1
|
Gissi DB, Gabusi A, Tarsitano A, Rossi R, Balbi T, Morandi L. Multi-Region Sequence Analysis of a Pregnancy-Related Oral Squamous Cell Carcinoma Exhibiting Low-Level Aggressive Behavior. Int J Surg Pathol 2019; 28:188-195. [PMID: 31544567 DOI: 10.1177/1066896919876058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We analyzed the genetic and epigenetic profiles of an oral squamous cell carcinoma affecting a 41-year-old pregnant female. The patient presented with an oral mass located at the hard and soft palate with bone involvement and lymph node metastases (T4N1M0). She had been treated with multimodal radiotherapy and chemotherapy, and she is currently alive with no evidence of disease 8 years after treatment. DNA methylation and DNA mutation analyses were used to analyze multiple samples from the tumor mass and from the non-neoplastic mucosa to verify tumor heterogeneity. Genetic and epigenetic analyses revealed the presence of one shared TP53 driver mutation with the same DNA methylation profile in each of the 3 areas of the tumor mass; only 2 additional passenger mutations were detected, suggesting a simple clonal homogeneous carcinoma, which usually is associated with low-level aggressive behavior. Additionally, no genetic or epigenetic alteration in the non-neoplastic oral mucosa was detected, demonstrating the absence of field cancerization. The low aggressiveness of the lesion was confirmed by the patient being free of disease at a long-term follow-up examination. These data suggest a different molecular transformation pathway in pregnancy-related oral squamous cell carcinomas, providing new perspectives for further investigation.
Collapse
|
2
|
Le Guevelou J, Lebars S, Kammerer E, de Gabory L, Vergez S, Janot F, Baujat B, Righini C, Jegoux F, Dufour X, Merol JC, Mauvais O, Lasne-Cardon A, Selleret L, Thariat J. Head and neck cancer during pregnancy. Head Neck 2019; 41:3719-3732. [PMID: 31329334 DOI: 10.1002/hed.25877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The incidence of cancer during pregnancy is low but is slightly increasing. Data on incidence and etiology of head and neck (HN) cancers in pregnant women are rare. We evaluated the frequency, tumor type, associated factors, and specific biomarkers in HN cancers occurring in pregnant (and peripartum) women. METHODS A systematic literature search was performed on PubMed, for any HN tumor site occurring in pregnant women. RESULTS Sixty cases of HN cancers occurring during pregnancy were identified. Most of them were oral cavity cancers. Relationships with oncogenic viruses, hormonal disturbance, and shift in maternal immunity profile were identified. CONCLUSION Carcinogenesis of HN cancers in pregnant women may be led by different cancer type-specific hallmarks. Relevance of these etiological factors with respect to treatments and birth control recommendations is being investigated by the REFCOR in an ambispective study.
Collapse
Affiliation(s)
| | | | | | - Ludovic de Gabory
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pellegrin, Bordeaux, France
| | - Sebastien Vergez
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Rangueil-Larrey, Toulouse, France
| | - François Janot
- Service de Chirurgie ORL, Centre Gustave Roussy, Villejuif, France
| | - Bertrand Baujat
- Service de Chirurgie ORL, Hopital Tenon, Université Paris-Est, Paris, France
| | - Christian Righini
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Franck Jegoux
- Service de Chirurgie ORL, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Xavier Dufour
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-Claude Merol
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Olivier Mauvais
- Service de Chirurgie ORL, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Audrey Lasne-Cardon
- Service de Chirurgie ORL Centre François Baclesse, Normandie Université-Unicaen, Caen, France
| | - Lise Selleret
- Service de Gynécologie Obstetrique, Hopital Tenon, Paris, France
| | - Juliette Thariat
- Service de Radiothérapie, Centre François Baclesse, Caen, France
| |
Collapse
|
3
|
Sato K, Shimamoto H, Mochizuki Y, Hirai H, Tomioka H, Shimizu R, Marukawa E, Fukayama H, Yoshimura R, Ishida H, Harada H. Treatment of oral cancers during pregnancy: a case-based discussion. J Otolaryngol Head Neck Surg 2019; 48:9. [PMID: 30717781 PMCID: PMC6360730 DOI: 10.1186/s40463-019-0331-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 01/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Malignancies occur in approximately 1:1000 pregnancies; the most common being breast (46%) and hematological (18%) malignancies. Oral cancers account for only 2% of all cancers in pregnant women, and there are no standard guidelines for the treatment of oral cancer during pregnancy. Methods Between 2007 and 2014, our department managed 1109 patients with oral cancers; four (0.4%) had tongue carcinomas during pregnancy. These cases were retrospectively reviewed. Results The four women were aged 29–39 (median 32.5) years. Two underwent partial glossectomy at 39 and 40 weeks’ gestation, respectively, one received radiotherapy at 17 weeks’ gestation, and one underwent supraomohyoid neck dissection and hemi-glossectomy with a forearm flap reconstruction. Conclusion In addition to tumor factors, the wishes of the patient and her family, gestational age, and fetal and maternal conditions are important factors in deciding on a treatment protocol. Moreover, treatment decisions require multidisciplinary approach.
Collapse
Affiliation(s)
- Kiyoshi Sato
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hideaki Hirai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Hirofumi Tomioka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Risa Shimizu
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Eriko Marukawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Haruhisa Fukayama
- Department of Anesthesiology and Clinical Physiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroo Ishida
- Department of Medical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| |
Collapse
|
4
|
Figueiró-Filho EA, Horgan RP, Muhanna N, Parrish J, Irish JC, Maxwell CV. Obstetrical Outcomes of Head and Neck (Nonthyroid) Cancers: A 27-Year Retrospective Series and Literature Review. AJP Rep 2019; 9:e15-e22. [PMID: 30701125 PMCID: PMC6351273 DOI: 10.1055/s-0039-1677876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/05/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To describe the clinical presentation and obstetrical outcomes of nonthyroid head and neck cancers (HNCs), and to review literature on this rare condition in pregnancy. Study Design Pregnant women with nonthyroid HNC were identified retrospectively from 1990 to 2017. Maternal, neonatal, pregnancy, and demographic data were collected. A review of the literature from January 1980 to May 2018 was performed. Results Over the 27-year time period, 16 women with history of nonthyroid HNC were identified (9 diagnosed during and 7 diagnosed before current pregnancy). The cases were analyzed in detail and the most updated review of management of each type of HNC was provided. Conclusions HNCs are rare with diagnosis and management challenges during pregnancy. In this series, the cases diagnosed and managed previously to pregnancy presented better perinatal outcomes than the cases presented during pregnancy. The maternal outcomes appeared similar for HNC diagnosed before or after pregnancy.
Collapse
Affiliation(s)
- Ernesto Antonio Figueiró-Filho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Richard P. Horgan
- Department of Obstetrics and Gynecology, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - Nidal Muhanna
- Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology, Tel Aviv University, Tel Aviv, Israel
| | - Jacqueline Parrish
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Department of Obstetrics and Gynecology, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - Cynthia V. Maxwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Murphy J, Berman DR, Edwards SP, Prisciandaro J, Eisbruch A, Ward BB. Squamous Cell Carcinoma of the Tongue During Pregnancy: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2016; 74:2557-2566. [DOI: 10.1016/j.joms.2016.06.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022]
|
6
|
Tongue cancer during pregnancy: Surgery and more, a multidisciplinary challenge. Crit Rev Oncol Hematol 2016; 98:1-11. [DOI: 10.1016/j.critrevonc.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 07/24/2015] [Accepted: 09/29/2015] [Indexed: 11/24/2022] Open
|
7
|
Eliassen AM, Hauff SJ, Tang AL, Thomas DH, McHugh JB, Walline HM, Stoerker J, Maxwell JH, Worden FP, Eisbruch A, Czerwinski MJ, Papagerakis SM, Chepeha DB, Bradford CR, Hanauer DA, Carey TE, Prince ME. Head and neck squamous cell carcinoma in pregnant women. Head Neck 2012; 35:335-42. [PMID: 22422571 DOI: 10.1002/hed.22973] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate oral cancer in pregnant women, a rare but therapeutically challenging patient subset. METHODS After institutional review board approval, an EMERSE search was used to identify all women treated at the University of Michigan from 1998 to 2010 with head and neck squamous cell carcinoma (HNSCC) during pregnancy. This identified 4 patients with tongue cancer. Biomarkers and human papillomavirus (HPV) were assessed by immunohistochemistry and multiplex PCR/mass spectrometry, respectively. RESULTS Two patients responded well to therapy and are alive more than 10 years after diagnosis; 2 patients died of disease. All tumors overexpressed EGFR and Bcl-xL, 3 of 4 overexpressed c-Met, both tumors that progressed overexpressed p53. All tumors were negative for HPV, p16, estrogen receptor, progesterone receptor, and HER-2. CONCLUSIONS Biomarkers of aggressive tumors (high EGFR, c-Met; high Bcl-xL-low p53) did not correlate with outcome. Additional studies are needed to determine whether perineural invasion, delay in diagnosis, and p53 overexpression are factors in poor survival.
Collapse
Affiliation(s)
- Anna M Eliassen
- Department of Otolaryngology Head and Neck Surgery, The University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Mhallem Gziri M, Han SN, Van Calsteren K, Heyns L, Delaere P, Nuyts S, Van den Heuvel F, Cheron AC, Fossion E, Van den Weyngaert D, Lok C, Amant F. Tongue cancers during pregnancy: Case reports and review of literature. Head Neck 2011; 35:E102-8. [PMID: 22009853 DOI: 10.1002/hed.21924] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Due to its rarity, there is no standard treatment for tongue cancers that concur with pregnancy. Treatment depends on the stage of cancer, gestational age of the pregnancy, and the wish of the mother to maintain the pregnancy. The purpose of this study was to review the literature and to report 5 new cases. METHODS Twelve cases of tongue cancer during pregnancy were already reported between 1987 and 2009. We report 5 new cases and first administration of concomitant radiochemotherapy for tongue cancer. RESULTS Median age of the patients was 29 years, 65% of diagnoses were made after the first trimester of pregnancy. Different treatment modalities are used to treat tongue cancer during pregnancy. CONCLUSION We hypothesize that tongue cancer treatment adhering to standard protocols provides the best guarantee to cure the mother. Based on a growing experience and insight taking fetal safety into consideration, the available data suggest that standard treatment is a realistic option.
Collapse
Affiliation(s)
- Mina Mhallem Gziri
- Department of Obstetrics and Gynecology, Division Gynecologic Oncology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Yokoshima K, Nakamizo M, Sakanushi A, Ozu RI, Yamaguchi S, Tone Y, Inai S, Murakami R, Okubo K. Surgical management of tongue cancer during pregnancy. Auris Nasus Larynx 2011; 39:428-30. [PMID: 21889278 DOI: 10.1016/j.anl.2011.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/30/2011] [Accepted: 08/01/2011] [Indexed: 11/18/2022]
Abstract
There are ethical dilemmas in managing head and neck cancers during pregnancy. Diagnostic and treatment modalities need to be carefully determined. We herein describe 3 cases of tongue cancer during pregnancy. The details of the management would contribute to the daily practices for head and neck cancers. All three patients were Japanese female patients, two of them were 29 years old and one was 26 years old. All patients were admitted to the Nippon Medical School Hospital during pregnancy, complaining of oral pain and/or discomfort. Case 1 was diagnosed as tongue cancer stage T3N0M0, however, the tumor was superficial and controllable by partial glossectomy. Case 2 was stage T2N0M0 with deep invasion with ulcer, and the hemi-glossectomy with neck dissection and the reconstruction was thought to be the standard modality. However, she underwent partial glossectomy in order to reduce the stress of the fetus. Case 3 could not be diagnosed on admission by biopsy and she underwent partial glossectomy after delivery. In case 3, the pathological diagnosis was pT1 tongue cancer. In case 1 and case 3, the patient and baby were healthy. In case 2, however, the patient died of recurrence at the primary site. In decision making of the strategy, the most important factors are not only oncological evaluation but also ethical and emotional factors.
Collapse
Affiliation(s)
- Kazuhiko Yokoshima
- Department of Otolaryngology, Head and Neck Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Shen S, Xu L, Yin X, Fan X, Zhang C, Hze-Khoong EP, Zhang C, Li J, Zhang L. A case of a squamous cell carcinoma of the tongue during pregnancy. Oral Oncol 2011; 47:924-6. [PMID: 21767976 DOI: 10.1016/j.oraloncology.2011.06.504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 06/15/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022]
|
11
|
Luis SA, Christie DRH, Kaminski A, Kenny L, Peres MH. Pregnancy and radiotherapy: Management options for minimising risk, case series and comprehensive literature review. J Med Imaging Radiat Oncol 2009; 53:559-68. [DOI: 10.1111/j.1754-9485.2009.02124.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Cheung EJ, Wagner H, Botti JJ, Fedok F, Goldenberg D. Advanced Oral Tongue Cancer in a 22-Year-Old Pregnant Woman. Ann Otol Rhinol Laryngol 2009; 118:21-6. [DOI: 10.1177/000348940911800104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Oral squamous cell carcinoma generally occurs in older men and is associated mostly with tobacco and alcohol as the primary risk factors. The incidence of oral squamous cell carcinoma in younger patients has increased. We report a case of a young woman, 25 weeks pregnant, who presented with stage IV carcinoma of the oral tongue. Methods: The following is a case presentation and literature review. Results: The patient presented with T4 N3 M0 oral tongue cancer. A team consisting of a head and neck surgeon, a radiation oncologist, a medical oncologist, and a maternal-fetal medicine specialist was assembled. The patient initially refused surgery. Chemotherapy was initiated until 32 weeks' gestation. After an infant boy was delivered via cesarean section, the patient began concurrent irradiation and chemotherapy, which induced complete regression of the primary tongue neoplasm with a partial response of the neck nodes. The patient underwent bilateral neck dissection followed by hemiglossectomy for recurrence. Conclusions: Management of advanced oral carcinoma in pregnancy presents a unique set of challenges. Few studies have described chemotherapy and radiotherapy during pregnancy, and long-term results are needed. Care must be taken to balance appropriate and adequate treatment of disease and to ensure the safety of the patient and the fetus.
Collapse
|
13
|
Atabo A, Bradley PJ. Management principles of head and neck cancers during pregnancy: A review and case series. Oral Oncol 2008; 44:236-41. [PMID: 17475540 DOI: 10.1016/j.oraloncology.2007.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Revised: 02/17/2007] [Accepted: 02/19/2007] [Indexed: 10/23/2022]
Abstract
Head and neck cancers during pregnancy are rising in incidence. Clinicians need to be aware of the principles of managing these cases. This paper is a review of the literature of head and neck cancers during pregnancy with a short case series of six non-thyroid pregnancy-associated cancers treated by a head and neck oncology surgeon. The age range is 20-34 years. Tumour types include carcinoma of the tongue, nasopharynx, maxillary sinus, parotid gland, subglottic region, and the neck. Five patients were treated surgically and four were treated with either chemotherapy or radiotherapy. Both foetal and maternal death occurred in two cases. The range of follow-up is 15 months to 14 years. Managing head and neck cancers during pregnancy requires the addition of a pregnancy-related layer of understanding to the armoury of existing specialist knowledge, encompassing a triad of effects, (i) the aetiological effect of pregnancy on cancer, (ii) the direct and indirect effects of cancer on pregnancy, and (iii) the effect of diagnostic and treatment modalities on pregnancy. Consideration must also be given to the ethical dilemmas of decision making.
Collapse
Affiliation(s)
- Adigo Atabo
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Nottingham, Queen's Medical Centre Campus, Nottingham NG7 2UH, United Kingdom
| | | |
Collapse
|
14
|
Squamous cell carcinoma of the tongue during pregnancy experiences in two-year treatments. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ooe.2004.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
15
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to document the information reported on cancers presenting in the head and neck area during pregnancy. RECENT FINDINGS Accidents and cancer account for most deaths during the reproductive years. Cancer complicates approximately 0.1% of all pregnancies and, in order of frequency, the incidence of cancers by site are breast, melanoma, thyroid, cervix, lymphoma, and ovary. Some of these cancers may present in the head and neck region, as well as more uncommon cancers such as mucosal squamous cell carcinoma. SUMMARY It is recognized that with the dramatic rise in births among "reproductively" older women and with the changing epidemiology of squamous cell carcinoma of the head and neck in nonsmoking and nonalcohol-drinking women, there is to be expected an increased incidence and presentation. Management of such patients must consider the gestational age of the pregnancy and must include alternatives to current treatments to accommodate the individual's wishes regarding her pregnancy.
Collapse
Affiliation(s)
- Patrick J Bradley
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Queens Medical Centre, Nottingham, UK.
| | | |
Collapse
|
16
|
Abstract
Malignant disease requiring radiation therapy during pregnancy presents an enormous challenge for the clinician. The optimal radiotherapeutic management of the patient and the optimal management of the pregnancy involve directly opposing demands. Ionizing radiation should be avoided during pregnancy whenever possible. Doses in excess of 0.1 Gy (10 rad) delivered during gestation have been associated with various detrimental effects, and therapeutic abortion has been recommended. If radiation is unavoidable, such as in the treatment of some gynecologic tumors, lymphomatous diseases, or other advanced solid tumors, it must be performed with extreme caution and maximal effort to reduce the dose to the fetus by special shielding techniques. Decisions regarding the use of radiation therapy during pregnancy, the delay of therapy, or pregnancy termination should be made by a multidisciplinary team and be guided by the prognosis of the disease, the stage of gestation, the risk to the fetus from the expected fetal radiation dose, and the patient's ethical and religious beliefs.
Collapse
Affiliation(s)
- N A Mayr
- Department of Radiology, University of Iowa College of Medicine, Iowa City, USA
| | | | | |
Collapse
|
17
|
Lasaridis N, Tilaveridis I, Karakasis D. Management of a carcinoma of the tongue during pregnancy: report of case. J Oral Maxillofac Surg 1996; 54:221-4. [PMID: 8604076 DOI: 10.1016/s0278-2391(96)90453-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- N Lasaridis
- Department of Oral and Maxillofacial Surgery, University Clinic, G. Papanikolaou General Hospital, Thessaloniki, Greece
| | | | | |
Collapse
|
18
|
Abstract
Oral cancer presenting in pregnancy is a rare combination which, because of current epidemiological changes in the disease, may present more often in the future. Treatment of the condition can be very difficult. Decisions have to be made about terminating the pregnancy or finding a balance between the treatment of the mother and protecting the foetus from the effects of various treatment modalities. This may result in a compromise treatment of the disease. To illustrate the problems, we discuss a case of carcinoma of the tongue presenting in a 23-week pregnant Gravida 1 Para 0 lady, and review the literature.
Collapse
Affiliation(s)
- S A Layton
- Department of Oral and Maxillofacial Surgery, Middlesbrough General Hospital
| | | | | |
Collapse
|
19
|
Abstract
A rare case of non-Hodgkin's lymphoma stage IE complicating pregnancy is presented. The diagnosis was made by biopsy at 28 weeks gestation and treated with 2635 rad of external radiotherapy with abdominal and pelvic shielding beginning at 30 weeks gestation. Following delivery, the patient received combination chemotherapy and is disease-free 6 years later. The baby, weighing 2015 g, was delivered by cesarean section at term. The effects of radiotherapy on a fetus are reviewed and the factors that were considered in the treatment of this patient are discussed. Radiotherapy with protective shielding can be an effective initial modality of treatment in this setting.
Collapse
Affiliation(s)
- M Spitzer
- Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York 11042
| | | | | | | |
Collapse
|