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Likhvantseva VG, Ovanesyan VE. [The effect of sex hormones and pregnancy on development and progression of uveal melanoma]. Vestn Oftalmol 2022; 138:110-117. [PMID: 35801889 DOI: 10.17116/oftalma2022138031110] [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] [Indexed: 06/15/2023]
Abstract
The analysis of literature revealed that men experience uveal melanoma (UM) more frequently and with worse prognosis. There are also descriptions of an aggressive course of UM in pregnant women. These facts prompted researchers to analyze the effect of sex hormones and pregnancy on the development and progression of UM. Many years of international experience have refuted the presence of a reliable difference between 5-year survival and 5-year survival without metastases between non-pregnant women with UM and pregnant women with UM. That data is regarded as level 3 evidence. The experts have concluded that UM is not a contraindication to current or future pregnancy, and exogenous hormones (oral contraceptives or hormone replacement therapy) do not affect the incidence and prognosis of UM. Publications provide evidence of expression of the receptors of certain sex hormones (ER, ERRα, LH and LHRH) in primary UM, as well as overexpression of the ESR1 and ESR2 genes in UM with poor predictive characteristics. Overall AR mRNA expression in UM was low, but it was higher in epithelial UMs. The fact of expression of estrogen receptors in UM gives grounds to experiment with them as a target for therapy.
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Affiliation(s)
- V G Likhvantseva
- Federal Medical Biophysical Center named after A.I. Burnazyan of the Federal Medical-Biological Agency, Moscow, Russia
- Academy of Postgraduate Education of the Federal Scientific-Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical-Biological Agency, Moscow, Russia
| | - V E Ovanesyan
- Yegoryevsk Central District Hospital, Yegoryevsk, Russia
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2
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Abstract
We present the updated recommendations of the French society for radiation oncology on radiotherapy and pregnancy. The occurrence of cancer during pregnancy is a rare event (approximately 1 in 1000 pregnancies). The risks for the embryo or the foetus depend on the gestational age at the time of irradiation. The main risks are malformations with microcephaly and mental retardation. There is also a risk of radiation-induced cancer in the unborn child. In the case of only supradiaphragmatic irradiation, radiotherapy can be performed most often in pregnant women without risk to the foetus. On the other hand, in the case of an indication for subdiaphragmatic irradiation, therapeutic termination of the pregnancy should be proposed. In all cases, when radiotherapy is chosen, a phantom estimation of the dose delivered to the foetus, confirmed by in vivo measurement, is recommended. Conformational radiotherapy is the preferred technique because of the lower dose delivered to the foetus (except in tumour locations where other techniques such as IMRT are recommended).
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Affiliation(s)
- M Michalet
- Institut du cancer de Montpellier, 208, avenue des Apothicaires, 34298 Montpellier, France.
| | - C Dejean
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06100 Nice, France
| | - U Schick
- CHRU de Brest, 2, avenue Foch, 29200 Brest, France
| | - C Durdux
- Hôpital européen Georges-Pompidou, APHP, 20, rue Leblanc, 75015 Paris, France
| | - A Fourquet
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Institut Curie, 26, rue d'Ulm, 75005 Paris, France
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CHOROIDAL MELANOMA DURING PREGNANCY: A CASE REPORT AND REVIEW OF THE LITERATURE. Retin Cases Brief Rep 2021; 15:556-563. [PMID: 30640816 DOI: 10.1097/icb.0000000000000851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To report a case of a woman diagnosed with choroidal melanoma during pregnancy, as well as review similar cases published in the literature. The prevalence, risk factors, treatment, prognosis, and outcomes of choroidal melanoma in pregnancy are addressed. METHODS An extensive search of the literature was conducted by accessing PubMed, MEDLINE, and Scopus databases in January 2018 to identify cases of choroidal or uveal melanoma diagnosed during pregnancy. PATIENT A 37-year-old white woman pregnant with twins and diagnosed with choroidal melanoma. RESULTS Choroidal melanoma in pregnancy has a prevalence ranging from 4.3% to 7.5% among women of childbearing age with the disease. Pregnancy has been linked to increased incidence of choroidal melanoma, but female hormones have not been shown to play a role in the pathogenesis of the disease. Other factors such as melanocyte-stimulation hormone and fetal-induced angiogenesis may be implicated. Choroidal melanoma in pregnancy has not resulted in a worse maternal or fetal outcome. CONCLUSION Although rare, choroidal melanoma in pregnancy is a clinical challenge. Management of these patients should be tailored to maternal and fetal needs.
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Miller M, Schoenfield L, Abdel-Rahman M, Cebulla CM. Is Uveal Melanoma a Hormonally Sensitive Cancer? A Review of the Impact of Sex Hormones and Pregnancy on Uveal Melanoma. Ocul Oncol Pathol 2021; 7:239-250. [PMID: 34604195 PMCID: PMC8443925 DOI: 10.1159/000514650] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite a higher incidence and worse prognosis of uveal melanoma (UM) in men, there have been many case reports of pregnant patients with aggressive UM. This has led researchers to explore the influence of sex hormones and pregnancy on the development and progression of UM and hormones as potential therapeutic targets. SUMMARY A systematic literature review was conducted. More work is needed to elucidate the basis of sex differences in UM incidence and survival. The evaluation of germline BAP1 mutation would be beneficial in patients with UM presenting at a young age. Importantly, multiple studies reported no significant difference between the 5-year survival and 5-year metastasis-free survival rates between nonpregnant women with UM and pregnant women with UM. Multiple case-control studies disagree on how parity affects risk of UM. However, most studies agree that oral contraceptives and hormone replacement therapy have no effect on the incidence of UM. Current treatment strategies for pregnant patients with UM are discussed. Looking forward, this review reports recent research on targeted receptor-based chemotherapy, which is based on evidence of estrogen receptor (ER), estrogen-related receptor alpha (ERRα), and luteinizing hormone-releasing hormone (LHRH) receptor expression in UM. KEY MESSAGES Based on review of the literature, UM is not a contraindication to oral contraceptives, hormone replacement therapy, or pregnancy. Globe-sparing radiation can be used as a treatment option for pregnant patients. Due to the presence of ER on a subset of unselected UM, its potential for adjunctive targeted therapy with agents like tamoxifen should be explored. Lessons from cutaneous melanoma regarding tissue ratios of estrogen receptors (ERα:ERβ) should be applied to assess their therapeutic predictive value. In addition, ERRα-targeted therapeutics and LHRH analogs are worthy of further exploration in UM.
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Affiliation(s)
- Manisha Miller
- Havener Eye Institute, Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lynn Schoenfield
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mohamed Abdel-Rahman
- Havener Eye Institute, Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Division of Genetics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Colleen M. Cebulla
- Havener Eye Institute, Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Yue H, Qian J, Ren H, Zhang R, Gan L, Bi YW. Accelerated growth of uveal melanoma related to pregnancy: a case report and literature review. Int J Ophthalmol 2021; 14:326-329. [PMID: 33614466 DOI: 10.18240/ijo.2021.02.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Han Yue
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
| | - Jiang Qian
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
| | - Hui Ren
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
| | - Rui Zhang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
| | - Lu Gan
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai 200031, China
| | - Ying-Wen Bi
- Department of Pathology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
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Semenova E, Finger PT, Kalach N, Choi W. Palladium-103 Brachytherapy for Choroidal Melanoma in a Pregnant Woman. Ophthalmic Surg Lasers Imaging Retina 2019; 49:364-368. [PMID: 29772048 DOI: 10.3928/23258160-20180501-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/04/2017] [Indexed: 12/19/2022]
Abstract
The authors present a case of a pregnant woman with uveal melanoma treated with plaque brachytherapy. Her calculated fetal radiation dose was significantly below accepted levels. The use of the authors' novel, custom-made lead chin shield further diminished irradiation of the fetus. This patient had uncomplicated treatment course, delivered a healthy child full term, achieved local tumor control, and maintained 20/25 vision at 1-year follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:364-368.].
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Shah SN, Kogachi K, Correa ZM, Schefler AC, Aronow ME, Callejo SA, Cebulla CM, Day-Ghafoori S, Francis JH, Lally S, McCannel TA, Paton KE, Phan IT, Pointdujour-Lim R, Ramasubramanian A, Rath P, Shields CL, Skalet AH, Wells JR, Jennelle RL, Berry JL. Trends in Radiation Practices for Female Ocular Oncologists in North America: A Collaborative Study of the International Society of Ocular Oncology. Ocul Oncol Pathol 2018; 5:54-59. [PMID: 30675478 DOI: 10.1159/000489219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/11/2018] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this study was to determine the known radiation exposure, attitudes, and consequent risk modifications among female ocular oncologists in North America who routinely administer radioactive plaque brachytherapy treatment and are members of the International Society of Ocular Oncology. Methods Nineteen female ocular oncologists completed an anonymous 17-question radiation exposure survey. Results Eleven of the participants chose to routinely wear lead protection during surgery; 8 did not. Fifteen of 19 participants reported using an unloaded "nonactive" template to prepare for plaque implantation. During pregnancy, 11 of 13 participants continued to perform plaque brachytherapy. Eight of these 11 undertook measures to decrease radiation exposure self-reported as lead wear and other. The average reported anxiety regarding fertility was 2.1 (SD, 2.2) on a scale from 1 to 10. Conclusion This study corroborates prior literature that surgeons' exposure to radiation during plaque brachytherapy is minimal. Nonetheless, there remains some anxiety regarding exposure risk to women, due to potential effects on fertility and fetal health. We found variability in exposure monitoring, required training, and precautions during pregnancy amongst this group of surgeons. Improved education and clearer pregnancy guidelines may equip female ocular oncologists with optimal knowledge regarding risk of radiation exposure.
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Affiliation(s)
- Sona N Shah
- USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA.,Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Kaitlin Kogachi
- USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA.,Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | | | - Mary E Aronow
- Massachusetts Eye and Ear, Retina Service, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Jasmine H Francis
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Sara Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tara A McCannel
- University of California, Los Angeles, Los Angeles, California, USA
| | | | - Isabella T Phan
- Kaiser Permanente, Northern California, San Francisco, California, USA
| | | | | | - Pamela Rath
- Everett and Hurite Ophthalmic Association, Pittsburgh, Pennsylvania, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alison H Skalet
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.,Department of Radiation Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jill R Wells
- Emory Eye Center, Emory University, Atlanta, Georgia, USA
| | - Richard L Jennelle
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Jesse L Berry
- USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA.,Children's Hospital Los Angeles, Los Angeles, California, USA
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Al-Jamal RT, Mudhar HS, Currie Z, Rennie IG, Salvi SM. Conjunctival Melanoma during Pregnancy. Ocul Oncol Pathol 2017; 3:101-105. [PMID: 28868278 DOI: 10.1159/000452162] [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: 08/10/2016] [Revised: 09/26/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To describe the clinical and histopathological features of a conjunctival melanoma (CM) during early pregnancy. PROCEDURES A 37-year-old, 20-week pregnant primigravida was referred to the Sheffield Ocular Oncology Service with a rapidly growing lesion arising from the right superior conjunctival fornix, noted from the first trimester of pregnancy. This was associated with pain and bloody discharge. Incisional biopsy confirmed the clinical suspicion of invasive CM. She was treated by primary surgical excision and cryotherapy under local anaesthesia. RESULTS Histology of the excised specimen showed an invasive malignant melanoma with surrounding in situ conjunctival changes arising from a naevus. The melanoma was 10.5 mm thick, focally necrotic, and had a mitotic count of 11/mm2 focally. The patient responded well to surgical treatment. She gave birth to a healthy boy, and the placenta showed no evidence of metastatic melanoma. There has been no recurrence or distant metastasis during 5 years of follow-up. CONCLUSION CM during pregnancy is extremely rare. Because of possible transformation to malignant melanoma, we recommend close monitoring of females known to have pigmented conjunctival lesions of the conjunctiva during pregnancy.
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Affiliation(s)
- Rana'a T Al-Jamal
- Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Zanna Currie
- Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Ian G Rennie
- Academic Unit of Ophthalmology and Orthoptics, Department of Oncology, CR-UK/YCR Sheffield Cancer Research Centre, Medical School, University of Sheffield, Sheffield, UK
| | - Sachin M Salvi
- Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
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