [PMID: 38611019 PMCID: PMC11011172 DOI: 10.3390/cancers16071341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.
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Affiliation(s)
- Jennifer Le Guévelou
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Radiation Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75005 Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, 75005 Paris, France
| | - Enora Laas
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
- Université de Paris, 75006 Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, 75005 Paris, France
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Ruan X. Chinese Expert Consensus on ovarian function and fertility preservation of cervical cancer in pregnancy (2023). Front Endocrinol (Lausanne) 2023; 14:1280631. [PMID: 38152134 PMCID: PMC10751331 DOI: 10.3389/fendo.2023.1280631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023] Open
Abstract
Cervical cancer in pregnancy (CCIP) refers to cervical cancer diagnosed during pregnancy, the most common gynecological malignant tumor. Because of the special physiological changes of CCIP, although preserving ovarian function and fertility is very important, the methods are very limited. There is no guideline or consensus on the preservation methods of ovarian function and fertility in this special period. Therefore, the Committee of Fertility Protection and Preservation of China Association for the Promotion of Health Science and Technology, combined with the Chinese Society of Gynecological Endocrinology affiliated to the International Society of Gynecological Endocrinology, Society Endocrinology Branch of Beijing Institute of Obstetrics & Gynecology, combined with Society on Fertility Preservation affiliated with the Chinese Preventive Medicine Association, organized relevant experts from different disciplines to formulate this consensus, in order to guide ovarian function and fertility preservation of CCIP patients.
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Affiliation(s)
- Xiangyan Ruan
- Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Women’s Health, University of Tuebingen, University Women’s Hospital and Research Centre for Women’s Health, Tuebingen, Germany
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He Z, Xie C, Qi X, Hu Z, He Y. The effect of preserving pregnancy in cervical cancer diagnosed during pregnancy: a retrospective study. BMC Womens Health 2022; 22:314. [PMID: 35879712 PMCID: PMC9317436 DOI: 10.1186/s12905-022-01885-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Cervical cancer diagnosed during pregnancy is a rare event, and data regarding efficacy of cancer treatment during pregnancy is limited. This study aimed to assess the safety of continuation of the pregnancy for mother and fetus when concomitantly diagnosed with cervical cancer. Methods This study retrospectively analyzed all cervical cancer patients diagnosed while pregnant or immediately postpartum, inclusive from Jan 2010 to June 2019 at our institute. Patient clinical details and follow-up were obtained from hospital records. Results The study comprised 40 patients with clinical cancer stages of IA1 (1/40, 2.5%); IB1 (15/40, 37.5%); IB2 (10/40, 25%); IIA (12/40, 30%); and IIB (2/40, 5%). There were 38 patients diagnosed during pregnancy, and 2 diagnosed in the postpartum period. Of the 38 patients, 17 were diagnosed in the first trimester, 13 in the second trimester, and 8 in the third trimester. 10 of 38 patients (26.3%) continued their pregnancy after learning of their diagnosis; 7 (70%) in the third trimester and 3 (30%) in the second trimester. The mean time from diagnosis to surgery in the patients who continued their pregnancy was 52.7 days, which was statistically significantly greater than the termination of pregnancy group (52.7 vs. 16.3 days, P < 0.01). Notably, there was no survival difference between the 2 groups (100% vs. 90.91%, P = 0.54), and none of the pregnant women who ultimately died had delayed treatment due to pregnancy. Similarly, the surgical estimated blood loss and operative duration comparison in the 2 groups were not significantly different. Conclusions In the present study, the gestational age of pregnancy at the time of initial diagnosis of cervical cancer was an important determinant in the disease management. Continuation of the pregnancy when diagnosed with cervical cancer may not affect the oncologic outcome of the mother nor increase either surgical or obstetric complications. Additionally, the use of neoadjuvant chemotherapy did not threaten the health of the fetus. These results may be useful in counseling patients facing the diagnosis of cervical cancer during pregnancy.
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Bernardini F, Ferrandina G, Ricci C, Fagotti A, Fanfani F, Cavaliere AF, Gui B, Scambia G, De Vincenzo R. Neoadjuvant Chemotherapy in Pregnant Patients with Cervical Cancer: A Monocentric Retrospective Study. Curr Oncol 2022; 29:5702-5714. [PMID: 36005188 PMCID: PMC9406620 DOI: 10.3390/curroncol29080450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To date, little and discordant data still exists on the management of cervical cancer (CC) during pregnancy. In this paper, we report our experience of the treatment of these patients analyzing the oncologic, obstetric, and neonatal outcomes. Methods: Between January 2010 and December 2021, 13 patients were diagnosed with CC during pregnancy. All patients underwent platinum-based neoadjuvant chemotherapy (NACT) and 11/13 patients underwent a cesarean radical hysterectomy (CRH). Results: All 13 patients were diagnosed with squamous-cell carcinoma, FIGO-2018 stage between IB2-IIIC1. The majority of patients had a partial (61.5%) or complete (15.4%) response to NACT. Most patients had a regular course of pregnancy and the obstetric complications observed were gestational diabetes mellitus in 23.1% and IUGR in 15.4% of cases. CRH was performed in the absence of major complications. Only 2 patients (15.4%) had disease recurrence and only 1 patient (7.7%) died of disease. All children are currently healthy. At birth, we observed mainly prematurity-related complications (38.5% respiratory distress syndrome and 7.7% neonatal jaundice) and only a case of congenital malformation (hypospadias). In our pediatric population, we reported a case of malignancy (acute myeloid leukemia). Conclusion: NACT seems to be safe and efficacious in controlling tumor burden during pregnancy. CRH following NACT appears to be feasible, avoiding repeated surgery and treatment delays. This approach is also reasonably safe from a maternal, obstetric, and neonatal point of view.
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Affiliation(s)
- Federica Bernardini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Gabriella Ferrandina
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Caterina Ricci
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Anna Fagotti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Fanfani
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Anna Franca Cavaliere
- Gynecology and Obstetric Department, Azienda USL Toscana Centro, Santo Stefano Hospital, 59100 Prato, Italy
| | - Benedetta Gui
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiodiagnostica Addominale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Rosa De Vincenzo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
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Enomoto S, Yoshihara K, Kondo E, Iwata A, Tanaka M, Tabata T, Kudo Y, Kondoh E, Mandai M, Sugiyama T, Okamoto A, Saito T, Enomoto T, Ikeda T. Trends in Pregnancy-Associated Cervical Cancer in Japan between 2012 and 2017: A Multicenter Survey. Cancers (Basel) 2022; 14:cancers14133072. [PMID: 35804845 PMCID: PMC9264791 DOI: 10.3390/cancers14133072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Large-scale data on maternal and neonatal outcomes of pregnancy-associated cervical cancer in Japan are scarce, and treatment strategies have not been established. This multicenter retrospective observational study investigated clinical features and trends in pregnancy-associated cervical cancer treatments at 523 hospitals in Japan. We included cervical cancer cases that were histologically diagnosed (between 1 January 2012, and 31 December 2017), and their clinical information was retrospectively collected. Of 40 patients diagnosed with pregnancy-associated cervical cancer at ≥22 gestational weeks, 34 (85.0%) were carefully followed until delivery without intervention. Of 163 diagnosed at <22 gestational weeks, 111 continued and 52 terminated their pregnancy. Ninety patients with stage IB1 disease had various treatment options, including termination of pregnancy. The 59 stage IB1 patients who continued their pregnancy were categorized by the primary treatment into strict follow-up, conization, trachelectomy, and neoadjuvant chemotherapy groups, with no significant differences in progression-free or overall survival. The birth weight percentile at delivery was smaller in the neoadjuvant chemotherapy group than in the strict follow-up group (p = 0.029). Full-term delivery rate was relatively higher in the trachelectomy group (35%) than in the other groups. Treatment decisions for pregnancy-associated cervical cancer are needed after estimating the stage, considering both maternal and fetal benefits.
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Affiliation(s)
- Sayako Enomoto
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan;
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
- Correspondence: (E.K.); (T.E.); Tel.: +81-59-232-1111 (E.K.); +81-25-227-2320 (T.E.)
| | - Akiko Iwata
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan;
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Hiroshima University Graduate School of Medicine, Hiroshima 739-0046, Japan;
| | - Eiji Kondoh
- Department of Obstetrics and Gynecology, Kumamoto University School of Medicine, Kumamoto 860-8556, Japan;
| | - Masaki Mandai
- Department of Obstetrics and Gynecology, Kyoto University School of Medicine, Kyoto 606-8507, Japan;
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University School of Medicine, Ehime 791-0295, Japan;
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo 105-8471, Japan;
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo 060-8543, Japan;
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan;
- Correspondence: (E.K.); (T.E.); Tel.: +81-59-232-1111 (E.K.); +81-25-227-2320 (T.E.)
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan; (S.E.); (T.I.)
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Estrogen receptor-positive adenocarcinoma of the cervix presenting during pregnancy: Two case reports and review of the literature. Gynecol Oncol Rep 2022; 39:100916. [PMID: 35036507 PMCID: PMC8753117 DOI: 10.1016/j.gore.2021.100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 12/03/2022] Open
Abstract
Estrogen receptor or progesterone receptor positivity are unusual in cervical adenocarcinomas. Estrogen receptor positivity in pregnancy could be associated with a faster growth rate. Both patients presented remain free of recurrence after definitive treatment.
The incidence of adenocarcinoma of the cervix in pregnancy is exceptionally rare, and thus there is no consensus on its management. Here, we report two cases of adenocarcinoma of the cervix diagnosed in the context of pregnancy. In our first case, a patient referred to colposcopy for atypical glandular cells of undetermined significance was subsequently diagnosed with well differentiated endocervical adenocarcinoma on cone biopsy. Just prior to the cone biopsy, she was incidentally found to have a first trimester pregnancy loss. The patient subsequently underwent a radical hysterectomy and bilateral sentinel lymph node dissection. Final pathology revealed a stage 1B1 (FIGO 2009) well differentiated adenocarcinoma of the cervix. Interestingly, the tumour was positive for estrogen receptor, which is unusual for cervical adenocarcinoma. In our second case, a patient presented with a pedunculated, exophytic cervical neoplasm at 31 weeks GA with self-limiting antepartum hemorrhage. The primary lesion measured 52 mm in diameter on MRI and was amputated at the base during the patient’s elective repeat cesarean section. Final pathology revealed a stage IB2 (FIGO 2009) mucinous adenocarcinoma of the cervix. The patient subsequently underwent a radical hysterectomy and bilateral pelvic lymph node dissection 17 weeks after initial presentation. The depth of invasion was 2.2 mm, restricted to the inner third of the cervical wall, and there was no lymphovascular space invasion in the surgical specimen. Surgical margins, parametria, and lymph nodes were all negative for adenocarcinoma. This tumour was also found to be estrogen receptor/progesterone receptor (ER/PR) positive, again unusual for cervical adenocarcinoma. P16 was strongly positive and HPV DNA studies were also positive for human papilloma virus 18. The patient received adjuvant external beam radiotherapy to the pelvis and currently remains in remission.
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Key Words
- Adenocarcinoma
- CT, Computed Tomography
- Cervical cancer
- Cervix
- DFS, disease-free survival
- EBRT, External Beam RadioTherapy
- ER, Estrogen Receptor
- Estrogen receptor
- GA, Gestational Age
- HPVA, Human PapillomaVirus-Associated
- IECC, International Endocervical Adenocarcinoma Criteria and Classification
- IHC, Immuno-Histo-Chemistery
- LVSI, LymphoVascular Space Invasion
- MRI, Magnetic Resonance Imaging
- NOS, Not Otherwise Specified
- OS, Overall Survival
- PFS, Progression Free Survival
- PR, Progesterone Receptor
- Pregnancy
- SCC, Squamous Cell Carcinoma
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Cancer survival in women diagnosed with pregnancy-associated cancer: An overview using nationwide registry data in Sweden 1970-2018. Eur J Cancer 2021; 155:106-115. [PMID: 34371441 DOI: 10.1016/j.ejca.2021.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pregnancy-associated cancer (PAC) is increasing over time in many countries. We provide a comprehensive, population-based overview of cancer survival in women with PAC across five decades. METHODS We performed a nationwide cohort study of 121,382 women diagnosed with cancer at age 15-49 between 1970 and 2018 using birth and cancer registers in Sweden. Pregnancy-associated cancer was defined as diagnosed during pregnancy and within one year of delivery, while non-PAC was outside this window. Cox regression estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) comparing cancer mortality for PAC versus non-PAC. RESULTS In total, 5079 women had a diagnosis of PAC. Cutaneous malignant melanoma, breast, cervical, thyroid and central nervous system (CNS) were the most common sites of PAC. A higher cancer mortality was observed in PAC versus non-PAC for breast (HR = 1.72, 95% CI 1.54-1.93) and uterine cancer (myometrium/unspecified) (8.62, 2.80-26.53), in which all PAC deaths were uterine sarcomas. Increased mortality was also observed in upper digestive tract cancer diagnosed during pregnancy and colon cancer diagnosed during first year after delivery. Contrary, the HR for CNS tumours was significantly decreased (0.71, 0.55-0.91). Survival after PAC improved for most sites over time, with survival after breast cancer during pregnancy in recent years being similar to that of non-pregnancy associated breast cancer. CONCLUSION For the majority of sites, PAC was not associated with poorer prognosis compared to non-PAC, a finding which was stable over time. The main exceptions were breast cancer and rarer cancers, such as uterine sarcoma.
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Human papillomavirus (HPV) in pregnancy - An update. Eur J Obstet Gynecol Reprod Biol 2021; 264:340-348. [PMID: 34385080 DOI: 10.1016/j.ejogrb.2021.07.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
Human papilloma viruses (HPV) are small epitheliotropic DNA viruses, of which there are 200 genotypes, 40 of which are known to cause genital infections and are also oncogenic. HPV is the most common sexually transmitted infection. Clinical features vary from asymptomatic (identified at routine cervical cancer screening) to large lesions on the vulva, vagina, cervix and some extragenital sites. Its prevalence in pregnancy varies from 5.5% to 65% depending on age, geography and gestational age (increasing with gestational age). Infection in pregnancy has been associated with adverse outcomes such as spontaneous miscarriage, preterm birth, placental abnormalities and fetal growth restriction. However, the evidence for these adverse outcomes is varied. Besides being oncogenic (and thus associated with cancer of the cervix in pregnancy), vertical transmission to the fetus/neonate can cause neonatal infections, especially juvenile-onset recurrent oral and respiratory papillomatosis (JORRP). Where there are very large lesions on the vulva, delivery may be obstructed. Diagnosis in pregnancy is mainly by viral PCR or from the clinical appearance of the characteristic lesions on the vulva. Treatment is local by either surgical or laser excision or application of trichloroacetic acid. Podophyllin/podophyllotoxin is contraindicated in pregnancy. HPV Infection is not an indication for caesarean delivery as this has not been shown to prevent vertical transmission. For those diagnosed at routine cervical cancer screening, management should follow guidelines for cervical cancer screening in pregnancy. Vaccination is currently not recommended for pregnant women, although studies on those inadvertently vaccinated in pregnancy have not shown any adverse effects on either the fetus or mother.
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Tafesse TB, Bule MH, Khan F, Abdollahi M, Amini M. Developing Novel Anticancer Drugs for Targeted Populations: An Update. Curr Pharm Des 2021; 27:250-262. [PMID: 33234093 DOI: 10.2174/1381612826666201124111748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Due to higher failure rates, lengthy time and high cost of the traditional de novo drug discovery and development process, the rate of opportunity to get new, safe and efficacious drugs for the targeted population, including pediatric patients with cancer, becomes sluggish. OBJECTIVES This paper discusses the development of novel anticancer drugs focusing on the identification and selection of targeted anticancer drug development for the targeted population. METHODS Information presented in this review was obtained from different databases, including PUBMED, SCOPUS, Web of Science, and EMBASE. Various keywords were used as search terms. RESULTS The pharmaceutical companies currently are executing drug repurposing as an alternative means to accelerate the drug development process that reduces the risk of failure, time and cost, which take 3-12 years with almost 25% overall probability of success as compared to de novo drug discovery and development process (10- 17 years) which has less than 10% probability of success. An alternative strategy to the traditional de novo drug discovery and development process, called drug repurposing, is also presented. CONCLUSION Therefore, to continue with the progress of developing novel anticancer drugs for the targeted population, identification and selection of target to specific disease type is important. Considering the aspects of the age of the patient and the disease stages such as each cancer types are different when we study the disease at a molecular level. Drug repurposing technique becomes an influential alternative strategy to discover and develop novel anticancer drug candidates.
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Affiliation(s)
- Tadesse B Tafesse
- Department of Medicinal Chemistry, School of Pharmacy, Drug Design and Development Research Center and The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammed H Bule
- Department of Medicinal Chemistry, School of Pharmacy, Drug Design and Development Research Center and The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazlullah Khan
- Department of Allied Health Sciences, Bashir Institute of Health Sciences, Bhara Kahu Islamabad, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), and Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohsen Amini
- Department of Medicinal Chemistry, School of Pharmacy, Drug Design and Development Research Center and The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Halaska MJ, Drochytek V, Shmakov RG, Amant F. Fertility sparing treatment in cervical cancer management in pregnancy. Best Pract Res Clin Obstet Gynaecol 2021; 75:101-112. [PMID: 33992541 DOI: 10.1016/j.bpobgyn.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/29/2021] [Indexed: 12/09/2022]
Abstract
The article focuses on fertility-sparing management during pregnancy and obstetrical management after fertility-sparing surgery. Over the years, more women in developed countries tend to delay childbirth to a later age, which leads to cervical cancer more often diagnosed during pregnancy. The advances in our understanding of prognosis and treatment options in these patients have helped us to address avenues and to circumvent standard therapy and fetal demise, respecting maternal and fetal chances. Childbearing trends also lead to an increase in the number of patients considering fertility-sparing management when diagnosed with cervical cancer. Such management represents a challenge for obstetricians as prior cervical surgery is a known risk factor for various adverse events. These include decreased fertility, second trimester miscarriage, preterm labor, or preterm premature rupture of membranes. Watchful follow-up and various prophylactic measures are keys when striving for the best possible outcome.
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Affiliation(s)
- Michael J Halaska
- Dept. of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Vit Drochytek
- Dept. of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Roman G Shmakov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Frédéric Amant
- Dept. Gynaecology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Dept. Oncology, KU Leuven, Belgium; Dept. Obstetrics and Gynaecology, Amsterdam University Medical Centers, the Netherlands.
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12
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Lopez A, Rodriguez J, Estrada E, Aragona A, Chavez C, Amaro K, De Padua C, Borges Garnica A, Rendón G, Alméciga A, Serrano O, Scasso S, Laufer J, Greif D, Taranto F, Hoegl J, Calderaro di Ruggiero F, Pareja R. Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study. Int J Gynecol Cancer 2021; 31:468-474. [PMID: 33649015 DOI: 10.1136/ijgc-2020-001764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy. METHODS A multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes. RESULTS Thirty-three patients were included. Median age was 34 years (range 31-36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA-IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34-36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0-36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease. CONCLUSION Neoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.
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Affiliation(s)
- Aldo Lopez
- Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Juliana Rodriguez
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia.,Department of Gynecology and Obstetrics. Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Erick Estrada
- Department of Gynecology and Obstetrics, Hospital General San Juan de Dios, Guatemala City, Guatemala, Guatemala
| | - Alejandro Aragona
- Hospital Municipal de Oncologia Marie Curie, Buenos Aires, Federal District, Argentina
| | - Carlos Chavez
- Instituto Regional de Enfermedades Neoplásicas (IREN Sur), Arequipa, Peru
| | - Karina Amaro
- Hospital Nacional Cayetano Heredia, Lima, Lima, Peru
| | | | - Alfredo Borges Garnica
- Unidad de Terapia Antineoplásica (UTAN), Centro Médico Guerra Méndez, Valencia, Venezuela, Bolivarian Republic
| | - Gabriel Rendón
- Department of Gynecologic Oncology, Instituto de Cancerología- Las Américas-AUNA, Medellin, Antioquia, Colombia
| | - Adriana Alméciga
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Oscar Serrano
- Department of Gynecologic Oncology, Hospital Militar Centra, Bogotá, Colombia
| | - Santiago Scasso
- Department of Gynecologic Oncology, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Joel Laufer
- Department of Gynecologic Oncology, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Diego Greif
- Department of Gynecology, Hospital de Clínicas Dr. Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Fernando Taranto
- Department of Gynecology, Hospital de Clínicas Dr. Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Jorge Hoegl
- Servicio Oncológico Hospitalario del Instituto Venezolano de los Seguros Sociales, Caracas, Venezuela
| | | | - René Pareja
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia .,Clínica de Oncología Astorga, Universidad Pontificia Bolivariana, Medellin, Colombia
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13
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Matsuo K, Novatt H, Matsuzaki S, Hom MS, Castaneda AV, Licon E, Nusbaum DJ, Roman LD. Wait-time for hysterectomy and survival of women with early-stage cervical cancer: A clinical implication during the coronavirus pandemic. Gynecol Oncol 2020; 158:37-43. [PMID: 32425268 PMCID: PMC7231758 DOI: 10.1016/j.ygyno.2020.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A global pandemic caused by a novel coronavirus (Covid-19) has created unique challenges to providing timely care for cancer patients. In early-stage cervical cancer, postponing hysterectomy for 6-8 weeks is suggested as a possible option in the Covid-19 burdened hospitals. Yet, literature examining the impact of surgery wait-time on survival in early-stage cervical cancer remains scarce. This study examined the association between surgery wait-time of 8 weeks and oncologic outcome in women with early-stage cervical cancer. METHODS This is a single institution retrospective observational study at a tertiary referral medical center examining women who underwent primary hysterectomy or trachelectomy for clinical stage IA-IIA invasive cervical cancer between 2000 and 2017 (N = 217). Wait-time from the diagnosis of invasive cervical cancer via biopsy to definitive surgery was categorized as: short wait-time (<8 weeks; n = 110) versus long wait-time (≥8 weeks; n = 107). Propensity score inverse probability of treatment weighting was used to balance the measured demographics between the two groups, and disease-free survival (DFS) and overall survival (OS) were assessed. A systematic literature review with meta-analysis was additionally performed. RESULTS In a weighted model (median follow-up, 4.6 years), women in the long wait-time group had DFS (4.5-year rates, 91.2% versus 90.7%, hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.47-2.59, P = 0.818) and OS (95.0% versus 97.4%, HR 1.47, 95%CI 0.50-4.31, P = 0.487) similar to those in the short wait-time group. Three studies were examined for meta-analysis, and a pooled HR for surgery wait-time of ≥8 weeks on DFS was 0.96 (95%CI 0.59-1.55). CONCLUSION Our study suggests that wait-time of 8 weeks for hysterectomy may not be associated with short-term disease recurrence in women with early-stage cervical cancer.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Hilary Novatt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Marianne S Hom
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, CA, USA
| | - Antonio V Castaneda
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ernesto Licon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - David J Nusbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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14
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Abstract
Cancer complicates 1 in 1000 pregnancies. Multidisciplinary consensus comprised of Gynecologic Oncology, Pathology, Neonatology, Radiology, Anesthesiology, Maternal Fetal Medicine, and Social Work should be convened. Pregnancy provides an opportunity for cervical cancer screening, with deliberate delays in treatment permissible for early stage carcinoma. Vaginal delivery is contraindicated in the presence of gross lesion(s) and radical hysterectomy with lymphadenectomy at cesarean delivery is recommended. Women with locally advanced and metastatic/recurrent disease should commence treatment at diagnosis with chemoradiation and systemic therapy, respectively; neoadjuvant chemotherapy to permit gestational advancement may be considered in select cases. Most adnexal masses are benign and resolve by the second trimester. Persistent, asymptomatic, benign-appearing masses can be managed conservatively; surgery, if indicated, is best deferred to 15-20 weeks, with laparoscopy preferable over laparotomy whenever possible. Benign and malignant germ cell tumors and borderline tumors are occasionally encountered, with unilateral adnexectomy and preservation of the uterus and contralateral ovary being the rule. Epithelial ovarian cancer is exceedingly rare. Ultrasonography and magnetic resonance imaging lack ionizing radiation and can be employed to evaluate disease extent. Tumor markers, including CA-125, AFP, LDH, inhibin-B, and even CEA and ßhCG may be informative. If required, chemotherapy can be administered following organogenesis during the second and third trimesters. Because platinum and other anti-neoplastic agents cross the placenta, chemotherapy should be withheld after 34 weeks to avoid neonatal myelosuppression. Bevacizumab, immune checkpoint inhibitors, and PARP inhibitors should be avoided throughout pregnancy. Although antenatal glucocorticoids to facilitate fetal pulmonary maturation and amniotic fluid index assessment can be considered, there is no demonstrable benefit of tocolytics, antepartum fetal heart rate monitoring, and/or amniocentesis. Endometrial, vulvar, and vaginal cancer in pregnancy are curiosities, although leiomyosarcoma and the dreaded twin fetus/hydatidiform mole have been reported. For gynecologic malignancies, pregnancy does not impart aggressive clinical behavior and/or worse prognosis.
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Affiliation(s)
- Travis-Riley K Korenaga
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA.
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15
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Wong JW, Sperling MM, Harvey SA, Killeen JL, Carney ME. A fight-and-flight for life: A rare case of advanced cervical cancer in pregnancy. Gynecol Oncol Rep 2020; 32:100565. [PMID: 32300631 PMCID: PMC7152695 DOI: 10.1016/j.gore.2020.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Advanced cervical cancer during pregnancy is an extremely rare event. We describe a case of at least stage IIIB cervical squamous cell carcinoma during pregnancy. This may possibly represent the longest gestation from time of diagnosis to delivery in a case of advanced cervical cancer, with potentially the most advanced gestational age at delivery and a relatively favorable outcome in the current literature.Case: A 29-year-old female at 20 0/7 weeks of gestation with at least stage IIIB squamous cell carcinoma of the cervix flew from Micronesia to Hawaii for oncologic treatment. After consultation with gynecologic oncology and maternal-fetal medicine, she opted to continue the pregnancy and began neoadjuvant chemotherapy with carboplatin and paclitaxel. At 33 2/7 weeks of gestation, she was admitted for preterm prelabor rupture of membranes and immediately underwent a cesarean delivery for heavy vaginal bleeding. Postpartum, she underwent cisplatin chemotherapy with concurrent radiation therapy. After 6 cycles of chemotherapy, the patient's cancer had progressed to the point that hospice was recommended. She died 11 months after initial presentation. CONCLUSION Advanced cervical cancer during pregnancy requires individualized treatment, shared decision making, and a multidisciplinary team approach. If the pregnancy is continued, antepartum chemotherapy should be strongly considered. Maternal prognoses tend to be poor, but neonatal outcomes appear to be favorable.
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Affiliation(s)
- Jennifer W.H. Wong
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Meryl M. Sperling
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Scott A. Harvey
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Jeffrey L. Killeen
- Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Michael E. Carney
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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16
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Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, Halaska MJ, Hasenburg A, Johansson ALV, Lambertini M, Lok CAR, Maggen C, Morice P, Peccatori F, Poortmans P, Van Calsteren K, Vandenbroucke T, van Gerwen M, van den Heuvel-Eibrink M, Zagouri F, Zapardiel I. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol 2019; 30:1601-1612. [PMID: 31435648 DOI: 10.1093/annonc/mdz228] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
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Affiliation(s)
- F Amant
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - P Berveiller
- Department of Obstetrics and Gynecology, Centre Hospitalier de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - I A Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, USA
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - M Fumagalli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - A Hasenburg
- Department of Obstetrics and Gynecology, Mainz University Medical Center, Mainz, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Lambertini
- Department of Medical Oncology, IRCCS Policlinico San Martino Hospital, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C A R Lok
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands
| | - C Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - P Morice
- Department of Gynecologic Surgery, Institute de Cancérologie Gustave Roussy, Villejuif, France
| | - F Peccatori
- Department of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Department of Radiation Oncology, Institut Curie and Paris Sciences & Lettres - PSL University, Paris, France
| | - K Van Calsteren
- Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | | | - M van Gerwen
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - F Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, Athens, Greece
| | - I Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
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17
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Halaska MJ, Uzan C, Han SN, Fruscio R, Dahl Steffensen K, Van Calster B, Stankusova H, Delle Marchette M, Mephon A, Rouzier R, Witteveen PO, Vergani P, Van Calsteren K, Rob L, Amant F. Characteristics of patients with cervical cancer during pregnancy: a multicenter matched cohort study. An initiative from the International Network on Cancer, Infertility and Pregnancy. Int J Gynecol Cancer 2019; 29:ijgc-2018-000103. [PMID: 30898935 DOI: 10.1136/ijgc-2018-000103] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Treatment of cervical cancer during pregnancy is often complex and challenging. This study aimed to analyze current patterns of practice in the management of pregnant patients diagnosed with cervical cancer. METHODS This was a matched cohort study comprising patients managed for cervical cancer during pregnancy from six European centers. Patient information was retrieved from the dataset of the International Network for Cancer, Infertility and Pregnancy from 1990 to 2012. Each center matched its patients with two non-pregnant controls for age (±5 years) and International Federation of Gynecology and Obstetrics (FIGO) 2009 stage. Information on age, histological type, grade, lymphovascular space invasion, stage, tumor size, method of diagnosis, site of recurrence, delivery, date of recurrence, and date of death was recorded. Progression-free survival was compared using multivariable Cox proportional hazards regression. RESULTS A total of 132 pregnant patients and 256 controls were analyzed. The pregnant patients (median age 34 years, range 21-43) were diagnosed at a median gestational age of 18.4 weeks of pregnancy (range 7-39). Stage distribution during pregnancy was 14.4% for stage IA, 47.0% for IB1, 18.9% for IB2, and 19.7% for II-IV. For treatment during pregnancy, 17.4% of the patients underwent surgery, 16.7% received neoadjuvant chemotherapy, 26.5% delayed their treatment, 12.9% had a premature delivery, and 26.5% had their pregnancy terminated. Median follow-up was 84 months (67 months for pregnant and 95 months for non-pregnant patients). The unadjusted hazard ratio of pregnancy for progression-free survival was 1.18 (95% confidence interval 0.74 to 1.88). CONCLUSION Surgery and chemotherapy is increasingly used in the management of pregnant patients with cervical cancer and prognosis is similar to that of non-pregnant patients.
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Affiliation(s)
- Michael J Halaska
- Department of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Catherine Uzan
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
- Department of Gynecology and Breast surgery, Pitié Salpêtrière Hospital, Institut Universitaire de Cancérologie, Sorbonne University, INSERM U938, Paris, France
| | - Sileny N Han
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | | | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hana Stankusova
- Department of Medical Oncology, Faculty Hospital Motol, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Martina Delle Marchette
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | | | | | - Petronella O Witteveen
- Department of Medical Oncology, Cancer Center University Medical Center, Utrecht, The Netherlands
| | - Patrizia Vergani
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Kristina Van Calsteren
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Lukas Rob
- Department of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Frederic Amant
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
- Centre for Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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18
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Capriglione S, Manzano A, Gulino FA, Lopez S. Management of gynecological cancer in pregnant patients. ACTA ACUST UNITED AC 2018; 71:133-145. [PMID: 30318875 DOI: 10.23736/s0026-4784.18.04324-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cancer during pregnancy is a rare but challenging condition. More women delay childbearing and consequently the incidence of cancer during pregnancy is constantly increasing. EVIDENCE ACQUISITION An extensive electronic search was performed in PubMed and Scopus. Only studies written after 1985 were considered eligible for this review. Abstracts, conference papers, book chapters, animal studies, commentaries as well as editorials articles were excluded from this review. EVIDENCE SYNTHESIS Cancer treatment during pregnancy is possible, but both maternal and fetal conditions need to be preserved. Randomized clinical trials are not feasible and current evidence are mainly based on case-series, small case reports and expert opinion. Cervical and ovarian cancers are the most common gynecological cancers diagnosed during pregnancy. Surgery and chemotherapy after the first trimester seem to be relatively safe for the newborn. Platinum-based chemotherapy administered during the 2nd-3rd trimester showed comparable adverse effects in newborns to those in the general population. Babies exposed to antenatal chemotherapy might be more likely to develop small for gestational age and NICU admission, than babies not exposed. CONCLUSIONS Management of pregnant women with cancer should be performed in specialized cancer centers and all cases should be discussed with a multidisciplinary approach. In the present review, we discuss the current recommendations for the management of pregnancies complicated by cancer and neonatal outcomes.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynecology, Institute for Social Security, Borgo Maggiore, San Marino
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | | | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA - .,Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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19
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Oliveira AFD, Souza LRMFD, Paschoini MC, Murta EFC, Nomelini RS. Chemotherapy for cervical cancer in pregnancy. J OBSTET GYNAECOL 2018; 39:425-426. [PMID: 30286666 DOI: 10.1080/01443615.2018.1474187] [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)
- Aline Figueredo de Oliveira
- a Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics , Federal University of Triângulo Mineiro , Uberaba , Brazil
| | | | - Marina Carvalho Paschoini
- c Discipline of Gynecology and Obstetrics , Federal University of Triângulo Mineiro , Uberaba , Brazil
| | - Eddie Fernando Candido Murta
- a Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics , Federal University of Triângulo Mineiro , Uberaba , Brazil
| | - Rosekeila Simões Nomelini
- a Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics , Federal University of Triângulo Mineiro , Uberaba , Brazil
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20
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Iavazzo C, Minis EE, Gkegkes ID. Current management of gynecologic cancer in pregnancy. J Turk Ger Gynecol Assoc 2018; 19:104-110. [PMID: 29699959 PMCID: PMC5994818 DOI: 10.4274/jtgga.2018.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer during pregnancy is a particularly challenging complication. The incidence has increased in recent years due to childbearing at advanced maternal ages due to career choices and/or the development of reproductive technology. Approximately two thirds of cancer cases during pregnancy comprise invasive cervical cancers and breast cancer. Cancer during gestation is characterized by a need for specialized treatment due to major changes in the hormonal profile (estrogen-progesterone), metabolism (enhancement of anabolism), hemodynamic changes (hyperdynamic circulation), immunologic changes (cell-mediated and humoral immunity), and increased angiogenesis (increased blood flow towards the uterus). Moreover, the management of such patients is based on the trimester of pregnancy, type and stage of cancer, and informed consent of the mother based on her wishes. The optimal treatment of cancer during pregnancy remains elusive because there are limited data from retrospective studies with small samples. As a result, it is crucial that data regarding survival of the women and long-term follow-up of the children from different cancer centers and registries are shared. This need is dictated by the fact that the incidence of cancer during pregnancy will continue to rise as child-bearing age continues to increase.
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Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Ioannis D Gkegkes
- Department of Surgery, General Hospital of Attica “KAT”, Athens, Greece
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