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Tang X, Zhang X, Ding Y, Zhang Y, Zhang N, Qiu J, Hua K. A long-term retrospective analysis of management of cervical cancer during pregnancy. Int J Gynaecol Obstet 2024; 165:1189-1198. [PMID: 38149695 DOI: 10.1002/ijgo.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE This study aims to describe cervical cancer during pregnancy (CCP) and investigate factors associated with survival outcomes. METHODS This retrospective matched study included CCP patients from May 2007 to August 2021 and matched non-pregnant cervical cancer patients (1:2) based on age (±5 years), year at diagnosis (±2 years), histological type and stage (2018 FIGO). The Kaplan-Meier method and multivariate Cox regression analyses were used to assess the impact of pregnancy and clinicopathologic factors on prognosis. RESULTS Thirty-eight CCP patients (stage IA to IIIC) and 76 non-pregnant patients were included. Most CCP patients were diagnosed in the first (31.6%) or second (47.4%) trimester. CCP patients had a longer waiting time than non-pregnant patients. Pregnancy continued in 42.1% (continuation of pregnancy [COP] group) and was terminated in 57.9% (termination of pregnancy [TOP] group) of patients. Survival analysis showed no significant differences in recurrence-free survival (RFS) or overall survival (OS) between pregnant and non-pregnant patients or between the COP and TOP groups. At the end of the follow-up period (range 12-178 months), 23 children born to CCP patients exhibited normal development. CONCLUSION Pregnancy does not impact cervical cancer prognosis. The oncologic outcomes of the TOP and COP groups were comparable. A pregnancy-preserving strategy could be considered for managing CCP patients.
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Affiliation(s)
- Xiaoyan Tang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Xuyin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Yan Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Yunqiang Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Ning Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Junjun Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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Bohlin KS, Brännström M, Dahm‐Kähler P. Gynecological cancer during pregnancy-From a gyne-oncological perspective. Acta Obstet Gynecol Scand 2024; 103:761-766. [PMID: 38183316 PMCID: PMC10993343 DOI: 10.1111/aogs.14763] [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: 11/30/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
Gynecological cancer diagnosed during pregnancy requires accurate diagnosis and staging to determine optimal treatment based on gestational age. Cervical and ovarian cancers are the most common and multidisciplinary team collaboration is pivotal. Magnetic resonance imaging and ultrasound can be used without causing fetal harm. In cervical cancer, early-stage treatments can often be delayed until fetal lung maturation and cesarean section is recommended if disease prevails, in combination with a simple/radical hysterectomy and lymphadenectomy. Chemoradiotherapy, the recommended treatment for advanced stages, is not compatible with pregnancy preservation. Most gestational ovarian cancers are diagnosed at an early stage and consist of nonepithelial cancers or borderline tumors. Removal of the affected adnexa during pregnancy is often necessary for diagnosis, though staging can be performed after delivery. In selected cases of advanced cervical and ovarian cancers, neoadjuvant chemotherapy may be an option to allow gestational advancement but only after thorough multidisciplinary discussions and counseling.
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Affiliation(s)
- Katja Stenström Bohlin
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Mats Brännström
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
| | - Pernilla Dahm‐Kähler
- Department of Obstetrics and GynecologySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
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Riano I, Contreras-Chavez P, Pabon CM, Meza K, Kiel L, Bejarano S, Florez N. An Overview of Cervical Cancer Prevention and Control in Latin America and the Caribbean Countries. Hematol Oncol Clin North Am 2024; 38:13-33. [PMID: 37330343 DOI: 10.1016/j.hoc.2023.05.012] [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: 06/19/2023]
Abstract
Cervical cancer is a health crisis affecting women and their families across the world. It is known that developed countries have comprehensive protocols with recommendations regarding workforce, expertise, and medical resources to address this common cancer among women. In contrast, disparities in addressing cervical cancer remain present in Latin America and Caribbean countries. Here, we reviewed the current strategies of cervical cancer prevention and control in the region.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, One Medical Drive, Lebanon, NH 03766, USA.
| | - Pamela Contreras-Chavez
- Division of Hematology and Oncology, Dana Farber Cancer Institute, St. Elizabeth's Medical Center, 736 Cambridge Street, Brighton, MA 02135, USA. https://twitter.com/PamChMD
| | - Cindy Medina Pabon
- Division of Hematology and Oncology, The University of Texas MD Anderson Cancer Center, Unit 0463, 1515 Holcombe Boulevard, FC11.3055, Houston, TX 77030, USA. https://twitter.com/cmpabon
| | - Kelly Meza
- Division of Internal Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. https://twitter.com/KellyMezaMD
| | - Lauren Kiel
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA
| | - Suyapa Bejarano
- Department of Radiation Oncology, Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Narjust Florez
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA. https://twitter.com/NarjustFlorezMD
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Aranda-Gutierrez A, Ferrigno Guajardo AS, Vaca-Cartagena BF, Gonzalez-Sanchez DG, Ramirez-Cisneros A, Becerril-Gaitan A, Azim HA, Villarreal-Garza C. Obstetric and neonatal outcomes following taxane use during pregnancy: a systematic review. BMC Cancer 2024; 24:9. [PMID: 38166767 PMCID: PMC10763111 DOI: 10.1186/s12885-023-11704-6] [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: 07/11/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The use of taxanes following the first trimester of pregnancy is endorsed by current clinical guidelines. However, evidence regarding their safety in terms of obstetric and neonatal outcomes is limited. METHODS A comprehensive literature search was performed using the MEDLINE, CENTRAL and Web of Sciences databases from their inception up to 12/16/2022. Eligibility criteria included gestational taxane use, presentation of original findings, and individual case data presented. A descriptive statistical analysis was undertaken. RESULTS A total of 159 patients treated with taxane-containing regimens during pregnancy were identified, resulting in 162 fetuses exposed in utero. The majority of patients had breast cancer (n = 88; 55.3%) or cervical cancer (n = 45; 28.3%). The most commonly employed taxane was paclitaxel (n = 131; 82.4%). A total of 111 (69.8%) patients were also treated with other cytotoxic drugs during pregnancy, including platinum salts (n = 70; 63.0%) and doxorubicin/cyclophosphamide (n = 20; 18.0%). While most patients received taxanes during the second trimester of pregnancy (n = 79; 70.0%), two were exposed to taxanes in the first trimester. Obstetric outcomes were reported in 105 (66.0%) cases, with the most frequent adverse events being preterm contractions or premature rupture of membranes (n = 12; 11.4%), pre-eclampsia/HELLP syndrome (n = 6; 5.7%), and oligohydramnios/anhydramnios (n = 6; 5.7%). All cases with pregnancy outcome available resulted in live births (n = 132). Overall, 72 (54.5%) neonates were delivered preterm, 40 (30.3%) were classified as small for gestational age (SGA), and 2 (1.5%) had an Apgar score of < 7 at 5 min. Perinatal complications included acute respiratory distress syndrome (n = 14; 10.6%), hyperbilirubinemia (n = 5; 3.8%), and hypoglycemia (n = 2; 1.5%). In addition, 7 (5.3%) cases of congenital malformations were reported. At a median follow-up of 16 months, offspring health status was available for 86 (65.2%), of which 13 (15.1%) had a documented complication, including delayed speech development, recurrent otitis media, and acute myeloid leukemia. CONCLUSIONS Taxanes appear to be safe following the first trimester of pregnancy, with obstetric and fetal outcomes being similar to those observed in the general obstetric population. Future studies should aim to determine the most effective taxane regimen and dosage for use during gestation, with a specific focus on treatment safety.
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Affiliation(s)
- Alejandro Aranda-Gutierrez
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Bryan F Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - David G Gonzalez-Sanchez
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Arantxa Ramirez-Cisneros
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Andrea Becerril-Gaitan
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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5
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Chen G, Huang K, Sun J, Yang L. Cervical neuroendocrine carcinoma in the third trimester: a rare case report and literature review. BMC Pregnancy Childbirth 2023; 23:571. [PMID: 37563542 PMCID: PMC10413603 DOI: 10.1186/s12884-023-05900-2] [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: 04/16/2023] [Accepted: 08/05/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND The incidence of cervical neuroendocrine carcinoma (CNECC) during pregnancy is extremely rare. Insufficient awareness of gynecological tumor screening, as well as atypical and insidious initial clinical symptoms, may result in diagnostic delays and misdiagnosis. There is no standardized treatment for cervical cancer in pregnancy. Herein, we present a case of cervical neuroendocrine carcinoma diagnosed in the third trimester of pregnancy. CASE PRESENTATION A 26-year-old female at 30 1/7 weeks of gestation presented with lower back and sacroiliac joint pain, abdominal distension, and lower limb dyskinesia. A pelvic examination revealed a large fungating gray mass that encompassed the entire cervix, with cervical contact bleeding testing positive. Imaging studies showed a significant cervical mass, diffuse liver changes, and metastasis to multiple sites. Biopsy results revealed poorly differentiated cervical carcinoma exhibiting high-grade neuroendocrine features, consistent with a diagnosis of large cell neuroendocrine carcinoma. The patient was diagnosed with stage IVB CNECC with HPV18 (+), and due to the gestational age of the fetus and her deteriorating condition, she underwent cesarean section delivery after receiving fetal lung maturation therapy. Following surgery, eight cycles of neoadjuvant chemotherapy were applied. Unfortunately, she succumbed to multiple tumor metastases six months post-treatment. Despite this tragic outcome, the infant was discharged in a healthy condition. CONCLUSIONS CNECC during pregnancy, particularly the large-cell type, is an ultra-rare condition with poor prognosis. This case highlights the importance of individualized treatment approach and the need for better screening, early detection, and treatment. Given the rarity of the disease, further research is warranted to determine the prognostic factors and develop effective treatment strategies for this ultra-rare and aggressive malignancy.
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Affiliation(s)
- Gezi Chen
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Huang
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinglei Sun
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Yang
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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6
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Cintra GF, Derchain SFM, Bicalho DS, Filho ALDS, Primo WQSP. Cervical cancer in pregnancy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:293-296. [PMID: 37339650 PMCID: PMC10281765 DOI: 10.1055/s-0043-1770142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Geórgia Fontes Cintra
- Instituto Brasileiro de Controle de Câncer, São Camilo Oncologia, São Paulo, SP, Brazil
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7
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He Z, Xie C, Qi X, Hu Z, He Y. The effect of preserving pregnancy in cervical cancer diagnosed during pregnancy: a retrospective study. BMC Womens Health 2022; 22:314. [PMID: 35879712 PMCID: PMC9317436 DOI: 10.1186/s12905-022-01885-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Cervical cancer diagnosed during pregnancy is a rare event, and data regarding efficacy of cancer treatment during pregnancy is limited. This study aimed to assess the safety of continuation of the pregnancy for mother and fetus when concomitantly diagnosed with cervical cancer. Methods This study retrospectively analyzed all cervical cancer patients diagnosed while pregnant or immediately postpartum, inclusive from Jan 2010 to June 2019 at our institute. Patient clinical details and follow-up were obtained from hospital records. Results The study comprised 40 patients with clinical cancer stages of IA1 (1/40, 2.5%); IB1 (15/40, 37.5%); IB2 (10/40, 25%); IIA (12/40, 30%); and IIB (2/40, 5%). There were 38 patients diagnosed during pregnancy, and 2 diagnosed in the postpartum period. Of the 38 patients, 17 were diagnosed in the first trimester, 13 in the second trimester, and 8 in the third trimester. 10 of 38 patients (26.3%) continued their pregnancy after learning of their diagnosis; 7 (70%) in the third trimester and 3 (30%) in the second trimester. The mean time from diagnosis to surgery in the patients who continued their pregnancy was 52.7 days, which was statistically significantly greater than the termination of pregnancy group (52.7 vs. 16.3 days, P < 0.01). Notably, there was no survival difference between the 2 groups (100% vs. 90.91%, P = 0.54), and none of the pregnant women who ultimately died had delayed treatment due to pregnancy. Similarly, the surgical estimated blood loss and operative duration comparison in the 2 groups were not significantly different. Conclusions In the present study, the gestational age of pregnancy at the time of initial diagnosis of cervical cancer was an important determinant in the disease management. Continuation of the pregnancy when diagnosed with cervical cancer may not affect the oncologic outcome of the mother nor increase either surgical or obstetric complications. Additionally, the use of neoadjuvant chemotherapy did not threaten the health of the fetus. These results may be useful in counseling patients facing the diagnosis of cervical cancer during pregnancy.
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Girardelli S, Rabaiotti E, Mauro F, Gentilini O, Zucchinelli P, Cioffi R, Valsecchi L, Mangili G, Peccatori FA, Candiani M. Weekly Paclitaxel Administered During a Twin Pregnancy for Recurrent Breast Cancer: Case Report and Review of the Literature. J Adolesc Young Adult Oncol 2022; 11:632-636. [PMID: 35180353 DOI: 10.1089/jayao.2021.0181] [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: 12/16/2022] Open
Abstract
Although cancer treatment during single pregnancy has been standardized, how to manage cancer diagnosed during a multiple gestation is still unclear. Chemotherapy during pregnancy has shown to be safe, however, there are reports of increased risks of fetal complications such as intrauterine growth restriction and preterm birth. Also, how to best adjust this to the pharmacokinetic characteristics of a twin gestation has yet to be fully investigated. We report the case of an IVF twin pregnancy with a diagnosis of breast cancer recurrence shortly after conception, and how the pregnancy was managed to obtain optimal obstetric, maternal/oncological, and fetal outcomes.
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Affiliation(s)
- Serena Girardelli
- Department of Obstetrics and Gynecology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Emanuela Rabaiotti
- Department of Obstetrics and Gynecology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Fabio Mauro
- Department of Obstetrics and Gynecology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Oreste Gentilini
- Department of Breast Surgery, and I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Patrizia Zucchinelli
- Department of Oncology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Raffaella Cioffi
- Department of Obstetrics and Gynecology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Luca Valsecchi
- Department of Obstetrics and Gynecology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Fedro A Peccatori
- Fertility and Procreation Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Bernardini F, Ferrandina G, Ricci C, Fagotti A, Fanfani F, Cavaliere AF, Gui B, Scambia G, De Vincenzo R. Neoadjuvant Chemotherapy in Pregnant Patients with Cervical Cancer: A Monocentric Retrospective Study. Curr Oncol 2022; 29:5702-5714. [PMID: 36005188 PMCID: PMC9406620 DOI: 10.3390/curroncol29080450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To date, little and discordant data still exists on the management of cervical cancer (CC) during pregnancy. In this paper, we report our experience of the treatment of these patients analyzing the oncologic, obstetric, and neonatal outcomes. Methods: Between January 2010 and December 2021, 13 patients were diagnosed with CC during pregnancy. All patients underwent platinum-based neoadjuvant chemotherapy (NACT) and 11/13 patients underwent a cesarean radical hysterectomy (CRH). Results: All 13 patients were diagnosed with squamous-cell carcinoma, FIGO-2018 stage between IB2-IIIC1. The majority of patients had a partial (61.5%) or complete (15.4%) response to NACT. Most patients had a regular course of pregnancy and the obstetric complications observed were gestational diabetes mellitus in 23.1% and IUGR in 15.4% of cases. CRH was performed in the absence of major complications. Only 2 patients (15.4%) had disease recurrence and only 1 patient (7.7%) died of disease. All children are currently healthy. At birth, we observed mainly prematurity-related complications (38.5% respiratory distress syndrome and 7.7% neonatal jaundice) and only a case of congenital malformation (hypospadias). In our pediatric population, we reported a case of malignancy (acute myeloid leukemia). Conclusion: NACT seems to be safe and efficacious in controlling tumor burden during pregnancy. CRH following NACT appears to be feasible, avoiding repeated surgery and treatment delays. This approach is also reasonably safe from a maternal, obstetric, and neonatal point of view.
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Affiliation(s)
- Federica Bernardini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Gabriella Ferrandina
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Caterina Ricci
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Anna Fagotti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Fanfani
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Anna Franca Cavaliere
- Gynecology and Obstetric Department, Azienda USL Toscana Centro, Santo Stefano Hospital, 59100 Prato, Italy
| | - Benedetta Gui
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiodiagnostica Addominale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Rosa De Vincenzo
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanita Pubblica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
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Jasrotia R, Dhanjal DS, Bhardwaj S, Sharma P, Chopra C, Singh R, Kumar A, Mubayi A, Kumar D, Kumar R, Goyal A. Nanotechnology based vaccines: Cervical cancer management and perspectives. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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Shima E, Itsukaichi M, Yoshihara K, Ishiguro T, Haino K, Nishino K, Nishikawa N, Nishijima K, Enomoto T. Fetal biometric and Doppler measurements following abdominal radical trachelectomy in the second trimester of the pregnancy. BMC Pregnancy Childbirth 2022; 22:343. [PMID: 35443666 PMCID: PMC9022245 DOI: 10.1186/s12884-022-04671-6] [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: 12/05/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our previous study demonstrated the safety and effectiveness of abdominal radical trachelectomy during pregnancy but did not focus on the fetus. This study aimed to clarify the influence of abdominal radical trachelectomy performed during pregnancy on the fetus. METHODS Eight cervical cancer patients who underwent abdominal radical trachelectomy at our hospital between February 2013 and August 2020 were enrolled in this study. To assess the peri- and postoperative influence on the fetus, we performed fetal heart monitoring at 30-min intervals during abdominal radical trachelectomy and calculated the estimated fetal body weight and resistance indexes of the middle cerebral artery and umbilical artery from postsurgery until delivery. RESULTS Four out of eight patients had preterm birth due to chorioamnionitis in one case and consideration of the recurrent risk of cervical cancer in three cases. Fetal heart monitoring during abdominal radical trachelectomy revealed deceleration just once in one case but no abnormal findings in the other cases. In all cases, the fetal growth after abdominal radical trachelectomy was normal until delivery. No abnormal Doppler findings were detected in the middle cerebral artery or umbilical artery. CONCLUSION Our findings clarified that abdominal radical trachelectomy performed for the treatment of early-stage cervical cancer during pregnancy has no obvious influence on fetal growth. Next, it is necessary to evaluate the growth and development of children delivered from mothers who have undergone abdominal radical trachelectomy during pregnancy.
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Affiliation(s)
- Eiri Shima
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Mina Itsukaichi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Tatsuya Ishiguro
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Koji Nishino
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Nobumichi Nishikawa
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Koji Nishijima
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan.
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Rapid Progression of Cervical Squamous Cell Carcinoma with Delayed Treatment in Pregnancy. Gynecol Oncol Rep 2022; 40:100960. [PMID: 35372656 PMCID: PMC8965899 DOI: 10.1016/j.gore.2022.100960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
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Beckmann MW, Stuebs FA, Vordermark D, Koch MC, Horn LC, Fehm T. The Diagnosis, Treatment, and Aftercare of Cervical Carcinoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:806-812. [PMID: 34755595 DOI: 10.3238/arztebl.m2021.0352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/16/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 4380 cases of cervical carcinoma were diagnosed in Germany in 2016. In women who had not participated in early detection programs, cervical carcinoma was usually already in an advanced stage at the time of diagnosis. Certified structures for care in conformity with the existing guidelines are available. METHODS The new German clinical practice guideline was revised with the participation of 50 medical societies under the expert guidance of the Guideline Program in Oncology, which includes the German Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). A systematic literature review was conducted. Systematic reviews, meta-analyses, and randomized controlled trials (RCTs) were considered. RESULTS The histologic tumor stage and lymph-node stage are essential determinants of the treatment strategy. The main innovation regarding surgical treatment is the revival of open hysterectomy (overall survival [minimally invasive vs open hysterectomy]: 94.04% vs 99.4%; hazard ratio [HR]: 6.00; 95% confidence interval [1.77; 20.30]). In addition, for tumors measuring 2 cm or less, sentinel node biopsy is recommended rather than radical pelvic lymphadenectomy. MRI-guided brachytherapy is an obligatory component of radiochemotherapy (overall survival [radiochemotherapy with vs without brachytherapy]: 58.2% vs 46.2%, p<0.001). The standard palliative treatment consists of bevacizumab combined with a platinum-containing agent (overall survival: HR: 0.77 [0.62; 0.95]; p = 0.007). CONCLUSION Despite the introduction of new treatments, the outcome of patients with advanced cervical carcinoma has not much improved. In the surgical treatment of cervical carcinoma, the open approach is now favored. The sentinel node biopsy technique has become well established for the surgical staging of small tumors. Controlled trials are needed so that the outcome of women with cervical carcinoma, particularly in its advanced and metastatic stages, can be improved.
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Chen YD, Cai FY, Mao YZ, Yang YS, Xu K, Liu XF, Fan WW, Chen W, Jiang FQ, Zhang H. The anti-neoplastic activities of aloperine in HeLa cervical cancer cells are associated with inhibition of the IL-6-JAK1-STAT3 feedback loop. Chin J Nat Med 2021; 19:815-824. [PMID: 34844720 DOI: 10.1016/s1875-5364(21)60106-1] [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: 03/28/2021] [Indexed: 12/09/2022]
Abstract
Cervical cancer (CC) is recognized as the most common neoplasm in the female reproductive system worldwide. The lack of chemotherapeutic agents with outstanding effectiveness and safety severely compromises the anti-cipated prognosis of patients. Aloperine (ALO) is a natural quinolizidine alkaloid with marked anti-cancer effects on multiple malignancies as well as favorable activity in relieving inflammation, allergies and infection. However, its therapeutic efficacy and underlying mechanism in CC are still unclear. In the current study, MTT assay was employed to evaluate the viability of HeLa cells exposed to ALO to preliminarily estimate the effectiveness of ALO in CC. Then, the effects of ALO on the proliferation and apoptosis of HeLa cells were further investigated by plate colony formation and flow cytometry, respectively, while the migration and invasion of ALO-treated HeLa cells were evaluated using Transwell assay. Moreover, nude mice were subcutaneously inoculated with HeLa cells to demonstrate the anti-CC properties of ALO in vivo. The molecular mechanisms underlying these effects of ALO were evaluated by Western blot and immunohistochemical analysis. This study experimentally demonstrated that ALO inhibited the proliferation of HeLa cells via G2 phase cell cycle arrest. Simultaneously, ALO promoted an increase in the percentage of apoptotic HeLa cells by increasing the Bax/Bcl-2 ratio. Additionally, the migration and invasion of HeLa cells were attenuated by ALO treatment, which was considered to result from inhibition of epithelial-to-mesenchymal transition. For molecular mechanisms, the expression and activation of the IL-6-JAK1-STAT3 feedback loop were markedly suppressed by ALO treatment. This study indicated that ALO markedly suppresses the proliferation, migration and invasion and enhances the apoptosis of HeLa cells. In addition, these prominent anti-CC properties of ALO are associated with repression of the IL-6-JAK1-STAT3 feedback loop.
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Affiliation(s)
- Yao-Dong Chen
- Department of Ultrasonic Imaging, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Fang-Yu Cai
- Department of Thoracic Surgery, the General Hospital of Heilongjiang Province Land Reclamation Bureau, Harbin 150088, China
| | - Yu-Ze Mao
- Department of Cardio-Thoracic Surgery, the First Affiliated Hospital of Jiamusi University, Jiamusi 154000, China
| | - Yong-Sheng Yang
- Department of Ultrasonic Imaging, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Kun Xu
- Department of Ultrasonic Imaging, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Xiao-Fang Liu
- Department of Ultrasonic Imaging, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Wen-Wen Fan
- Department of Ultrasonic Imaging, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Wu Chen
- Department of Ultrasonic Imaging, the First Hospital of Shanxi Medical University, Taiyuan 030001, China.
| | - Feng-Qi Jiang
- Department of General Surgery, Heilongjiang Provincial Hospital, Harbin 150001, China.
| | - Hui Zhang
- Department of Radiology, the First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China.
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15
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Clinical Effects of Chinese Herbal Decoction Combined with Basic Chemoradiotherapy and Nursing Intervention in the Treatment of Cervical Cancer and the Effect on Serum CEA, CA125, and TNF- α Levels. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1446864. [PMID: 34603461 PMCID: PMC8483916 DOI: 10.1155/2021/1446864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/08/2021] [Indexed: 01/11/2023]
Abstract
Objective This study was aimed to investigate the clinical effect of Chinese herbal decoction combined with basic chemoradiotherapy and nursing intervention in the treatment of cervical cancer and the effect on serum carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), and tumor necrosis factor-α (TNF-α) levels. Methods A total of 200 cervical cancer patients in our hospital from June 2015 to November 2018 were selected and randomly divided into a study group and a control group. The control group was given chemoradiotherapy and psychological nursing treatment, and the study group was given self-made Chinese herbal decoction on the basis of the control group. The clinical efficacy and serum CEA, CA125, and TNF-α levels were assessed. Results After treatment, the total effective rate of the study group was significantly higher than that of the control group. The levels of serum CEA, CA125, and TNF-α were decreased in the two groups after treatment, and the decrease in the study group was more significant than that in the control group. After treatment, CD3+ and CD4+ levels were increased compared with those before treatment, and the increase in the study group was also more obvious than that of the control group. The level of CD8+ was decreased compared with before treatment, and the decrease in the study group was more notable than that of the control group. The two-year cumulative survival rate of the study group was markedly higher than that of the control group. The quality-of-life of patients treated for 3 months, 1 year, and 2 years was dramatically improved compared to before treatment. The incidence of adverse reactions in the study group was lower than that of the control group. Conclusion The treatment of basic chemoradiotherapy and psychological nursing intervention combined with Chinese herbal decoction on cervical cancer patients can improve the clinical treatment effects, improve the patient's body immunity, reduce serum CEA, CA125, and TNF-α levels, prolong survival time, improve life quality, and reduce the incidence of adverse reactions, and it is worthy of clinical promotion.
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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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Schwab R, Anic K, Hasenburg A. Cancer and Pregnancy: A Comprehensive Review. Cancers (Basel) 2021; 13:3048. [PMID: 34207252 PMCID: PMC8234287 DOI: 10.3390/cancers13123048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 01/11/2023] Open
Abstract
Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. Tumor entity, stage, biology and gestational week at diagnosis determine the appropriate approach. As premature delivery emerged as one of the main risk factors for adverse long-term outcome of the progeny, it should be avoided, if reasonable from the oncological perspective. This article offers a comprehensive review with respect to the various aspects of cancer in pregnancy.
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Affiliation(s)
- Roxana Schwab
- Department of Obstetrics and Women’s Health, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.A.); (A.H.)
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Wang M, Yin Z, Miao J, Wu Y. The fetal outcomes after neoadjuvant platinum and paclitaxel chemotherapy during pregnancy: analysis of three cases and review of the literature. Arch Gynecol Obstet 2021; 305:49-54. [PMID: 34115181 DOI: 10.1007/s00404-021-06113-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Data on the outcomes of fetus who are exposed to neoadjuvant platinum and paclitaxel chemotherapy during pregnancy are lacking. METHODS Relevant data were abstracted from patients in our institution, PubMed, Embase and Cochrane Library databases. The primary assessment was the frequency of fetal death and congenital abnormalities. The secondary assessment was other negative fetal/infant outcomes including FGR, RDS, secondary malignant diseases and other recorded adverse events. RESULTS Of the three infants in our center who exposed to platinum and paclitaxel chemotherapy during pregnancy, the physical evaluation and qualified Denver Developmental Screening Test showed normal findings at the last follow-up (19-24 months). Hearing evaluation among three children also showed normal findings. Another 34 infants (including a twins) of 21 studies in previous studies who exposed to platinum and paclitaxel chemotherapy during pregnancy were included in the final analysis. Of the 37 infants identified, 24 were exposed to cisplatin plus paclitaxel, and 13 were exposed to carboplatin plus paclitaxel. None of the 37 fetuses was abortion or dead during the pregnancy. 97.3% (36/37) infants were delivered by cesareans and the median gestational ages of delivery were 34.76 weeks (95% CI, 34.08-35.44). 1 fetus showed intrauterine growth restriction and one was found with left-sided ventriculomegaly and hydramnios before chemotherapy. Adverse events occurred in 18.9% (7/37) infants at birth, including two RDS, one hearing loss, one pathological jaundice, one first-degree intraventricular hemorrhage, one erythema, one corresponding to -0.5 standard deviation from average body weight of the same gestational weeks. No reports of neonatal cardiologic abnormalities are reported in these infants after the initiating of chemotherapy. The infant with congenital anomaly died 5 days after birth. During the follow-up, 5.4% (2/37) of the infants were diagnosed with malignant diseases. One retroperitoneal embryonal rhabdomyosarcoma at 5 years old and one acute myeloid leukemia at 22 months of age. 32/37 (86.5%) children were healthy at the end of follow-ups (median 33 months, IQR 15.75-54.25 months). CONCLUSIONS Our results showed that neoadjuvant platinum and paclitaxel combined chemotherapy was a feasible and safe choice for the management of patients with cervical and ovarian cancer during the second and third trimesters of gestation.
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Affiliation(s)
- Ming Wang
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qihelou St, Dongcheng District, Beijing, 100006, China
| | - Ziran Yin
- Department of Common Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jinwei Miao
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qihelou St, Dongcheng District, Beijing, 100006, China
| | - Yumei Wu
- Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 17 Qihelou St, Dongcheng District, Beijing, 100006, China.
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Benoit L, Mir O, Vialard F, Berveiller P. Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents. Cancers (Basel) 2021; 13:1238. [PMID: 33799824 PMCID: PMC8000411 DOI: 10.3390/cancers13061238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
The occurrence of cancer during pregnancy is observed in 1 in 1000 pregnancies and is expected to increase given the trend of delaying childbearing. While breast cancer is the most common, the incidence of other cancers, such as cervical, ovarian, and lung cancers as well as hemopathies and melanomas, is also increasing. Thus, cancer occurrence in pregnant women raises questions of management during pregnancy and, especially, assessment of the treatment benefit-risk ratio to ensure optimal management for the mother while ensuring the safety of the fetus. Chemotherapy remains a cornerstone of cancer management. If the use of anticancer agents appears possible during pregnancy, while avoiding the first trimester, the extent of placental transfer of different anticancer agents varies considerably thereafter. Furthermore, the significant physiological pharmacokinetic variations observed in pregnant women may have an impact on the placental transfer of anticancer agents. Given the complexity of predicting placental transfer of anticancer agents, preclinical studies are therefore mandatory. The aim of this review was to provide updated data on in vivo and ex vivo transplacental transfer of anticancer agents used in the management of the most common pregnancy-associated cancers to better manage these highly complex cases.
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Affiliation(s)
- Laure Benoit
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Gynecology and Obstetrics, 78300 Poissy, France;
| | - Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, 94800 Villejuif, France;
| | - François Vialard
- Université Paris-Saclay, UMR 1198, INRAE, BREED, RHuMA, 78350 Jouy-en-Josas, France;
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Genetics, 78300 Poissy, France
| | - Paul Berveiller
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Department of Gynecology and Obstetrics, 78300 Poissy, France;
- Université Paris-Saclay, UMR 1198, INRAE, BREED, RHuMA, 78350 Jouy-en-Josas, France;
- Ecole Nationale Vétérinaire d’Alfort, BREED, 94700 Maisons-Alfort, France
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Lopez A, Rodriguez J, Estrada E, Aragona A, Chavez C, Amaro K, De Padua C, Borges Garnica A, Rendón G, Alméciga A, Serrano O, Scasso S, Laufer J, Greif D, Taranto F, Hoegl J, Calderaro di Ruggiero F, Pareja R. Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study. Int J Gynecol Cancer 2021; 31:468-474. [PMID: 33649015 DOI: 10.1136/ijgc-2020-001764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy. METHODS A multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes. RESULTS Thirty-three patients were included. Median age was 34 years (range 31-36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA-IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34-36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0-36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease. CONCLUSION Neoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.
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Affiliation(s)
- Aldo Lopez
- Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Juliana Rodriguez
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia.,Department of Gynecology and Obstetrics. Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Erick Estrada
- Department of Gynecology and Obstetrics, Hospital General San Juan de Dios, Guatemala City, Guatemala, Guatemala
| | - Alejandro Aragona
- Hospital Municipal de Oncologia Marie Curie, Buenos Aires, Federal District, Argentina
| | - Carlos Chavez
- Instituto Regional de Enfermedades Neoplásicas (IREN Sur), Arequipa, Peru
| | - Karina Amaro
- Hospital Nacional Cayetano Heredia, Lima, Lima, Peru
| | | | - Alfredo Borges Garnica
- Unidad de Terapia Antineoplásica (UTAN), Centro Médico Guerra Méndez, Valencia, Venezuela, Bolivarian Republic
| | - Gabriel Rendón
- Department of Gynecologic Oncology, Instituto de Cancerología- Las Américas-AUNA, Medellin, Antioquia, Colombia
| | - Adriana Alméciga
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Oscar Serrano
- Department of Gynecologic Oncology, Hospital Militar Centra, Bogotá, Colombia
| | - Santiago Scasso
- Department of Gynecologic Oncology, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Joel Laufer
- Department of Gynecologic Oncology, Hospital Pereira Rossell, Montevideo, Uruguay
| | - Diego Greif
- Department of Gynecology, Hospital de Clínicas Dr. Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Fernando Taranto
- Department of Gynecology, Hospital de Clínicas Dr. Manuel Quintela, Universidad de la República, Montevideo, Uruguay
| | - Jorge Hoegl
- Servicio Oncológico Hospitalario del Instituto Venezolano de los Seguros Sociales, Caracas, Venezuela
| | | | - René Pareja
- Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia .,Clínica de Oncología Astorga, Universidad Pontificia Bolivariana, Medellin, Colombia
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Stanca M, Ciobanu V, Gheorghe M, Kiss SL, Cozlea AL, Căpîlna ME. The Double Life-Saving Approach of Abdominal Radical Trachelectomy during Pregnancy for Early-Stage Cervical Cancer-An Overview of the Literature and Our Institutional Experience. J Pers Med 2021; 11:jpm11010029. [PMID: 33466295 PMCID: PMC7824800 DOI: 10.3390/jpm11010029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Cervical cancer is the most common type of cancer encountered during pregnancy, with a frequency of 0.8–1.5 cases per 10,000 births. It is a dire condition endangering patients’ lives and pregnancy outcomes, and jeopardizing their fertility. However, there is a lack of current evidence and consensus regarding a standard surgical technique for pregnant patients who suffer from this condition during pregnancy. The study aims to comprehensively update all published data, evaluating the obstetrical and oncological results of pregnant patients who underwent abdominal radical trachelectomy during early stages of cervical cancer. (2) Methods: A literature search on the Medline, PubMed, and Google Scholar databases was performed, including all articles in question up to July 2020. This study presents an overview of the literature and our institutional experience. (3) Results: A total of 25 cases of abdominal radical trachelectomy were performed during pregnancy for early cervical cancer, including the five cases managed by the authors. Of these, 81% (19 patients) gave birth to live newborns through elective C-section, and 19% (6 patients) experienced miscarriage shortly after the procedure. None of the 25 patients (100%) reported disease recurrence. (4) Conclusions: The results of the current study were satisfactory. However, abdominal radical trachelectomy does not represent the current standard of care for cervical cancer during pregnancy, but it could play an important role if more evidence on its effectiveness will be provided.
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Li M, Zhao Y, Qie M, Zhang Y, Li L, Lin B, Guo R, You Z, An R, Liu J, Zhang Z, Bi H, Hong Y, Chang S, He G, Hua K, Zhou Q, Liao Q, Wang Y, Wang J, Li X, Wei L. Management of Cervical Cancer in Pregnant Women: A Multi-Center Retrospective Study in China. Front Med (Lausanne) 2020; 7:538815. [PMID: 33365317 PMCID: PMC7750630 DOI: 10.3389/fmed.2020.538815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background: This retrospective multi-center study aimed to describe the epidemiological characteristics, clinical features, and management of patients with cervical cancer in pregnancy (CCIP) and evaluate maternal and infant outcomes. Methods: The data of patients with CCIP were retrospectively collected from those diagnosed and treated in 17 hospitals in 12 provinces in China between January 2009 and November 2017. The information retrieved included patients' age, clinical features of the tumor, medical management (during pregnancy or postpartum), obstetrical indicators (i.e., gestational age at diagnosis, delivery mode, and birth weight), and maternal and neonatal outcomes. Survival analyses were performed using Kaplan-Meier survival curves and log-rank tests that estimated the overall survival of patients. Results: One-hundred and five women diagnosed with CCIP (median age = 35 years) were identified from ~45,600 cervical cancer patients (0.23%) and 525,000 pregnant women (0.020%). The median gestational age at cancer diagnosis was 20.0 weeks. The clinical-stage of 93.3% of the patients with CCIP was IB1, 81.9% visited the clinic because of vaginal bleeding during pregnancy, and 72.4% had not been screened for cervical cancer in more than 5 years. To analyze cancer treatments during pregnancy, patients were grouped into two groups, termination of pregnancy (TOP, n = 67) and continuation of pregnancy (COP, n = 38). Analyses suggested that the TOP group was more likely to be diagnosed at an earlier gestational stage than the COP group (14.8 vs. 30.8 weeks, p < 0.001). The unadjusted hazard ratio for the COP group's overall survival was 1.063 times that of the TOP group (95% confidence interval = 0.24, 4.71). There were no significant differences between the TOP and COP groups in maternal survival (p = 0.964). Thirty-three of the infants of patients with CCIP were healthy at the end of the follow-up period, with a median age of 18 ± 2.8 months. Conclusions: Most patients with CCIP had not been screened for cervical cancer in over 5 years. The oncologic outcomes of the TOP and COP groups were similar. A platinum-based neoadjuvant chemotherapy regimen could be a favorable choice for the management of CCIP during the second and third trimesters of pregnancy.
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Affiliation(s)
- Mingzhu Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Yun Zhao
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Mingrong Qie
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Shandong, China
| | - Longyu Li
- Department of Obstetrics and Gynecology, Jiangxi Maternal and Child Health Hospital, Nan Chang, China
| | - Bei Lin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ruixia Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhixue You
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruifang An
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi 'An Jiaotong University, Xi'an, China
| | - Jun Liu
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhijun Zhang
- Department of Obstetrics and Gynecology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Hui Bi
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Ying Hong
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing, China
| | - Shufang Chang
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoli He
- Department of Obstetrics and Gynecology, Hainan General Hospital, Hainan, China
| | - Keqin Hua
- Department of Obstetrics and Gynecology, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - Qi Zhou
- Department of Gynecology Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qinping Liao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Xiaoping Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Lihui Wei
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
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Huang Z, Zhang Q, Wang Y, Chen R, Wang Y, Huang Z, Zhou G, Li H, Rui X, Jin T, Li S, Zhang Y, Huang Z. Inhibition of caspase-3-mediated GSDME-derived pyroptosis aids in noncancerous tissue protection of squamous cell carcinoma patients during cisplatin-based chemotherapy. Am J Cancer Res 2020; 10:4287-4307. [PMID: 33415000 PMCID: PMC7783734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/13/2020] [Indexed: 06/12/2023] Open
Abstract
The side effects of platinum-based chemotherapy are important factors limiting the survival of oral squamous cell carcinoma (OSCC) patients. Current research suggests that pyroptosis is involved in this process. However, how this mechanism can be used to reduce side effects has not yet been elucidated. In this study, we reported that GSDME was expressed at higher levels in normal tissues than in cancerous tissues in OSCC patients and was the main cause of platinum-based side effects. In an OSCC xenograft model, the inflammatory status and GSDME expression were increased after cisplatin chemotherapy. Cellular experiments showed that higher expression of GSDME was associated with less chemoresistance to cisplatin. A subsequent study demonstrated that cisplatin treatment promotes the maturation of caspase-3, triggers GSDME-mediated pyroptosis and induces cell death. When the amino acid sequence of GSDME cleaved by caspase-3 was mutated, cellular death and pyroptosis induced by cisplatin were significantly inhibited. Moreover, application of vitamin D during cisplatin-based chemotherapy could successfully inhibit GSDME cleavage and pyroptotic cell death in vitro and in vivo. Taken together, our study revealed that vitamin D can inhibit caspase-3-mediated GSDME cleavage and thus reduce normal tissue pyroptosis, relieving chemotherapeutic side effects. Inhibition of systemic GSDME during chemotherapy is currently unachievable. Vitamin D supplementation during chemotherapy in OSCC patients might be able to reduce the process described above and benefit patients. However, additional follow-up clinical studies are needed.
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Affiliation(s)
- Zixian Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Qianyu Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
| | - Rui Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
| | - Yongqiang Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Zhuoshan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Guangming Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Haigang Li
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
| | - Xi Rui
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Tingting Jin
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
| | - Shihao Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Yin Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, Guangdong, China
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Multidisciplinary consensus on cancer management during pregnancy. Clin Transl Oncol 2020; 23:1054-1066. [PMID: 33191439 PMCID: PMC8084770 DOI: 10.1007/s12094-020-02491-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
Cancer during pregnancy is a challenge for multi- and interdisciplinary collaboration due to the diagnostic, prognostic and therapeutic implications, the need for an integrated harmonization of medical action for the pregnant patient and the embryo or foetus and the characteristics of each gestational period, which will determine the protocol to be proposed and its limitations. For this reason, a group of experts appointed by participating scientific societies, which includes the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica—SEOM), the Spanish Association of Surgeons (Asociación Española de Cirujanos—AEC), the Spanish Society of Gynaecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia—SEGO), the Spanish Society of Nuclear Medicine and Molecular Imaging (Sociedad Española de Medicina Nuclear e Imagen Molecular—SEMNIM), the Spanish Society of Oncological Radiotherapy (Sociedad Española de Oncología Radioterápica—SEOR) and the Spanish Society of Medical Radiology (Sociedad Española de Radiología Médica—SERAM), have worked together to establish consensus recommendations that allow the harmonization of management and ultimately the optimization of the healthcare of pregnant patients with cancer. When cancer is detected in a pregnant woman, the week of gestation in which the diagnosis is made must be considered, as well as the characteristics of the tumour. It is strongly recommended that a multidisciplinary team assesses the situation and guides the patient and her family during the informing, diagnosis and treatment process. Likewise, the foetus should be monitored and managed by specialized obstetricians who are part of a multidisciplinary cancer committee.
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Boudy AS, Zaccarini F, Selleret L, Arfi A, Guiggi I, Touboul C, Bendifallah S, Darai E. Oncological management of pregnancy-associated cancers: analysis from the French CALG (Cancer Associé à La Grossesse) network. Acta Oncol 2020; 59:1043-1050. [PMID: 32525429 DOI: 10.1080/0284186x.2020.1767300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Pregnancy-associated cancers constitute a major medical challenge. The objective of this study was to describe their epidemiological, oncological and obstetrical outcomes from the French CALG (Cancer Associé à La Grossesse) network.Material and methods: Retrospective analysis of patients diagnosed with a cancer associated with pregnancy between January 2015 and December 2018 after advice from the CALG network.Results: Of 218 patients, 197 (90%) were diagnosed with a cancer during pregnancy and 21 the year following delivery. Requests to the CALG network increased from 36 cases in 2015 to 77 cases in 2018. The disease was diagnosed at local and regional stages in 77% of cases. Breast cancer was the most frequent (56%), followed by ovarian (12%) and uterine cervical cancers (10%). Of the 218 patients, 157 (72%) underwent a treatment during pregnancy. Surgery and chemotherapy during pregnancy were performed in 83 patients (83/218, 38%) and 101 patients (46%) at a median term of 17 (IQR 11-24) and 25 (IQR 18-30) WG, respectively. Eighteen (8.5%) of the women had a pregnancy termination, two (1%) an abortion, one (0.5%) a miscarriage, one (0.5%) had a stillbirth and one (0.5%) patient died during pregnancy. The remaining 174 patients (88%) were allowed to continue the pregnancy. Eight recurrences and four deaths were observed with a median follow-up time of 2.6 years (IQR 2.2-3.8).Conclusions: Our data further describe the incidence and management of pregnancy-associated cancers in western Europe allowing comparisons with other regions.
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Affiliation(s)
- Anne-Sophie Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - François Zaccarini
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - Alexandra Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - Ilaria Guiggi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
- UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
- UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France
- Centre CALG (Cancer Associé à La Grossesse), Paris, France
- UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
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26
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Abstract
Cancer complicates 1 in 1000 pregnancies. Multidisciplinary consensus comprised of Gynecologic Oncology, Pathology, Neonatology, Radiology, Anesthesiology, Maternal Fetal Medicine, and Social Work should be convened. Pregnancy provides an opportunity for cervical cancer screening, with deliberate delays in treatment permissible for early stage carcinoma. Vaginal delivery is contraindicated in the presence of gross lesion(s) and radical hysterectomy with lymphadenectomy at cesarean delivery is recommended. Women with locally advanced and metastatic/recurrent disease should commence treatment at diagnosis with chemoradiation and systemic therapy, respectively; neoadjuvant chemotherapy to permit gestational advancement may be considered in select cases. Most adnexal masses are benign and resolve by the second trimester. Persistent, asymptomatic, benign-appearing masses can be managed conservatively; surgery, if indicated, is best deferred to 15-20 weeks, with laparoscopy preferable over laparotomy whenever possible. Benign and malignant germ cell tumors and borderline tumors are occasionally encountered, with unilateral adnexectomy and preservation of the uterus and contralateral ovary being the rule. Epithelial ovarian cancer is exceedingly rare. Ultrasonography and magnetic resonance imaging lack ionizing radiation and can be employed to evaluate disease extent. Tumor markers, including CA-125, AFP, LDH, inhibin-B, and even CEA and ßhCG may be informative. If required, chemotherapy can be administered following organogenesis during the second and third trimesters. Because platinum and other anti-neoplastic agents cross the placenta, chemotherapy should be withheld after 34 weeks to avoid neonatal myelosuppression. Bevacizumab, immune checkpoint inhibitors, and PARP inhibitors should be avoided throughout pregnancy. Although antenatal glucocorticoids to facilitate fetal pulmonary maturation and amniotic fluid index assessment can be considered, there is no demonstrable benefit of tocolytics, antepartum fetal heart rate monitoring, and/or amniocentesis. Endometrial, vulvar, and vaginal cancer in pregnancy are curiosities, although leiomyosarcoma and the dreaded twin fetus/hydatidiform mole have been reported. For gynecologic malignancies, pregnancy does not impart aggressive clinical behavior and/or worse prognosis.
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Affiliation(s)
- Travis-Riley K Korenaga
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA.
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27
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Puchar A, Boudy AS, Selleret L, Arfi A, Owen C, Bendifallah S, Darai E. Invasive and in situ cervical cancer associated with pregnancy: analysis from the French cancer network (CALG: Cancer Associé à La Grossesse). Clin Transl Oncol 2020; 22:2002-2008. [PMID: 32240504 DOI: 10.1007/s12094-020-02343-5] [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: 12/28/2019] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the oncologic and obstetric outcomes of patients diagnosed with invasive cervical cancer (ICC) and in situ adenocarcinoma (ISA) during pregnancy or during the year following delivery. METHODS This retrospective observational study involved a cohort of 28 patients diagnosed with invasive cervical cancer (20 patients) or in situ adenocarcinoma (eight patients) during pregnancy or during the year following delivery who received expert opinion from physicians of the Cancer Associé à La Grossesse (CALG) network between 2005 and 2018. Descriptive results were expressed in median, range and interquartile range (IQR). RESULTS Between 2005 and 2018, 20 patients with ICC and eight with ISA received expert opinion from physicians of the CALG network. Both ICC and ISA were mostly diagnosed during pregnancy with a median term at diagnosis of 23.3 weeks of gestation (WG) for ICC and 7.3 WG for ISA. Overall, the median age at diagnosis for both ICC and ISA was 33 years. Most ICCs (n = 9) had FIGO stage ≥ IB2 and five underwent neoadjuvant chemotherapy at a median term of 22.5 WG. Seventeen patients with ICC underwent surgery. Three patients had medical termination of the pregnancy. Two patients experienced recurrence and three died. Median time of follow-up was 59.3 months (IQR 30.5-129.2). CONCLUSION Management of cervical cancer during pregnancy is challenging especially in terms of maternal outcomes with a relative poor prognosis requiring a multidisciplinary expert advice.
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Affiliation(s)
- A Puchar
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France. .,Centre CALG (Cancer Associé à La Grossesse), Paris, France.
| | - A S Boudy
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - L Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - A Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - C Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France.,UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
| | - E Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre-et-Marie-Curie Paris VI, Institut Universitaire de Cancérologie (IUC), Paris, France.,Centre CALG (Cancer Associé à La Grossesse), Paris, France.,UMRS-938 4, Faculté de Médecine Sorbonne Université, Paris, France
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Huang Z, Zhang Y, Li H, Zhou Y, Zhang Q, Chen R, Jin T, Hu K, Li S, Wang Y, Chen W, Huang Z. Vitamin D promotes the cisplatin sensitivity of oral squamous cell carcinoma by inhibiting LCN2-modulated NF-κB pathway activation through RPS3. Cell Death Dis 2019; 10:936. [PMID: 31819048 PMCID: PMC6901542 DOI: 10.1038/s41419-019-2177-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Abstract
Chemoresistance is a major cause of cancer progression and the mortality of cancer patients. Developing a safe strategy for enhancing chemosensitivity is a challenge for biomedical science. Recent studies have suggested that vitamin D supplementation may decrease the risk of many cancers. However, the role of vitamin D in chemotherapy remains unknown. We found that vitamin D sensitised oral cancer cells to cisplatin and partially reversed cisplatin resistance. Using RNA-seq, we discovered that lipocalin 2 (LCN2) is an important mediator. Cisplatin enhanced the expression of LCN2 by decreasing methylation at the promoter, whereas vitamin D enhanced methylation and thereby inhibited the expression of LCN2. Overexpression of LCN2 increased cell survival and cisplatin resistance both in vitro and in vivo. High LCN2 expression was positively associated with differentiation, lymph node metastasis, and T staging and predicted a poor prognosis in oral squamous cell carcinoma (OSCC) patients. LCN2 was also associated with post-chemotherapy recurrence. Moreover, we found that LCN2 promoted the activation of NF-κB by binding to ribosomal protein S3 (RPS3) and enhanced the interaction between RPS3 and p65. Our study reveals that vitamin D can enhance cisplatin chemotherapy and suggests that vitamin D should be supplied during chemotherapy; however, more follow-up clinical studies are needed.
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Affiliation(s)
- Zixian Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yin Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haigang Li
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yufeng Zhou
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qianyu Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingting Jin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kaishun Hu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shihao Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiliang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Zhiquan Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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29
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Beharee N, Shi Z, Wu D, Wang J. Diagnosis and treatment of cervical cancer in pregnant women. Cancer Med 2019; 8:5425-5430. [PMID: 31385452 PMCID: PMC6745864 DOI: 10.1002/cam4.2435] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 11/23/2022] Open
Abstract
In recent years, the incidence of gynecological malignant tumors during pregnancy has increased, mainly due to the increased number of old age pregnancy. The most common gynecological malignant tumors in pregnancy are cervical cancer, accounting for 71.6%, followed by ovarian malignant tumors, accounting for 7.0%. The incidence of cervical cancer in pregnancy is itself not very high, and the symptoms are easily confused with other diseases in pregnancy. During pregnancy, gynecological examination is limited, and therefore, the rate of misdiagnosis is higher. The treatment of cervical cancer during pregnancy is related to many factors, such as tumor size, pathological type, period of gestation, lymph node involvement, and patients' willingness to maintain pregnancy. As a reason of these factors, it is difficult to determine the optimal treatment. This article reviews the research progress on the diagnosis and treatment principles of cervical cancer in pregnancy, in order to strike a balance between effective treatment of tumors and protection of fetal health, and avoid delays in treatment and preterm delivery.
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Affiliation(s)
- Nitish Beharee
- Department of Gynecologic OncologyJiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceP.R. China
| | - Zhujun Shi
- Department of Gynecologic OncologyJiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceP.R. China
| | - Dongchen Wu
- Department of Gynecologic OncologyJiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceP.R. China
| | - Jinhua Wang
- Department of Gynecologic OncologyJiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical UniversityNanjingJiangsu ProvinceP.R. China
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30
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Ma J, Yu L, Xu F, Yi H, Wei W, Wu P, Wu S, Li H, Ye H, Wang W, Xing H, Fan L. Treatment and clinical outcomes of cervical cancer during pregnancy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:241. [PMID: 31317011 DOI: 10.21037/atm.2019.04.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to investigate clinicopathological factors associated with survival rate and treatment of patients with cervical cancer during pregnancy (CCP). Methods A total of 92 patients diagnosed CCP were retrospectively reviewed. One patient was from Nanfang Hospital of Southern Medical University, 5 patients were from Tongji Hospital, and 86 patients were from case reports in the PubMed database from 1961 to 2019. Patients and tumor characteristics were evaluated. Kaplan-Meier and Cox regression methods were used to analyze the 5-year disease-specific survival (DSS). Results Most patients (73 cases) were stage I according to the 2018 International Federation of Gynecology and Obstetrics (FIGO) standards. Twelve patients (13.04%) terminated pregnancy once diagnosed. These patients were diagnosed at the mean gestational age (GA) of 11±3 weeks, during early pregnancy. For the rest of the patients (80 cases) who continued pregnancy, the mean GA was 35±2 weeks at delivery. There was a significant difference in survival whether the treatment was performed once diagnosed or not. The 5-year DSS was 75% in adenocarcinoma (AC), 68.5% in squamous cell carcinoma (SCC), and 43.7% in the rare subtype. Among the 38 patients who underwent neoadjuvant chemotherapy (NACT), one patient suffered from spontaneous abortion, and one baby experienced acute myeloid leukemia (AML) ex-FAB (French-American-British)-M7 subtype and received bone marrow transplantation. Other delivered newborns showed no abnormality or malformation. Cox multi-factorial analysis demonstrated that tumor size (2 cm) was an independent overall survival predictor for CCP patients (P<0.05). Conclusions Tumor size was an independent prognostic factor of survival in CCP patients. Pregnancy has adverse effects on the prognosis of cervical cancer. Personalized treatment is a priority for CCP patients.
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Affiliation(s)
- Jing Ma
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China.,Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Lan Yu
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, Nanchong Central Hospital, North Sichuan Medical University, Nanchong 637000, China
| | - Hongyan Yi
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wenfei Wei
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Peng Wu
- Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Sha Wu
- Department of Immunology, School of Basic Medical Sciences, Southern Medical University, Guangdong Provincial Key Laboratory of Proteomics, Guangzhou 510515, China
| | - Hua Li
- Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Hong Ye
- Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang 443000, China
| | - Wei Wang
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
| | - Hui Xing
- Department of Gynecology and Obstetrics, Xiangyang Hospital, Xiangyang 441000, China
| | - Liangsheng Fan
- Department of Gynecology and Obstetrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China
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