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Xing N, Wang L, Sui X, Zhao C, Huang Y, Peng J. The Safety of Chemotherapy for Ovarian Malignancy during Pregnancy. J Clin Med 2022; 11:jcm11247520. [PMID: 36556136 PMCID: PMC9784446 DOI: 10.3390/jcm11247520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Data on epidemiologic features, treatments and outcomes in women diagnosed with ovarian malignancy during pregnancy are very sparse due to its low incidence. The goal of our study was to summarize the epidemiologic characteristics of pregnant women complicated with ovarian malignancy and investigate the safety and efficacy of chemotherapy during pregnancy. METHODS We retrospectively analyzed the clinicopathological data of eight patients suffering from ovarian malignancy during pregnancy in our institution from June 2011 to July 2021. Furthermore, a systematic literature search was conducted in PubMed up to 1 September 2021, which identified 92 cases with ovarian malignancy during pregnancy eligible for the analysis. Therefore, we collected the data of 100 pregnant patients complicated with ovarian malignancy, including clinical demographics, tumor characteristics, treatment interventions and outcomes. RESULTS In total, 100 pregnant patients complicated with ovarian malignancy were investigated and classified into three groups: 34 cases in the epithelial ovarian cancer (EOC) group, 38 cases in the germ cell tumors (GCTs) group and 28 cases in the sex cord-stromal tumors (SCSTs) group. The onset age of pregnant patients with epithelial ovarian cancer was significantly higher than that of other patients. Pelvic mass and abdominal pain were the common clinical presentations of pregnant patients with ovarian malignancy. For distinguishing epithelial ovarian cancer during pregnancy, the area under the curve (AUC) of CA-125 was 0.718 with an optimal cutoff value of 58.2 U/mL. Moreover, 53 patients underwent surgery during pregnancy, the majority of whom underwent unilateral adnexectomy in the second trimester. Furthermore, 43 patients received chemotherapy during pregnancy, and 28 delivered completely healthy newborns at birth; 13 neonates showed transient abnormalities without further complications; and 2 died during the neonatal period. CONCLUSIONS Our study reveals the safety of chemotherapy for ovarian malignancy during pregnancy. However, large-sample prospective studies are still needed to further explore the safety of chemotherapy in pregnant patients with malignancy to choose the appropriate chemotherapy regimen and achieve the maximum benefit for patients.
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Affiliation(s)
- Naidong Xing
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Lihui Wang
- Gynecology Center, Qingdao Women and Children’s Hospital, Qingdao 266034, China
| | - Xinlei Sui
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250001, China
| | - Chunru Zhao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Yan Huang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Jin Peng
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
- Correspondence:
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Pei Y, Gou Y, Li N, Yang X, Han X, Huiling L. Efficacy and Safety of Platinum-Based Chemotherapy for Ovarian Cancer During Pregnancy: A Systematic Review and Meta-Analysis. Oncol Ther 2021; 10:55-73. [PMID: 34865206 PMCID: PMC9098723 DOI: 10.1007/s40487-021-00179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Based on the available data on ovarian cancer during pregnancy, we performed a review and meta-analysis to evaluate the efficacy and safety of platinum-based chemotherapy against ovarian cancer during pregnancy. Methods We systematically searched three databases including the PubMed, Embase, and Cochrane Library databases for articles published from January 1986 to December 2020 using the following terms: “ovarian tumors OR ovarian carcinoma OR adnexal masses OR ovarian cancer” AND “pregnancy” AND “chemotherapy.” Two authors (Yaping Pei and Yuanfeng Gou) independently searched the literature and extracted data from each eligible study. The outcome measures were overall survival (OS) and progression-free survival (PFS). The OS and PFS of all patients were estimated by Kaplan–Meier survival curves and log-rank tests. Results A total of 43 studies including 55 cases of ovarian cancer during pregnancy were selected. Forty-eight patients were comprehensively staged using the International Federation of Gynecology and Obstetrics (FIGO) staging system. Twenty-six of the 48 patients (54.17%) were diagnosed with early-stage disease, while the remaining had advanced stages (II, III, and IV). The mean age at diagnosis was 29.31 years. The majority of patients in this meta-analysis were diagnosed at a mean gestational age of 16.05 weeks. The mean GA at chemotherapy administration was 17.42 weeks. Overall, 55 women gave birth to 56 newborns, including a pair of twins. At the end of follow-up (median 10 months, range 0–73 months), all the children were healthy, except for one child who died 5 days after delivery due to a congenital abnormality. During 2–204 months of follow-up, there were five cases of recurrence, with no evidence of recurrence in the remaining cases. Unfortunately, one patient died 29 months after diagnosis. Neither median overall survival nor median progression-free survival was obtained. Conclusion Platinum-based chemotherapy may be a good choice for pregnant women with ovarian cancer who want to continue their pregnancy. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-021-00179-9.
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Affiliation(s)
- Yaping Pei
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Yuanfeng Gou
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Na Li
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Xiaojuan Yang
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Xue Han
- Department of Gynecology and Obstetrics, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, China
| | - Liu Huiling
- Department of Gynecology and Obstetrics, Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, China.
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Jiang X, Ye Z, Yu W, Fang Q, Jiang Y. Chemotherapy for ovarian cancer during pregnancy: A systematic review and meta-analysis of case reports and series. J Obstet Gynaecol Res 2021; 47:3425-3436. [PMID: 34342108 DOI: 10.1111/jog.14957] [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: 03/23/2021] [Revised: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aims to investigate the safety and efficacy of chemotherapy in ovarian cancer patients in pregnancy. METHODS In this study, eligible studies were searched on PubMed, Embase, and Cochrane Library databases up to December 31, 2020. Data were calculated and presented by frequency and percentage, mean ± standard deviation (SD), and median (range), respectively. Kaplan-Meier survival analysis was performed to estimate overall survival (OS) and progression-free survival (PFS). RESULTS Finally, 34 studies including 40 ovarian cancer cases receiving chemotherapy during pregnancy were included. All 40 patients received chemotherapy during pregnancy. During the follow-up, seven of 37 (18.9%) women had a relapse and four of them (4/7, 57.1%) died of recurrence. Survival analysis failed to reach median OS and PFS within the follow-up (range 3-72 months). Better OS and PFS after chemotherapy in pregnancy were obtained in women with early-stage ovarian cancer (I) compared with those with advanced stage (III-IV). Neither OS nor FS differed between women treated with multi-drugs and those with monotherapy. Forty-one newborns were delivered from 40 pregnant women. Thirty-four (34/41, 82.9%) were completely healthy at birth and the end of follow-up (range 0.18-160 months). However, one newborn died 5 days after birth due to multiple congenital malformations, and another one developed Tourette's syndrome, aphasia, Asperger's syndrome as well as speech delay. CONCLUSIONS This meta-analysis first reveals the efficacy and safety of chemotherapy for ovarian cancer during pregnancy, especially for early-stage patients. Cisplatin or carboplatin is suggested to be used as monotherapy to reduce adverse effects.
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Affiliation(s)
- Xingzhi Jiang
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhongxue Ye
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Wen Yu
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Qian Fang
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Yafen Jiang
- Department of Obstetrics and Gynecology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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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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Feto-maternal outcomes of pregnancy complicated by ovarian malignant germ cell tumor: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol 2014; 181:145-56. [DOI: 10.1016/j.ejogrb.2014.07.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/19/2014] [Accepted: 07/29/2014] [Indexed: 12/26/2022]
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Manikandan K, Veena P, Elamurugan S, Soundararaghavan S. Mediastinal dysgerminoma complicating pregnancy. Obstet Med 2012; 5:135-7. [PMID: 27582872 DOI: 10.1258/om.2011.110066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2011] [Indexed: 11/18/2022] Open
Abstract
Malignancy complicating pregnancy represents one of the most challenging clinical situations. Lack of evidence and the presence of the dependent fetus contribute to the management dilemma. A 26-year-old primigravida presented at 23 weeks of gestation with a bulging substernal mass. Fine-needle aspiration was reported as mediastinal dysgerminoma. She was treated with weekly bleomycin and three weekly cisplatin and etoposide (BEP). Maternal neutropenia after 11 weeks of bleomycin required colony stimulator factor. Fetal growth restriction necessitated delivery at 31 weeks. Significant clinical and radiological tumour regression was noted after chemotherapy. Postnatally mother received external beam radiotherapy but the disease worsened two weeks after the completion of radiotherapy. Mediastinal dysgerminoma differs from the ovarian counterpart and therefore therapeutic success reports on ovarian germ cell tumours complicating pregnancy cannot be extrapolated. The safety of the BEP regimen for the fetus is yet to be established.
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Affiliation(s)
- K Manikandan
- Jawaharlal Institute of Postgraduate Medical Education and Research - Obstetrics and Gynaecology , Dhanvantari Nagar, Puducherry 605006 , India
| | - P Veena
- Jawaharlal Institute of Postgraduate Medical Education and Research - Obstetrics and Gynaecology , Dhanvantari Nagar, Puducherry 605006 , India
| | - S Elamurugan
- Jawaharlal Institute of Postgraduate Medical Education and Research - Obstetrics and Gynaecology , Dhanvantari Nagar, Puducherry 605006 , India
| | - S Soundararaghavan
- Jawaharlal Institute of Postgraduate Medical Education and Research - Obstetrics and Gynaecology , Dhanvantari Nagar, Puducherry 605006 , India
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Viana LS, Tsunoda AT, Nunes JS, Fregnani JHTG, Vieira MA, Borges AKN, Andrade CEMDC, Serrano SV. Preservation of pregnancy in a patient with acute abdominal pain secondary to advanced and hemorrhagic yolk sac tumor of the right ovary. J Clin Oncol 2011; 29:e758-62. [PMID: 21931036 DOI: 10.1200/jco.2011.35.9554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Luciano Souza Viana
- Medical Oncology Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
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Doxorubicin and ifosfamide for high-grade sarcoma during pregnancy. Cancer Chemother Pharmacol 2011; 69:357-67. [DOI: 10.1007/s00280-011-1707-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/05/2011] [Indexed: 11/30/2022]
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