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Lucrezia DC, Claudio F, Anna C, Miriam T, Laura G, Alessandro L, Andrei F, Sara B, Marcella P, Nadia DM, Italo D. A case of radiotherapy during pregnancy for oropharyngeal cancer: long term pediatric outcome evaluation and literature review. Pract Radiat Oncol 2024:S1879-8500(24)00202-9. [PMID: 39182646 DOI: 10.1016/j.prro.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/14/2024] [Accepted: 06/05/2024] [Indexed: 08/27/2024]
Abstract
Oropharyngeal cancer (OphC) is extremely rare during pregnancy, although its incidence is expected to increase in the years to come. Any delay of treatment can heavily affect cancer control and survival. Information regarding radiotherapy during pregnancy and long-term pediatric outcome is lacking. In this article, we discuss a case of OphC in a pregnant woman, treated with surgery and radiotherapy, offering also an update review with respect to the limited current evidences of the feasibility and clinical results of radiotherapy during pregnancy. A 39-year-old pregnant woman (through assisted fertilization) with locally advanced OphC underwent surgery and subsequent radiotherapy. A special fetal shielding device and a modified planning optimization strategy were used to reduce the dose to the fetus as much as possible. Phantom and in-vivo dosimetry were performed to estimate the dose to the fetus and the related risks, according to ICRP90. Thanks to the actions taken, the mean dose to the fetus was estimated to be around 50 mSv. A healthy baby was born at 33 weeks of gestation + 6 days. After ten-year follow-up, the patient is in complete remission and her 16-year old daughter is healthy with good school performances. Adjuvant radiotherapy in OphC during pregnancy may be optimized to reduce the dose to the fetus and the measures taken represents a realistic option to ensure mother and baby health.
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Affiliation(s)
| | - Fiorino Claudio
- Medical Physics Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Anna
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Torrisi Miriam
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giannini Laura
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Loria Alessandro
- Medical Physics Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fodor Andrei
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Broggi Sara
- Medical Physics Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pasetti Marcella
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Dell'Oca Italo
- Radiation Oncology Department, IRCCS Ospedale San Raffaele, Milan, Italy
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Heesterbeek CJ, Lenaerts L, Tjan-Heijnen VCG, Amant F, van Rij MC, Theunis M, de Die-Smulders CEM, Vermeesch JR, Macville MVE. Comprehensive Recommendations for the Clinical Management of Pregnant Women With Noninvasive Prenatal Test Results Suspicious of a Maternal Malignancy. JCO Oncol Pract 2024; 20:1027-1034. [PMID: 38608208 DOI: 10.1200/op.23.00594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/12/2024] [Accepted: 02/29/2024] [Indexed: 04/14/2024] Open
Abstract
In this article, we defined comprehensive recommendations for the clinical follow-up of pregnant women with a malignancy-suspicious NIPT result, on the basis of the vast experience with population-based NIPT screening programs in two European countries complemented with published large data sets. These recommendations provide a tool for classifying NIPT results as malignancy-suspicious, and guide health care professionals in structured clinical decision making for the diagnostic process of pregnant women who receive such a malignancy-suspicious NIPT result.
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Affiliation(s)
- Catharina J Heesterbeek
- Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frédéric Amant
- Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Gynecologic Oncology, Catholic University Leuven, Leuven, Belgium
- Department of Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Maartje C van Rij
- Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Miel Theunis
- Centre of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Christine E M de Die-Smulders
- Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Clinical Genetics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joris R Vermeesch
- Centre of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Merryn V E Macville
- Department of Clinical Genetics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
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Pelczar P, Kosteczko P, Wieczorek E, Kwieciński M, Kozłowska A, Gil-Kulik P. Melanoma in Pregnancy-Diagnosis, Treatment, and Consequences for Fetal Development and the Maintenance of Pregnancy. Cancers (Basel) 2024; 16:2173. [PMID: 38927879 PMCID: PMC11202133 DOI: 10.3390/cancers16122173] [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: 05/24/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Cutaneous malignant melanoma is one of the most common neoplasms among pregnancy-associated cancers (PACs). Risk factors include excessive exposure to ultraviolet radiation, the presence of benign and dysplastic nevi, and a patient or family history of melanoma. Self-examination and careful inspection of nevi are crucial, especially in the context of their progression over time. Physiological changes that occur during pregnancy, such as the darkening and enlargement of the nevi, delay the diagnosis of CMM. In the fetus, metastases are very rare, and if they do occur, they concern the placenta or fetal tissues. The choice of treatment is influenced by the cancer stage, symptoms, the time of termination of pregnancy, and the patient's decision. Essential procedures which are safe for the fetus are diagnostic biopsy, ultrasound, and the therapeutic excision of the lesion and the affected lymph nodes. Other imaging methods can be used with a safe radiation dose limit of 100 mGy. Immunotherapy and targeted treatments must be carefully considered, because of their possible adverse effects on the fetus. An interdisciplinary approach to the problem of melanoma during pregnancy is necessary, involving doctors of various specialties.
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Affiliation(s)
- Patrycja Pelczar
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Pola Kosteczko
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Ewelina Wieczorek
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Maciej Kwieciński
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Aleksandra Kozłowska
- Department of Radiotherapy, Medical University of Lublin, 13 Radziwillowska Str., 20-080 Lublin, Poland;
| | - Paulina Gil-Kulik
- Department of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland
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Vulasala SS, Virarkar M, Karbasian N, Calimano-Ramirez LF, Daoud T, Amini B, Bhosale P, Javadi S. Whole-body MRI in oncology: A comprehensive review. Clin Imaging 2024; 108:110099. [PMID: 38401295 DOI: 10.1016/j.clinimag.2024.110099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024]
Abstract
Whole-Body Magnetic Resonance Imaging (WB-MRI) has cemented its position as a pivotal tool in oncological diagnostics. It offers unparalleled soft tissue contrast resolution and the advantage of sidestepping ionizing radiation. This review explores the diverse applications of WB-MRI in oncology. We discuss its transformative role in detecting and diagnosing a spectrum of cancers, emphasizing conditions like multiple myeloma and cancers with a proclivity for bone metastases. WB-MRI's capability to encompass the entire body in a singular scan has ushered in novel paradigms in cancer screening, especially for individuals harboring hereditary cancer syndromes or at heightened risk for metastatic disease. Additionally, its contribution to the clinical landscape, aiding in the holistic management of multifocal and systemic malignancies, is explored. The article accentuates the technical strides achieved in WB-MRI, its myriad clinical utilities, and the challenges in integration into standard oncological care. In essence, this review underscores the transformative potential of WB-MRI, emphasizing its promise as a cornerstone modality in shaping the future trajectory of cancer diagnostics and treatment.
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Affiliation(s)
- Sai Swarupa Vulasala
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States.
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Niloofar Karbasian
- Department of Radiology, McGovern Medical School at University of Texas Health Houston, Houston, TX, United States
| | - Luis F Calimano-Ramirez
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Taher Daoud
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Behrang Amini
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Priya Bhosale
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sanaz Javadi
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Milosevic B, Likic Ladjevic I, Dotlic J, Beleslin A, Mihaljevic O, Pilic I, Kesic V, Gojnic M, Stefanovic A, Stefanovic K. Cancer during pregnancy: Twenty-two years of experience from a tertiary referral center. Acta Obstet Gynecol Scand 2024; 103:716-728. [PMID: 38216215 PMCID: PMC10993340 DOI: 10.1111/aogs.14756] [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: 03/30/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Cancer complicating pregnancy is a rare but potentially life-threatening condition for both the mother and her child. The aim of the present study was to assess the outcomes for mothers and children after pregnancy complicated by malignancy and to investigate which parameters are important for their 1-year survival. MATERIAL AND METHODS The study included 84 pregnant women diagnosed with malignant tumors during pregnancy from 2001 to 2022. The pregnancy course and outcome, as well as parameters that could influence the survival and condition of the mother and child were evaluated. Mothers and children were followed up for 1 year after delivery to assess their condition/complications and overall survival. RESULTS Most malignancies were gynecological (31%) or hematological (23.8%) and were diagnosed and surgically treated in the second trimester. Most children (69%) showed adequate growth and development throughout pregnancy but were delivered before term (53.6%) to allow mothers to receive therapy. Adjuvant therapy during pregnancy mostly caused a transitory deterioration of the child's condition, while surgery did not significantly impact the pregnancy course. Deliveries, on average, occurred during the 33.01 ± 6.16 gestational week (range: 20-40) and mostly by cesarean section (76.2%). For mothers, the pregnancy survival rate was 95.2% and survival after 1 year was 87.5%. However, 37.5% of women were still ill and required additional therapy 1 year postpartum. The pregnancy survival rate for children was 94%, whereas the 1-year survival rate was 76.2%. Most children had a favorable condition (alive, adequately growing and developing, and without complications) at birth (81%) as well as at the 1-year follow-up (63.7%). Regression analysis identified the following predictors of favorable 1-year maternal condition: applying therapy during pregnancy, no progression of the malignancy during pregnancy, and delivery at a later gestational week. Predictors of favorable 1-year condition of children were lower histopathological grade of malignancy, surgery as therapy for malignancy, obtaining higher birthweight, and delivery by cesarean section. CONCLUSIONS If the malignancy is not progressing, pregnancy should be continued as long as possible for the child to obtain adequate birthweight. Both surgery and chemotherapy were safe therapeutic choices, as most pregnancies continued successfully after therapy.
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Affiliation(s)
- Branislav Milosevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Ivana Likic Ladjevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Jelena Dotlic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandra Beleslin
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Olga Mihaljevic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
| | - Igor Pilic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Vesna Kesic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Miroslava Gojnic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Aleksandar Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | - Katarina Stefanovic
- Clinic for Obstetrics and GynecologyUniversity Clinical Center of SerbiaBelgradeSerbia
- Medical FacultyUniversity of BelgradeBelgradeSerbia
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Galante A, Cerbone M, Mannavola F, Marinaccio M, Schonauer LM, Dellino M, Damiani GR, Pinto V, Cormio G, Cicinelli E, Vimercati A. Diagnostic, Management, and Neonatal Outcomes of Colorectal Cancer during Pregnancy: Two Case Reports, Systematic Review of Literature and Metanalysis. Diagnostics (Basel) 2024; 14:559. [PMID: 38473031 DOI: 10.3390/diagnostics14050559] [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: 12/06/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE Colorectal cancer (CRC) during pregnancy is a rare occurrence, with a reported incidence of 0.8 cases per 100,000 pregnancies. Managing CRC during pregnancy poses substantial challenges for clinicians: the diagnosis is often complicated and delayed due to symptom overlap with pregnancy-related manifestations, and medical imaging is constrained by safety concerns for the foetus. METHODS This article presents two cases of advanced CRC diagnosed and managed during pregnancy. Additionally, we conducted a systematic review of the literature to assess diagnostic and prognostic factors involved in CRC in pregnant individuals. The systematic review, with pre-registration and approval through Prospero, involved an extensive search of medical databases (Pubmed, Web of Science, Scopus and Scholar) and statistical analysis using t-test for continuous variables and chi square for dichotomous variables. RESULTS A total of 1058 studies were identified. After applying exclusion criteria, sixty-six studies were included. Women whose initial symptoms were severe abdominal pain not responsive to common medical treatments and constipation (acute abdomen) had a mean gestational age at delivery lower than those who presented with paucisymptomatic onset. In our study groups, women who underwent chemotherapy during pregnancy had a higher mean gestational age at delivery and did not experience worse neonatal outcomes compared to those who did not undergo chemotherapy. CONCLUSIONS CRC during pregnancy poses unique diagnostic and therapeutic challenges. Collaborative efforts among various medical disciplines are essential to manage CRC during pregnancy.
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Affiliation(s)
- Arianna Galante
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Cerbone
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Francesco Mannavola
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Marco Marinaccio
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Luca Maria Schonauer
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Vincenzo Pinto
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Gennaro Cormio
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
- Gynecologic Oncology Unit, Istituto Tumori Bari Giovanni Paolo II IRCCS, 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari, 70124 Bari, Italy
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Rafizadeh SM, Ghadimi H, Zarei Vesal N, Nozarian Z, Nikdel M. Unexpected recurrence and rapid progression of lacrimal gland adenoid cystic carcinoma during pregnancy: a case report. Orbit 2023; 42:645-649. [PMID: 35502667 DOI: 10.1080/01676830.2022.2070920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Adenoid cystic carcinoma (ACC) is the most common malignant neoplasm involving the lacrimal glands, with high rates of recurrence and metastasis. During the pregnancy, reports of recurrence of ACC of the salivary glands and trachea have previously been published, but no lacrimal gland ACC recurrence has been reported. We present a 35-year-old woman with lacrimal gland ACC who was initially treated by surgical resection and adjunctive radiotherapy, but her cancer recurred during pregnancy, with rapid progression to cavernous sinuses and brain. Estrogen and progesterone receptors have been detected on lacrimal glands and ACCs of salivary glands. Thus, hormonal changes during pregnancy might contribute to the recurrence of ACC. However, the inherent invasive and recurrent nature of ACC could also account for the regrowth in this patient and further molecular studies can provide more accurate explanations.
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Affiliation(s)
- Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Ghadimi
- Department of Ophthalmology, Private practice, Rasht, Iran
| | - Nasim Zarei Vesal
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Nozarian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Nikdel
- Department of Ophthalmology, Private practice, Rasht, Iran
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Sorouri K, Loren AW, Amant F, Partridge AH. Patient-Centered Care in the Management of Cancer During Pregnancy. Am Soc Clin Oncol Educ Book 2023; 43:e100037. [PMID: 37220323 DOI: 10.1200/edbk_100037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The management of cancer during pregnancy requires a patient-centered, multidisciplinary approach to balance maternal and fetal well-being given the rarity of this clinical scenario and lack of substantial data. Involvement of oncology and nononcology medical specialists and ethical, legal, and psychosocial supports, as needed, is instrumental in navigating the complexities of care for this patient population. Critical periods of fetal development and physiological changes in pregnancy must be considered when planning diagnostic and therapeutic approaches during pregnancy. The complexity of symptom recognition and interventional approaches contributes to diagnostic delays of cancers during pregnancy. Ultrasound and whole-body diffusion-weighted magnetic resonance imaging are safe throughout pregnancy. Surgery can be safely performed throughout pregnancy, with the early second trimester preferred for intra-abdominal surgery. Chemotherapy can be safely administered after 12-14 weeks of gestation until 1-3 weeks before the anticipated delivery. Most targeted and immunotherapeutic agents are contraindicated during pregnancy because of limited data. Pelvic radiation during pregnancy is absolutely contraindicated, while if radiation to the upper body is needed, administration should only be considered early in pregnancy. To ensure that the total cumulative fetal exposure to ionizing radiation does not exceed 100 mGy, early inclusion of the radiology team in the care plan is required. Closer prenatal monitoring is recommended for maternal and fetal treatment-related toxicities. Delivery before 37 weeks of gestation should be avoided if possible, and vaginal delivery is preferred unless obstetrically indicated or specific clinical scenarios. Postpartum, breastfeeding should be discussed, and the neonate should receive blood work to assess for acute toxicities with follow-up arranged for long-term monitoring.
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Affiliation(s)
- Kimia Sorouri
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alison W Loren
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Frédéric Amant
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- KU Leuven, Leuven, Belgium
- University of Amsterdam, Amsterdam, the Netherlands
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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Burhan A, Elmalaika Husian N, Yahia R, Abbasher L. Locally advanced cervical cancer complicating early pregnancy: A case of multiple challenges in a limited-resource setting. Gynecol Oncol Rep 2023; 46:101154. [PMID: 36910447 PMCID: PMC9995935 DOI: 10.1016/j.gore.2023.101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Carcinoma of the cervix is the most common malignant tumor associated with pregnancy and still poses a complex management problem. Limited data are available on locally advanced cervical cancer outcomes in the first half of pregnancy and how disadvantaged young women in low- and middle-income countries are. A 34-year-old woman at 17 weeks of gestation was diagnosed with FIGO stage III-C1r cervical cancer. All available treatment options were associated with significant risks. The patient opted for pregnancy termination, followed by chemoradiation. We present the challenges that gynecologists face in low-resource settings in managing locally advanced cervical cancer.
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Affiliation(s)
- Amira Burhan
- Cervical Cancer Prevention & Research (CCPR) Unit, Department of Obstetrics & Gynaecology, Soba University Hospital, Khartoum Postal Code 13314, Sudan.,Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Khartoum, Khartoum Postal Code 11115, Sudan
| | - Nazik Elmalaika Husian
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, PO Box 382, 14415 Omdurman, Sudan
| | - Rabab Yahia
- Department of Obstetrics & Gynaecology, Soba University Hospital, Khartoum Postal Code 13314, Sudan
| | - Liena Abbasher
- Cervical Cancer Prevention & Research (CCPR) Unit, Department of Obstetrics & Gynaecology, Soba University Hospital, Khartoum Postal Code 13314, Sudan
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Burden of maternal and fetal outcomes among pregnant cancer survivors during delivery hospitalizations in the United States. Sci Rep 2022; 12:9989. [PMID: 35705610 PMCID: PMC9200828 DOI: 10.1038/s41598-022-13852-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022] Open
Abstract
Existing studies on pregnancy-related outcomes among cancer survivors are limited by sample size or specificity of the cancer type. This study estimated the burden of adverse maternal and fetal outcomes among pregnant cancer survivors using a national database. This study was a retrospective analysis of National Inpatient Sample collected during 2010-2014. Multivariate regression models were used to calculate odds ratios for maternal and fetal outcomes. The study included a weighted sample of 64,506 pregnant cancer survivors and 18,687,217 pregnant women without cancer. Pregnant cancer survivors had significantly higher odds for death during delivery hospitalization, compared to pregnant women without cancer (58 versus 5 deaths per 100,000 pregnancies). They also had higher odds of severe maternal morbidity (aOR 2.00 [95% CI 1.66-2.41]), cesarean section (aOR 1.27 [95% CI 1.19-1.37]), labor induction (aOR 1.17 [95% CI 1.07-1.29]), pre-eclampsia (aOR 1.18 [95% CI 1.02-1.36]), preterm labor (aOR 1.55 [95% CI 1.36-1.76]), chorioamnionitis (aOR 1.45 [95% CI 1.15-1.82]), postpartum infection (aOR 1.68 [95% CI 1.21-2.33]), venous thromboembolism (aOR 3.62 [95% CI 2.69-4.88]), and decreased fetal movements (aOR 1.67 [95% CI 1.13-2.46]). This study showed that pregnancy among cancer survivors constitutes a high-risk condition requiring advanced care and collective efforts from multiple subspecialties.
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Zhou H, Alhaskawi A, Sun Q, Dong Y, Kota VG, Hasan Abdulla MHA, Ezzi SHA, Wang Z, Lu H. Desmoplastic Small Round Cell Tumor in a Pregnant Woman: A Case Report and Literature Review. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:613-622. [PMID: 34970100 PMCID: PMC8686780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Desmoplastic small round cell tumor (DSRCT) is an aggressive malignant tumor commonly found in young men; most occurs in the abdominal cavity. Here we conducted an in-depth analysis of a pregnant patient in our hospital and explored all the case information in the literature on small round cell carcinoma of women. Case presentation: A 27-year-old pregnant woman underwent tumor resection in our hospital at 29 weeks gestational age for a large progressive shoulder lump. The postoperative pathology showed that the mass was a DSRCT. Genetic testing found no fusion gene. At 36 weeks gestation, a painful mass was found in the breast and proved to be a metastatic focus of the desmoplastic small round cell tumor. Twenty days after a successful cesarean section at 40 weeks gestation, she received the VAC-IE chemotherapy regimen, successfully completed the first course, but when awaiting the next chemotherapy, unfortunately, the patient died during follow-up due to tumor recurrence and metastasis. Conclusion: The treatment of DSRCT in pregnant women requires a multidisciplinary consultation, and the treatment and examination during pregnancy are subject to many constraints, which may have a negative impact on the patient's prognosis. Also, a review of the literature found that there is still no standard treatment protocol for DSRCT, and its prognosis in female patients is independent of age and tissue origin.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated
Hospital, Zhejiang University, Hangzhou, P. R. China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated
Hospital, Zhejiang University, Hangzhou, P. R. China
| | - Qingrong Sun
- Department of Basic Medicine, School of Basic Medicine
and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R.
China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated
Hospital, Zhejiang University, Hangzhou, P. R. China
| | | | | | | | - Zewei Wang
- Zhejiang University School of Medicine, Hangzhou, P. R.
China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated
Hospital, Zhejiang University, Hangzhou, P. R. China,To whom all correspondence should be addressed:
Hui Lu, MD, Department of Orthopedics, The First Affiliated Hospital, College of
Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China;
; ORCID iD:
https://orcid.org/0000-0002-2969-4400
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12
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Safi N, Saunders C, Anazodo A, Dickinson JE, Boyle F, Ives A, Wang A, Li Z, Sullivan E. Clinical Decision Making in the Management of Breast Cancer Diagnosed During Pregnancy: A Review and Case Series Analysis. J Adolesc Young Adult Oncol 2021; 11:245-251. [PMID: 34813371 DOI: 10.1089/jayao.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To highlight the various options available for the management of breast cancer diagnosed during pregnancy by describing the investigations, treatment, and outcomes in relation to these women. Methods: This is a narrative review of the literature to describe the issues related to pregnancy and obstetric management in patients with breast cancer. It incorporates a description of six cases of women (aged 29-39 years) with a first-time diagnosis of breast cancer during pregnancy to illustrate a number of issues that need to be considered during different trimesters. Results: Of the six cases, two were diagnosed in each pregnancy trimester. A painless breast mass was the presenting symptom in five cases (83%). In all cases, breast ultrasound was the primary diagnostic imaging procedure. Chest X-ray was performed in 3 (50%) and computed tomography in 2 (33%). A core needle biopsy was performed in all cases, and sentinel lymph node biopsy in 3 (50%) cases. Four women had grade 3 tumor; five had estrogen receptor-positive tumors. Four women had breast surgery during pregnancy. Five women gave birth after the induction of labor and/or cesarean section. In all six cases, a multidisciplinary team was involved in the delivery of health care. Conclusion: Regular breast examinations are needed for all pregnant woman during prenatal visits. Breast ultrasonography should be offered if a breast lump or other symptoms are detected. Breast surgery can be safely performed during all pregnancy trimesters, and some systemic therapeutic agents can be administered safely in the second and third trimesters.
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Affiliation(s)
- Nadom Safi
- School of Public Health, University of Technology Sydney, Broadway, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christobel Saunders
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.,The Kids Cancer Centre, Sydney Children's Hospital, Sydney, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jan E Dickinson
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Patricia Ritchie Centre for Cancer Care & Research, Mater Hospital, North Sydney, New South Wales, Australia
| | - Angela Ives
- Division of Surgery, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Alex Wang
- School of Public Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Zhuoyang Li
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth Sullivan
- School of Public Health, University of Technology Sydney, Broadway, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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13
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Lannoo L, Lenaerts L, Van Den Bogaert K, Che H, Brison N, Devriendt K, Amant F, Vermeesch JR, Van Calsteren K. Non-invasive prenatal testing suggesting a maternal malignancy: What do we tell the prospective parents in Belgium? Prenat Diagn 2021; 41:1264-1272. [PMID: 34405430 DOI: 10.1002/pd.6031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 12/20/2022]
Abstract
Cancer is diagnosed in one in 1000 to 1500 pregnancies. Most frequently encountered malignancies during pregnancy are breast cancer, hematological cancer, cervical cancer and malignant melanoma. Maternal cancer is associated with an increased risk of IUGR and preterm labor, especially in patients with systemic disease or those receiving chemotherapy during pregnancy, requiring a high-risk obstetrical follow-up. Fetal aneuploidy screening by non-invasive prenatal testing (NIPT) can lead to the incidental identification of copy number alterations derived from non-fetal cell-free DNA (cfDNA), as seen in certain cases of maternal malignancy. The identification of tumor-derived cfDNA requires further clinical, biochemical, radiographic and histological investigations to confirm the diagnosis. In such cases, reliable risk estimation for fetal trisomy 21, 18 and 13 is impossible. Therefore, invasive testing should be offered when ultrasonographic screening reveals an increased risk for chromosomal anomalies, or when a more accurate test is desired. When the fetal karyotype is normal, long term implications for the fetus refer to the consequences of the maternal disease and treatment during pregnancy. This manuscript addresses parental questions when NIPT suggests a maternal malignancy. Based on current evidence and our own experience, a clinical management scheme in a multidisciplinary setting is proposed.
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Affiliation(s)
- Lore Lannoo
- Department of Development and Regeneration, Division Woman and Child, Clinical Department Obstetrics and Gynaecology, University Hospital Leuven, KULeuven, Leuven, Belgium
| | | | | | - Huiwen Che
- Department of Human Genetics, KULeuven, Leuven, Belgium
| | | | | | - Frédéric Amant
- Department of Gynaecological Oncology, KULeuven, Leuven, Belgium.,Center for Gynecological Oncology Amsterdam, Academic Medical Centre Amsterdam, University of Amsterdam, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Kristel Van Calsteren
- Department of Development and Regeneration, Division Woman and Child, Clinical Department Obstetrics and Gynaecology, University Hospital Leuven, KULeuven, Leuven, Belgium
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14
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Lenaerts L, Che H, Brison N, Neofytou M, Jatsenko T, Lefrère H, Maggen C, Villela D, Verheecke M, Dehaspe L, Croitor A, Hatse S, Wildiers H, Neven P, Vandecaveye V, Floris G, Vermeesch JR, Amant F. Breast Cancer Detection and Treatment Monitoring Using a Noninvasive Prenatal Testing Platform: Utility in Pregnant and Nonpregnant Populations. Clin Chem 2021; 66:1414-1423. [PMID: 33141904 DOI: 10.1093/clinchem/hvaa196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Numerous publications have reported the incidental detection of occult malignancies upon routine noninvasive prenatal testing (NIPT). However, these studies were not designed to evaluate the NIPT performance for cancer detection. METHODS We investigated the sensitivity of a genome-wide NIPT pipeline, called GIPSeq, for detecting cancer-specific copy number alterations (CNAs) in plasma tumor DNA (ctDNA) of patients with breast cancer. To assess whether a pregnancy itself, with fetal cell-free DNA (cfDNA) in the maternal circulation, might influence the detection of ctDNA, results were compared in pregnant (n = 25) and nonpregnant (n = 25) cancer patients. Furthermore, the ability of GIPSeq to monitor treatment response was assessed. RESULTS Overall GIPSeq sensitivity for detecting cancer-specific CNAs in plasma cfDNA was 26%. Fifteen percent of detected cases were asymptomatic at the time of blood sampling. GIPSeq sensitivity mainly depended on the tumor stage. Also, triple negative breast cancers (TNBC) were more frequently identified compared to hormone-positive or HER2-enriched tumors. This might be due to the presence of high-level gains and losses of cfDNA or high ctDNA loads in plasma of TNBC. Although higher GIPSeq sensitivity was noted in pregnant (36%) than in nonpregnant women (16%), the limited sample size prohibits a definite conclusion. Finally, GIPSeq profiling of cfDNA during therapy allowed monitoring of early treatment response. CONCLUSIONS The results underscore the potential of NIPT-based tests, analyzing CNAs in plasma cfDNA in a genome-wide and unbiased fashion for breast cancer detection, cancer subtyping and treatment monitoring in a pregnant and nonpregnant target population.
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Affiliation(s)
- Liesbeth Lenaerts
- Department of Oncology, Laboratory of Gynecological Oncology, KU Leuven, Leuven, Belgium
| | - Huiwen Che
- Department of Human Genetics, Laboratory for Cytogenetics and Genome Research, KU Leuven, Leuven, Belgium
| | - Nathalie Brison
- Centre of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Maria Neofytou
- Department of Human Genetics, Laboratory for Cytogenetics and Genome Research, KU Leuven, Leuven, Belgium.,Cancer Research UK Cambridge Institute, Molecular and Computational Diagnostics, University of Cambridge, Cambridge, UK
| | - Tatjana Jatsenko
- Department of Human Genetics, Laboratory for Cytogenetics and Genome Research, KU Leuven, Leuven, Belgium
| | - Hanne Lefrère
- Department of Oncology, Laboratory of Gynecological Oncology, KU Leuven, Leuven, Belgium
| | - Charlotte Maggen
- Department of Oncology, Laboratory of Gynecological Oncology, KU Leuven, Leuven, Belgium.,Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Darine Villela
- Department of Human Genetics, Laboratory for Cytogenetics and Genome Research, KU Leuven, Leuven, Belgium.,Departamento de Genética e Biologia Evolutiva, University of São Paulo, São Paulo, Brazil
| | - Magali Verheecke
- Gynaecology and Obstetrics Department, General Hospital Turnhout, Turnhout, Belgium
| | - Luc Dehaspe
- Genomics Core Facility, University Hospitals Leuven, Leuven, Belgium
| | - Anca Croitor
- Department of Imaging and Pathology, Unit of Biomedical MRI, KU Leuven, Leuven, Belgium
| | - Sigrid Hatse
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Oncology, Laboratory of Gynecological Oncology, KU Leuven, Leuven, Belgium.,Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Vandecaveye
- Department of Imaging and Pathology, Unit of Translational MRI, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Giuseppe Floris
- Department of Imaging and Pathology, Unit of Translational Cell & Tissue Research, KU Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Joris Robert Vermeesch
- Department of Human Genetics, Laboratory for Cytogenetics and Genome Research, KU Leuven, Leuven, Belgium.,Centre of Human Genetics, University Hospitals Leuven, Leuven, Belgium.,Genomics Core Facility, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, Laboratory of Gynecological Oncology, KU Leuven, Leuven, Belgium.,Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.,Center for Gynecological Oncology Amsterdam, Academic Medical Centre Amsterdam-University of Amsterdam and The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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15
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Gui B, Cambi F, Micco M, Sbarra M, Petta F, Autorino R, De Vincenzo R, Valentini V, Scambia G, Manfredi R. MRI in pregnant patients with suspected abdominal and pelvic cancer: a practical guide for radiologists. ACTA ACUST UNITED AC 2021; 26:183-192. [PMID: 32071031 DOI: 10.5152/dir.2019.19343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The incidence of abdominal and pelvic cancer in pregnancy is low, but it is rising as the population of pregnant women gets older. Depending on disease stage, gestational age and patient's preference, active surveillance as well as surgery and chemotherapy are feasible options during pregnancy. Correct diagnosis and staging of the tumor is crucial for choosing the best therapeutic approach. Moreover, a reproducible modality to assess the treatment response is requested. Magnetic resonance imaging (MRI) is commonly used with good results for the local staging and treatment response evaluation of most abdominal and pelvic cancers in nonpregnant patients, and it is considered relatively safe during pregnancy. The purpose of this article is to analyze the most relevant topics regarding the use of MRI in pregnant women with abdominal and pelvic cancer. We discuss MRI safety during pregnancy, including the use of gadolinium-based contrast agents (GBCAs), how to prepare the patient for the exam and MRI technique. This will be followed by a brief review on the most common malignancies diagnosed during pregnancy and their MRI appearance.
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Affiliation(s)
- Benedetta Gui
- General Diagnostic and Interventional Radiology, Diagnostic Imaging Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Cambi
- General Diagnostic and Interventional Radiology, Diagnostic Imaging Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy;Institute of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maura Micco
- General Diagnostic and Interventional Radiology, Diagnostic Imaging Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Martina Sbarra
- General Diagnostic and Interventional Radiology, Diagnostic Imaging Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy;Institute of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Federica Petta
- General Diagnostic and Interventional Radiology, Diagnostic Imaging Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy;Institute of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Rosa Autorino
- Radiation Oncology, Radiation Oncology Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Rosa De Vincenzo
- Department of Woman and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy;Institute of Obstetric and Gynaecology Clinic, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Valentini
- Radiation Oncology, Radiation Oncology Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy;Institute of Radiation Oncology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy;Institute of Obstetric and Gynaecology Clinic, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Riccardo Manfredi
- General Diagnostic and Interventional Radiology, Diagnostic Imaging Area, Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy;Institute of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
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16
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Vandecaveye V, Amant F, Lecouvet F, Van Calsteren K, Dresen RC. Imaging modalities in pregnant cancer patients. Int J Gynecol Cancer 2021; 31:423-431. [PMID: 33649009 PMCID: PMC7925814 DOI: 10.1136/ijgc-2020-001779] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer during pregnancy is increasingly diagnosed due to the trend of delaying pregnancy to a later age and probably also because of increased use of non-invasive prenatal testing for fetal aneuploidy screening with incidental finding of maternal cancer. Pregnant women pose higher challenges in imaging, diagnosis, and staging of cancer. Physiological tissue changes related to pregnancy makes image interpretation more difficult. Moreover, uncertainty about the safety of imaging modalities, fear of (unnecessary) fetal radiation, and lack of standardized imaging protocols may result in underutilization of the necessary imaging tests resulting in suboptimal staging. Due to the absence of radiation exposure, ultrasound and MRI are obvious first-line imaging modalities for detailed locoregional disease assessment. MRI has the added advantage of a more reproducible comprehensive organ or body region assessment, the ability of distant staging through whole-body evaluation, and the combination of anatomical and functional information by diffusion-weighted imaging which obviates the need for a gadolinium-based contrast-agent. Imaging modalities with inherent radiation exposure such as CT and nuclear imaging should only be performed when the maternal benefit outweighs fetal risk. The cumulative radiation exposure should not exceed the fetal radiation threshold of 100 mGy. Imaging should only be performed when necessary for diagnosis and likely to guide or change management. Radiologists play an important role in the multidisciplinary team in order to select the most optimal imaging strategies that balance maternal benefit with fetal risk and that are most likely to guide treatment decisions. Our aim is to provide an overview of possibilities and concerns in current clinical applications and developments in the imaging of patients with cancer during pregnancy.
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Affiliation(s)
- Vincent Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium .,Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium.,Center for Gynecological Oncology, Academic Medical Centre Amsterdam-University of Amsterdam and The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Frédéric Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Kristel Van Calsteren
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Raphaëla Carmen Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
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17
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Kömürcü Karuserci Ö, Sucu S. Retrospective Evaluation of Patients Treated for Ectopic Pregnancy: Experience of a Tertiary Center. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:800-804. [PMID: 33348396 PMCID: PMC10309192 DOI: 10.1055/s-0040-1718444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. METHODS In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. RESULTS Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. CONCLUSION The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.
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Affiliation(s)
- Özge Kömürcü Karuserci
- Obstetrics and Gynecology Department, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Seyhun Sucu
- Obstetrics and Gynecology Department, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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18
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Abstract
PURPOSE OF REVIEW Pregnancy-associated lymphoma (PAL) is an uncommon entity that lacks detailed prospective data. It poses significant management challenges that incorporate maternal and fetal risks associated with treatment or delayed intervention. Herein, we review the current literature for the diagnosis, management, and supportive care strategies for PAL. RECENT FINDINGS Establishment of a multidisciplinary team, including hematology-oncology, maternal-fetal medicine, and neonatology, is critical in the management of PAL. For staging, ultrasound and MRI are preferred modalities with use of computerized tomography in select situations. Data for the safety and effectiveness of therapy for PAL is largely based on retrospective studies. The timing of lymphoma-directed antenatal systemic therapy depends on the trimester, gestational age, lymphoma subtype and aggressiveness, and patient wishes. Therapy in the first trimester is usually not advocated, while treatment in the second and third trimesters appears to result in similar outcomes for PAL compared with non-pregnant patients with lymphoma. An overarching goal in most PAL cases should be to plan for delivery at term (i.e., gestational age > 37 weeks). For supportive care, most antiemetics, including agents such as neurokinin-1 receptor antagonists, have been used safely during pregnancy. For prevention or treatment of infections, particular antibiotics (i.e., macrolides, cephalosporins, penicillins, metronidazole), antivirals (i.e., acyclovir, valacyclovir, famciclovir), and antifungals (amphotericin B) have demonstrated safety and with use of growth factors reserved for treatment of neutropenia (vs. primary prophylaxis). Therapy for PAL should be individualized with goals of care that balance maternal and fetal well-being, which should include a multidisciplinary care team and overall intent for term delivery in most cases.
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19
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Sravanthi MV, Suma Kumaran S, Palle A, Bojanapally P. Adenocarcinoma of Sigmoid Colon Diagnosed in Pregnancy: A Case Report. Cureus 2020; 12:e9491. [PMID: 32879815 PMCID: PMC7458711 DOI: 10.7759/cureus.9491] [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] [Indexed: 11/05/2022] Open
Abstract
With more women getting pregnant at later ages than in the past, the incidence of malignancies in pregnancy is on the rise. Common malignancies of pregnancy are melanoma, breast cancer, cervical cancer, lymphomas, and leukemias. Colorectal carcinoma is rare in pregnancy, with an estimated incidence of 1 in 13',000 cases. We describe such a case of colorectal carcinoma in pregnancy (CRC-p), in a 31-year-old patient. She presented in the 21st week of her second pregnancy with constipation of two weeks duration despite appropriate medical management. This prompted further evaluation with abdominal imaging revealing partial small bowel obstruction of unclear etiology. She was treated surgically with subtotal colectomy with ileostomy. Pathologic evaluation revealed Stage III B: pT3N2a adenocarcinoma with mucinous features of the sigmoid colon with lymph node metastases. Adjuvant FOLFOX chemotherapy was started in the third trimester and was continued postpartum for a total of 12 cycles. She is doing well, and ileostomy reversal is being planned at the time of writing this. Advancing maternal age is a significant risk factor for CRC-p. Common presenting symptoms in CRC-p include bleeding per rectum, abdominal pain, vomiting, and constipation. The frequent occurrence of many of these symptoms, as well as risks and restrictions associated with diagnostic modalities such as computed tomography scan and colonoscopy during pregnancy, makes the diagnosis challenging. Colonoscopy, followed by pathology evaluation, remains the standard diagnostic method in CRC-p. Management of CRC-p is determined by multiple variables such as the stage of the disease, gestational age, and most importantly, patient wishes. Surgical resection is performed following the diagnosis if the gestational age is less than 20 weeks and delayed until after delivery if gestational age is above 20 weeks. 5-fluorouracil based chemotherapy regimens are used in second and third trimesters, in patients with stage III CRC-p. Prognosis has been reported variably. Despite advanced stages at presentation, most of the studies indicate a similar prognosis compared to CRC in the non-pregnant population. Two-year survival was found to be 64.4% in one case series.
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Affiliation(s)
| | - Sharmil Suma Kumaran
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Abhinav Palle
- Student, Abington Heights High School, Scranton, USA
| | - Padmaja Bojanapally
- Oncology, Hematology & Oncology Associates of Northeastern Pennsylvania, Scranton, USA
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20
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Kermarrec É, Gardavaud F, Kerrou K, Bekhouche A, Wahab CA, Milon A, Thomassin-Naggara I. Risques et sécurité de l’imagerie mammaire chez la femme enceinte et en cours d’allaitement. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2019.11.002] [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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21
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Buckingham L, Janssen M, Ray EM, Tucker K, Davidson BA, Arenth J, Lefkowits C, Jones JA, Gehrig P, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Serious Illness in Pregnancy. J Palliat Med 2020; 23:712-718. [PMID: 31928374 DOI: 10.1089/jpm.2019.0651] [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] [Indexed: 11/12/2022] Open
Abstract
Palliative care (PC) teams are increasingly being called upon to provide care earlier and more remote from end of life. Because much of the field has grown out of hospice and geriatric care, most teams have little to no experience caring for pregnant women or their fetuses when serious or life-threatening illness strikes. This article, written by a team of oncologists (gynecologic, medical, and radiation) and PC providers, seeks to demystify the care of seriously ill pregnant women and their fetuses by exploring the diagnostic, treatment, prognostication, symptom management, and communication needs of these patients. Truly comprehensive PC extends throughout the life span, from conception to death, regardless of age. Accordingly, increased knowledge of the unique needs of these vulnerable groups will enhance our ability to provide care across this continuum.
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Affiliation(s)
- Lindsey Buckingham
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew Janssen
- Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily M Ray
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine Tucker
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Joshua Arenth
- Divisions of Pediatric Critical Care and Pediatric Palliative Care, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carolyn Lefkowits
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Division of Palliative Care, Department of Internal Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joshua A Jones
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paola Gehrig
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher A Jones
- Department of Medicine and the Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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22
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Parazzini F, Gadducci A, Cicinelli E, Maggino T, Peccatori F, Scarfone G, Roncella E, Scambia G, Zola P, Sartori E. Pregnancy-associated cancers: frequency and temporal trends in Italy. Int J Gynecol Cancer 2019; 30:241-244. [PMID: 31744888 DOI: 10.1136/ijgc-2019-000828] [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: 08/10/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Limited data are available on the frequency and time trends of pregnancy-associated cancers, particularly from Southern European countries. The aim of this study was to analyze the frequency and time trends of pregnancy-associated cancer in Italy. METHODS This was a population-based linkage study using the regional hospital discharge forms database of four Italian regions with more than 17 million inhabitants. All resident women with a hospital discharge form reporting a birth or abortion in the time period under consideration were identified. The time period of the study was 2003-2015 for the Piemonte and Puglia region, 2006-2015 for the Tuscany region, and 2005-2015 for the Veneto region. Risk of developing a pregnancy-associated cancer was calculated as the ratio of the number of pregnancy-related cancers to the total number of pregnancies. RESULTS A total of 2 297 648 pregnancies were identified. Overall, the pregnancy-associated cancer frequency was 134.8 per 100 000 pregnancies: the frequency ranged from 127.1 in Puglia to 157.3 in Tuscany. The frequency for 100 000 pregnancies was 66.4 in women aged <30 years; the risk increased with age, with a frequency of 275.6 among women aged 40+ years. Approximately two-thirds of cancers were associated with pregnancies resulting in a delivery and one-third with pregnancies resulting in a termination of pregnancy or spontaneous pregnancy loss. No clear trend emerged in the risk of pregnancy-associated cancer per 100 000 pregnancies and calendar year. CONCLUSION No clear time trend was observed in the frequency of pregnancy-associated cancers in Italy during the last 10 years, the rates being 104, 164, and 130 per 100 000 pregnancies, respectively, in 2003, 2010, and 2015.
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Affiliation(s)
- Fabio Parazzini
- Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Angiolo Gadducci
- Division of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, School of Medicine, 'Aldo Moro' University of Bari, Bari, Italy
| | - Tiziano Maggino
- Division of Obstetrics and Gynecology, Dell'Angelo Hospital, Mestre, Italy
| | - Fedro Peccatori
- Division of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanna Scarfone
- Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Roncella
- Department of Obstetrics, Gynecology, and Neonatology, University of Milan, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milan, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Enrico Sartori
- Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy
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23
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Kocián P, de Haan J, Cardonick EH, Uzan C, Lok CAR, Fruscio R, Halaska MJ, Amant F. Management and outcome of colorectal cancer during pregnancy: report of 41 cases. Acta Chir Belg 2019; 119:166-175. [PMID: 30010511 DOI: 10.1080/00015458.2018.1493821] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer in pregnancy is rare, with an incidence of 0.8 per 100,000 pregnancies. Advanced disease (stage III or IV) is diagnosed more frequently in pregnant patients. We aimed to review all cases of colorectal cancer in pregnancy from the International Network on Cancer, Infertility and Pregnancy database in order to learn more about this rare disease and improve its management. METHODS Data on the demographic features, symptoms, histopathology, diagnostic and therapeutic interventions and outcomes (obstetric, neonatal and maternal) were analysed. RESULTS Twenty-seven colon and 14 rectal cancer cases were identified. Advanced disease was present in 30 patients (73.2%). During pregnancy, 21 patients (51.2%) received surgery and 12 patients (29.3%) received chemotherapy. Thirty-three patients (80.5%) delivered live babies: 21 by caesarean section and 12 vaginally. Prematurity rate was high (78.8%). Eight babies were small for gestational age (27.6%). Three patients (10.7%) developed recurrence of disease. Overall 2-year survival was 64.4%. CONCLUSION Despite a more frequent presentation with advanced disease, colorectal cancer has a similar prognosis in pregnancy when compared with the general population. Diagnostic interventions and treatment should not be delayed due to the pregnancy but a balance between maternal and foetal wellbeing must always be kept in mind.
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Affiliation(s)
- P. Kocián
- Department of Surgery, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - J. de Haan
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, Netherlands
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - E. H. Cardonick
- Department of Obstetrics and Gynaecology, Division Maternal Fetal Medicine, Cooper Medical School at Rowan University, Camden, United States of America
| | - C. Uzan
- Department of Gynaecological Surgery, Institute Gustave Roussy, Villejuif, France
- Department of Gynaecology and Breast Surgery, Pitié Salpêtrière Hospital, Institut Universitaire de Cancérologie, Sorbonne University, Paris, France
| | - C. A. R. Lok
- Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
| | - R. Fruscio
- Division of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - M. J. Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - F. Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
- Division of Gynaecologic Oncology, University Hospitals Leuven, Leuven, Belgium
- Centre for Gynaecologic Oncology Amsterdam, Academic Medical Centre, Amsterdam, Netherlands
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24
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Hepner A, Negrini D, Hase EA, Exman P, Testa L, Trinconi AF, Filassi JR, Francisco RPV, Zugaib M, O'Connor TL, Martin MG. Cancer During Pregnancy: The Oncologist Overview. World J Oncol 2019; 10:28-34. [PMID: 30834049 PMCID: PMC6396773 DOI: 10.14740/wjon1177] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 01/11/2023] Open
Abstract
Although a rare and challenging condition, cancer during pregnancy should promptly be identified and treated. Not only standards of care guidelines for the underlying disease are taken into account, but also fetal safety might be weighted for clinical decisions. Frequent lack of experience and knowledge about this condition could lead to late diagnosis, imprecise management, suboptimal treatment and fetal and maternal harm. Therefore, this review aims to summarize the current evidence regarding the epidemiology, clinical presentation, diagnostic workup, staging and treatment, including novel treatment modalities for patients diagnosed with cancer during pregnancy.
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Affiliation(s)
- Adriana Hepner
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Negrini
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eliane Azeka Hase
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Pedro Exman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura Testa
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Angela F Trinconi
- Mastology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jose Roberto Filassi
- Mastology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Tracey L O'Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, The Jacobs School of Medicine, University of Buffalo, Buffalo, NY, USA
| | - Michael Gary Martin
- Division of Hematology and Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN, USA
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25
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A new type of gadodiamide-conjugated amphiphilic chitosan nanoparticle and its use for MR imaging with significantly enhanced contrastability. Carbohydr Polym 2018; 203:256-264. [PMID: 30318211 DOI: 10.1016/j.carbpol.2018.09.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/27/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022]
Abstract
Magnetic resonance imaging (MRI) has been one of the most frequently-used diagnostic tools with high dimensional precision and positioning accuracy in clinical practices. To achieve contrast enhancement, utilization of high-efficient MR imaging contrast agents becomes a prime consideration and is indispensably reinforced the diagnosis precision, especially for the emerging precision medicine. Gadolinium (Gd)-based complexes has been widely used in current clinical MRI operations, however, numerous side effects were reported and highlighted in clinic. Those drawbacks render specific unmet needs to be clinically and technically improved with a new version of Gd-based compound. Here we report a newly-synthesized amphiphilic Gadodiamide-conjugated carboxymethyl-hexanoyl chitosan (termed as CHC-Gd) hybrid. The gadodiamide was selected is due to its smallest molecular size among other Gd-based complexes reported in literature, which assumed to give least influence on the resulting physicochemical properties such as colloidal stability, nanostructural evolution, and cytocompability, particularly self-assembly capability, of the resulting hybrid upon practical uses. Experimental outcomes showed a successful synthesis of the CHC-Gd hybrid using a one-pot synthesis protocol, where the gadodiamide complexes were covalently attached to the carboxyl groups along the CHC backbone. Self-assembly behavior can be observed to form a sphere-like nanoparticle of 100-200 nm in size as of amphiphilic native CHC macromolecule. Experimental outcomes indicated a largely improved cytocompatibility of the hybrid, compared with free Gd, suggesting the Gd+3 ions were well stabilized in the CHC nanostructure. Excellent contrastability in-vitro and in particular in vivo were measured, where for in-vivo test, a 10-40-folded reduction in dosage, compared with clinical Gd dose, was used and demonstrated a comparative-to-better imaging resolution and brightness. Therefore, from this preliminary investigation, a potential translation to clinical practice through the use of newly-synthesized amphiphilic CHC-Gd hybrid appears to be relatively promising.
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26
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Jeremic K, Stefanovic A, Dotlic J, Kadija S, Kontic O, Gojnic M, Jeremic J, Kesic V. Cancer during pregnancy - clinical characteristics, treatment outcomes and prognosis for mothers and infants. J Perinat Med 2018; 46:35-45. [PMID: 28222037 DOI: 10.1515/jpm-2016-0212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/12/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess which obstetrical characteristics and treatment improved outcomes and prognosis of pregnant women with malignancy. METHODS A prospective study, undertaken between 2005 and 2014, involving 35 pregnant women who were diagnosed with malignant tumors during pregnancy. Patients were followed-up for 1 year after delivery. The pregnancy course and outcome and parameters that could influence the condition of mother and fetus were evaluated. RESULTS Most malignancies were hematological, diagnosed in the second trimester and treated with combined therapy (surgery/adjuvant) after pregnancy. Most fetuses were in good state throughout pregnancy, but were delivered by caesarean section (CS) before term. Adjuvant therapy during pregnancy mostly caused transitory deterioration of fetal conditions. The majority of both mothers and infants were in a good state 12 months postpartum, although numerous mothers were still ill and on therapy. Surviving pregnancy and preventing tumors progression during pregnancy were the best predictors of mothers' future condition (P=0.022). High birthweight and term delivery were the most important factors for good outcome of the infants (P=0.001). CONCLUSIONS If the tumor is not progressing, pregnancy should be continued as long as possible to obtain adequate birthweight of the infant. Second trimester surgery is safe, while other therapies should preferably be applied after delivery.
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Affiliation(s)
- Katarina Jeremic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Aleksandar Stefanovic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Sasa Kadija
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Olivera Kontic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Miroslava Gojnic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
| | - Jelena Jeremic
- Clinic for Plastic and Reconstructive Surgery, Clinical Center of Serbia, Zvecanska 9, Belgrade, Serbia
| | - Vesna Kesic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Dr Koste Todorovica 26, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia
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27
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Whole-Body Magnetic Resonance Imaging in the Oncology Setting: An Overview and Update on Recent Advances. J Comput Assist Tomogr 2018; 43:66-75. [PMID: 30015799 DOI: 10.1097/rct.0000000000000772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Whole-body magnetic resonance imaging is becoming an important tool in oncology as a nonirradiating imaging technique since recent technological advances allowed the incorporation of high-quality imaging in an adequate time. Moreover, the noninjection of radioisotope/intravenous contrast, low cost compared with traditional nuclear medicine techniques, and fast acquisition times are another distinct feature. Thus, the purpose of this article is to review the whole-body magnetic resonance imaging protocol and its main applications in the oncology setting.
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28
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Ferrari F, Faccio F, Peccatori F, Pravettoni G. Psychological issues and construction of the mother-child relationship in women with cancer during pregnancy: a perspective on current and future directions. BMC Psychol 2018; 6:10. [PMID: 29548301 PMCID: PMC5857118 DOI: 10.1186/s40359-018-0224-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/11/2018] [Indexed: 12/24/2022] Open
Abstract
Background Cancer during pregnancy is a rare event. However, knowledge about treatment has progressed in recent years with improved maternal and neonatal outcomes. The number of women who decide to continue their pregnancy and undergo cancer treatment is increasing. Main body Women face two critical events simultaneously; oncological illness and pregnancy, with different and conflicting emotions. In addition, the last trimester of gestation sets the ground for construction of the mother-child relationship, which is of great importance for the child’s development. Studies have showed that maternal exposure to stressful events during pregnancy is linked to adverse outcomes in children. Although several authors consider cancer to be a ‘critical life event’, studies that address the psychosocial implications of cancer in expecting mothers are scarce. There are no studies addressing the possible negative impact of a cancer diagnosis during pregnancy on the mother-child relationship and on the child’s development. It is important to emphasize the need for in-depth knowledge of the contributing psychological factors involved in order to provide holistic, individualised, and supportive care. Conclusion An analysis of cognitive aspects, emotional processes, and maternal attachment in cases of cancer during pregnancy may contribute to the development of a model of care, both in an evolutionary and in a psycho-oncology context, with implications for clinical practice.
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Affiliation(s)
- Federica Ferrari
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Flavia Faccio
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20141, Milan, Italy.
| | - Fedro Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Division, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20141, Milan, Italy
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29
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Boussios S, Moschetta M, Tatsi K, Tsiouris AK, Pavlidis N. A review on pregnancy complicated by ovarian epithelial and non-epithelial malignant tumors: Diagnostic and therapeutic perspectives. J Adv Res 2018; 12:1-9. [PMID: 29988841 PMCID: PMC6032492 DOI: 10.1016/j.jare.2018.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/21/2022] Open
Abstract
The management of gestational ovarian cancer can be challenging because of the risk of fetal wastage, and the possibility of treatment-related complications to the fetus; it is based on insufficient data from retrospective studies and case series. Here, a literature review of the diagnostic and surgical approaches to the gestational ovarian cancer has been performed; moreover, data on safety of chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes, have also been reviewed. Up to now, 193 cases of ovarian cancers during pregnancy have been reported in the English literature. Treatment of ovarian malignancies during pregnancy depends on histology, stage, and gestational weeks. When possible, surgical excision is indicated, and fertility-sparing surgery can be offered to stage I epithelial ovarian tumours (EOC), germ cell ovarian, or sex-cord stromal ovarian tumours. Neoadjuvant and/or adjuvant chemotherapy for advanced ovarian tumours is indicated as in non-pregnant women. Administration of chemotherapy after the first trimester, can cause fetal growth restriction, while being seemingly safe. The therapeutic approach of ovarian cancer in pregnancy should be individualized and intended in specialized centers.
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Affiliation(s)
- Stergios Boussios
- Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
- Corresponding author.
| | - Michele Moschetta
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London W1G 6AD, UK
| | - Konstantina Tatsi
- Gynaecology Unit, General Hospital “G. Hatzikosta”, Makrigianni Avenue, 45001 Ioannina, Greece
| | - Alexandros K. Tsiouris
- Department of Biological Applications & Technology, University of Ioannina, Stavros Niarchou Avenue, 45110 Ioannina, Greece
| | - Nicholas Pavlidis
- Medical School, University of Cyprus, Old road Lefkosias Lemesou, No. 215/6, 2029 Aglantzia, Nicosia, Cyprus
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30
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de Haan J, Lok CAR, Schutte JS, van Zuylen L, de Groot CJM. Cancer related maternal mortality and delay in diagnosis and treatment: a case series on 26 cases. BMC Pregnancy Childbirth 2018; 18:10. [PMID: 29301502 PMCID: PMC5755279 DOI: 10.1186/s12884-017-1639-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer during pregnancy is relatively rare but may lead to maternal mortality. We aimed to assess the incidence of cancer related maternal mortality and the neonatal outcome in these patients. Also, doctor- and patient-related delay in cancer diagnosis and therapy among patients with cancer related maternal mortality is assessed. METHODS Maternal mortality was defined as death during pregnancy or within 1 year after delivery. Data of the Dutch Maternal Mortality Committee was used to calculate the cancer related maternal mortality rate and to assess neonatal outcome in the Netherlands. Delay was scored by ten medical specialist based on case descriptions. RESULTS Cancer related maternal mortality rate was 1.23 per 100,000 live births. Delay in either diagnosis or treatment occurred in 65%. Delay in diagnosis was more frequent then delay in treatment, and was mainly caused by health care providers. Only 77% of pregnancies were ongoing, and 65% ended preterm of which 85% was induced. CONCLUSIONS Avoiding delay in diagnosis and therapy in case of pregnancy related cancer could potentially improve maternal and neonatal outcome. It is therefore essential to increase awareness among health care providers about the occurrence and recurrence of cancer in pregnancy and the possibilities of diagnostic and therapeutic interventions in these women.
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Affiliation(s)
- Jorine de Haan
- Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands. .,Department of Oncology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Christianne A R Lok
- Department of Gynaecologic Oncology, Center for Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands
| | - Joke S Schutte
- Department of Obstetrics and Gynaecology, Isala Clinics, Zwolle, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
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31
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Han SN, Amant F, Michielsen K, De Keyzer F, Fieuws S, Van Calsteren K, Dresen RC, Gziri MM, Vandecaveye V. Feasibility of whole-body diffusion-weighted MRI for detection of primary tumour, nodal and distant metastases in women with cancer during pregnancy: a pilot study. Eur Radiol 2017; 28:1862-1874. [PMID: 29218610 DOI: 10.1007/s00330-017-5126-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 09/28/2017] [Accepted: 10/11/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the feasibility of whole-body diffusion-weighted MRI (WB-DWI/MRI) for detecting primary tumour, nodal and distant metastases in pregnant women with cancer. METHODS Twenty pregnant patients underwent WB-DWI/MRI in additional to conventional imaging. Reproducibility of WB-DWI/MRI between two readers was evaluated using Cohen's κ statistics and accuracy was compared to conventional imaging for assessing primary tumour site, nodal and visceral metastases. RESULTS Both WB-DWI/MRI readers showed good-very good agreement for lesion detection (primary lesions: κ=1; lymph nodes: κ=0.89; distant metastases: κ=0.61). Eight (40 %) patients were upstaged after WB-DWI/MRI. For nodal metastases, WB-DWI/MRI showed 100 % (95 % CI: 83.2-100) sensitivity for both readers with specificity of 99.4 % (96.9-100) and 100 % (80.5-100) for readers 1 and 2, respectively. For distant metastases, WB-DWI/MRI showed 66.7 % (9.4-99.2) and 100 % (29.2-100) sensitivity and specificity of 94.1 % (71.3-99.9) and 100 % (80.5-100) for readers 1 and 2, respectively. Conventional imaging showed sensitivity of 50 % (27.2-72.8) and 33.3 % (0.8-90.6); specificity of 100 % (98-100) and 100 % (80.5-100), for nodal and distant metastases respectively. CONCLUSIONS WB-DWI/MRI is feasible for single-step non-invasive staging of cancer during pregnancy with additional value for conventional imaging procedures. KEY POINTS • In our study, WB-DWI/MRI was more accurate than conventional imaging during pregnancy. • WB-DWI/MRI improves diagnostic assessment of patients with cancer during pregnancy. • Accurate imaging and oncologic staging improves treatment and outcome.
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Affiliation(s)
- Sileny N Han
- Departments of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Frédéric Amant
- Departments of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. .,Center for Gynaecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | | | | | - Steffen Fieuws
- Department of Public Health and Primary Care, KU Leuven - University of Leuven and Universiteit Hasselt, Leuven, Belgium
| | - Kristel Van Calsteren
- Departments of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | | | - Mina Mhallem Gziri
- Obstetrics and Gynaecology, Cliniques Universitaires Saint-Luc, Woluwe Saint-Lambert, Belgium
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32
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Boucek J, de Haan J, Halaska MJ, Plzak J, Van Calsteren K, de Groot CJM, Dahl Steffensen K, Fruscio R, Massolt ET, Klaritsch P, Zola P, Amant F. Maternal and obstetrical outcome in 35 cases of well-differentiated thyroid carcinoma during pregnancy. Laryngoscope 2017; 128:1493-1500. [PMID: 28988434 DOI: 10.1002/lary.26936] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/13/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Thyroid cancer, with 6% to 10% of cancer diagnoses, is one of the most common malignancies during pregnancy. Its treatment poses a risk for the pregnancy, as the thyroid gland plays a crucial role in the evolution of pregnancy. The aim of this study is to evaluate treatment of primary well-differentiated thyroid carcinoma during pregnancy and fetal and maternal outcomes. STUDY DESIGN This is an international cohort study. METHODS Primary thyroid cancer patients were identified from the database of the International Network on Cancer, Infertility, and Pregnancy registration study. Data on histopathological characteristics, diagnostic and therapeutic interventions, outcome (obstetrical, neonatal, and maternal) and maternal follow-up were analyzed. RESULTS Thirty-five patients with well-differentiated thyroid carcinoma were eligible. All 35 patients underwent surgery, 29 (83%) of which during pregnancy. Procedures during pregnancy were mainly total thyroidectomies (n = 24). The median number of days between diagnosis and surgical treatment was different between the groups with surgery during and after pregnancy (27 vs. 139 days, P < .001). Both maternal and neonatal outcomes were uncomplicated, regardless of gestational age during surgery. CONCLUSIONS Well-differentiated thyroid carcinoma diagnosed during pregnancy has a favorable outcome for both mother and child. Surgical management during pregnancy has no negative impact on the pregnancy regardless of the trimester at the time of surgery. However, the potential negative effects of thyroid surgery early in pregnancy demand management of these patients in an experienced multidisciplinary team to provide the best possible care for these patients and their unborn babies. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1493-1500, 2018.
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Affiliation(s)
- Jan Boucek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
| | - Jorine de Haan
- Department of Oncology, University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Michael J Halaska
- Department of Obstetrics and Gynecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Plzak
- Department of Otorhinolaryngology, Head and Neck Surgery, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.,Department of Reproduction and Regeneration, University of Leuven, Leuven, Belgium
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Karina Dahl Steffensen
- Department of Clinical Oncology, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Elske T Massolt
- Department of Endocrinology, Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Frédéric Amant
- Department of Oncology, University of Leuven, Leuven, Belgium.,Division of Gynecologic Oncology, University Hospitals Leuven, Leuven, Belgium.,Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
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de Haan J, Van Calsteren K, Lok CAR, de Groot CJM, Amant F. Comment on "Maternal and perinatal outcomes in pregnancy-associated melanoma. Report of two cases and a systematic literature review". Eur J Obstet Gynecol Reprod Biol 2017; 216:261-262. [PMID: 28768572 DOI: 10.1016/j.ejogrb.2017.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Jorine de Haan
- Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands; Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christianne A R Lok
- Department of Gynaecologic Oncology, Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Frédéric Amant
- Department of Gynaecologic Oncology, Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Division of Gynaecologic Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Fruscio R, de Haan J, Van Calsteren K, Verheecke M, Mhallem M, Amant F. Ovarian cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 41:108-117. [PMID: 28029502 DOI: 10.1016/j.bpobgyn.2016.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
Abstract
Although the occurrence of ovarian masses in pregnancy is relatively common, the majority of them is functional and resolve spontaneously; nevertheless, ovarian cancer is the fifth most common malignancy diagnosed in pregnancy. If malignancy is suspected, treatment should be decided on the basis of gestational age, stage of the disease and patient preferences. In early stage, ovarian cancer surgery may be planned preferably after 16 weeks of pregnancy, and chemotherapy can be administered from the second trimester if indicated as in non-pregnant patients. In advanced-stage disease, when complete cytoreduction is not achievable, neoadjuvant chemotherapy could be administered even in pregnancy. Chemotherapy should be a combination of carboplatin and paclitaxel in epithelial ovarian cancer patients and a combination of cisplatin, vinblastin and bleomycin in non-epithelial ovarian cancer. The outcome of patients with ovarian cancer diagnosed in pregnancy is similar to non-pregnant patients, and stage of the disease is the most important prognostic factor.
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Affiliation(s)
- Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy.
| | - Jorine de Haan
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Magali Verheecke
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Division of Gynecologic Oncology, University Hospitals Leuven, Belgium
| | - Mina Mhallem
- Department of Obstetrics and Gynaecology, Cliniques Universitaires St. Luc, UCL, Brussels, Belgium
| | - Frederic Amant
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Division of Gynecologic Oncology, University Hospitals Leuven, Belgium; Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
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Zagouri F, Dimitrakakis C, Marinopoulos S, Tsigginou A, Dimopoulos MA. Cancer in pregnancy: disentangling treatment modalities. ESMO Open 2016; 1:e000016. [PMID: 27843602 PMCID: PMC5070264 DOI: 10.1136/esmoopen-2015-000016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 01/25/2023] Open
Abstract
Pregnancy-associated cancer constitutes an uncommon and difficult to manage clinical situation. It is defined as the cancer diagnosed from the first day of childbearing to 1 year post partum. Coexistence of cancer with pregnancy adds complexity to treatment recommendations, as both the mother and the fetus may be affected. The optimal therapeutic management of pregnant women with cancer diagnosis should take into account, apart from medical factors, a host of other parameters (ethical, psychological, religious, legal, etc). Unfortunately, this situation becomes more complex as more women delay childbearing, and consequently the incidence of cancer during pregnancy is constantly increasing. This manuscript summarises the general principles in managing pregnant patients with cancer and gives detailed instructions in the management of pregnant patients with breast cancer, ovarian cancer, melanoma, lymphoma, lung cancer, soft-tissue sarcoma and cervical cancer. Of note, management of pregnant women with cancer diagnosis should be performed in specialised centres with experience and all cases should be discussed in multidisciplinary meetings composed of multiple specialists (medical oncologists, obstetricians, surgeons, radiologists and paediatricians).
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Constantine Dimitrakakis
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Spyridon Marinopoulos
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Alexandra Tsigginou
- Department of Obstetrics and Gynecology , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Meletios-Athanassios Dimopoulos
- Department of Clinical Therapeutics , Alexandra Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
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A mini review on pregnant mothers with cancer: A paradoxical coexistence. J Adv Res 2016; 7:559-63. [PMID: 27408757 PMCID: PMC4921772 DOI: 10.1016/j.jare.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/29/2016] [Accepted: 01/30/2016] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of cancer during pregnancy at least in the Western world is a rare phenomenon, but this might be raised into the future due to late pregnancies in the modern societies. The coexistence of pregnancy and cancer implicates numerous medical, ethical, psychological and sometimes religious issues between the mother, the family and the treating physician. Breast, cervical cancer, melanoma and lymphoma are the most common malignancies diagnosed during pregnancy. Diagnostic or therapeutic irradiation requires careful application, whereas systemic chemotherapy is not allowed during the first trimester of pregnancy due to lethal or teratogenic effects as well as to congenital malformations. In some gestational cancers, tumor cells can invade the placenta or the fetus.
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Woitek R, Prayer D, Hojreh A, Helbich T. Radiological staging in pregnant patients with cancer. ESMO Open 2016; 1:e000017. [PMID: 27843585 PMCID: PMC5070210 DOI: 10.1136/esmoopen-2015-000017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ramona Woitek
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Azadeh Hojreh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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