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Sorouri K, Loren AW, Amant F, Partridge AH. Patient-Centered Care in the Management of Cancer During Pregnancy. Am Soc Clin Oncol Educ Book 2023; 43:e100037. [PMID: 37220323 DOI: 10.1200/edbk_100037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The management of cancer during pregnancy requires a patient-centered, multidisciplinary approach to balance maternal and fetal well-being given the rarity of this clinical scenario and lack of substantial data. Involvement of oncology and nononcology medical specialists and ethical, legal, and psychosocial supports, as needed, is instrumental in navigating the complexities of care for this patient population. Critical periods of fetal development and physiological changes in pregnancy must be considered when planning diagnostic and therapeutic approaches during pregnancy. The complexity of symptom recognition and interventional approaches contributes to diagnostic delays of cancers during pregnancy. Ultrasound and whole-body diffusion-weighted magnetic resonance imaging are safe throughout pregnancy. Surgery can be safely performed throughout pregnancy, with the early second trimester preferred for intra-abdominal surgery. Chemotherapy can be safely administered after 12-14 weeks of gestation until 1-3 weeks before the anticipated delivery. Most targeted and immunotherapeutic agents are contraindicated during pregnancy because of limited data. Pelvic radiation during pregnancy is absolutely contraindicated, while if radiation to the upper body is needed, administration should only be considered early in pregnancy. To ensure that the total cumulative fetal exposure to ionizing radiation does not exceed 100 mGy, early inclusion of the radiology team in the care plan is required. Closer prenatal monitoring is recommended for maternal and fetal treatment-related toxicities. Delivery before 37 weeks of gestation should be avoided if possible, and vaginal delivery is preferred unless obstetrically indicated or specific clinical scenarios. Postpartum, breastfeeding should be discussed, and the neonate should receive blood work to assess for acute toxicities with follow-up arranged for long-term monitoring.
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Affiliation(s)
- Kimia Sorouri
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alison W Loren
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Frédéric Amant
- Netherlands Cancer Institute, Amsterdam, the Netherlands
- KU Leuven, Leuven, Belgium
- University of Amsterdam, Amsterdam, the Netherlands
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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2
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Qin C, Long W, Zhang C, Xie Y, Wu C, Li Y, Xiao Q, Ji N, Liu Q. Multidisciplinary Therapy Managed Recurrent Glioblastoma in a BRAF-V600E Mutant Pregnant Female: A Case Report and Review of the Literature. Front Oncol 2020; 10:522816. [PMID: 33117675 PMCID: PMC7550879 DOI: 10.3389/fonc.2020.522816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Glioblastoma (GBM) is the most malignant intracranial tumor in adults. However, the overall management of GBM in pregnancy is rarely reported. How to balance the therapeutic benefits to the mother and risks to the fetus remains hugely challenging for clinicians. The application of specific targeting therapy combined with conventional treatment sheds light on a longer lifetime for the patients suffering from GBM. Case Presentation: We present a pregnant female at 20 weeks gestation diagnosed with GBM. Surgical resection was initially performed without adjuvant therapy, and the tumor recurred de novo 2 months later. A secondary craniotomy and cesarean section were performed simultaneously at 32 weeks gestation, both the patient and infant were survived. She was subsequently treated with traditional chemo-radiotherapy. No other identified genetic alterations indicating an optimistic prognosis were detected except for BRAF V600E mutation. Thus, the BRAF inhibitor was placed on her with achieving a good clinical outcome of more than 2-year survival without recurrence. Conclusion: Personalized multidisciplinary therapy should be considered when GBMs occur in pregnancy. Response to the therapy in this presenting case suggests that BRAF V600E mutation is a favorable biomarker for GBM. The mortality of GBM might be reduced through genetic testing and targeted treatment. However, more studies must be conducted to confirm our observation.
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Affiliation(s)
- Chaoying Qin
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Wenyong Long
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Chi Zhang
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Yuanyang Xie
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Changwu Wu
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Qun Xiao
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
| | - Nan Ji
- Department of Neurosurgery in Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qing Liu
- Department of Neurosurgery in Xiangya Hospital, Central South University, Changsha, China
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Eckenstein M, Thomas AA. Benign and malignant tumors of the central nervous system and pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:241-258. [PMID: 32768091 DOI: 10.1016/b978-0-444-64240-0.00014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tumors of the central nervous system (CNS) are rare entities, typically affecting the very young or the very old, but span a spectrum of disease that may present in any age group. Women of reproductive age are more likely to be affected by benign tumors, including pituitary adenomas and meningiomas, and aggressive intracranial malignancies, such as brain metastases and glioblastoma, rarely present in pregnancy. Definitive management of CNS tumors may involve multimodal therapy, including surgery, radiation, and chemotherapy, and each of these treatments carries risk to the mother and developing fetus. CNS tumors often present with challenging and morbid symptoms such as headache and seizure, which need to be managed throughout a pregnancy. Decisions about timing treatment during pregnancy or delaying until after delivery, continuing or electively terminating a pregnancy, and future family planning and fertility are complex and require a multidisciplinary care team to evaluate the implications to both mother and baby. There are no guidelines or consensus recommendations regarding brain tumor management in pregnancy, and thus, individual treatment decisions are made by the care team based on experiential evidence, extrapolation of guidelines for nonpregnant patients, and patient values and preferences.
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Affiliation(s)
- Midori Eckenstein
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Alissa A Thomas
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States.
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Policicchio D, Doda A, Muggianu G, Dipellegrini G, Boccaletti R. Ethical and therapeutic dilemmas in glioblastoma management during pregnancy: Two case reports and review of the literature. Surg Neurol Int 2019; 10:41. [PMID: 31528379 PMCID: PMC6743686 DOI: 10.25259/sni-86-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/04/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: There are no guidelines about the management of glioblastoma multiforme (GBM) during pregnancy: treatment of these patients presents therapeutic and ethical challenges. Case Description: Two patients, respectively, 28 years old at the 14th week of gestation with a thalamic GBM and 38 years old at the 28th week of gestation with fronto-mesial GBM. Patients and their relatives were deeply informed about the natural history of GBM and potential risks and benefits of surgery, radiotherapy (XRT), and chemotherapy (CTX) for both, mother and fetus. The first patient’s will was to preserve her fetus from any related, even minimal, risk of XRT, and CTX until safe delivery despite progression of GBM, accepting only surgery (tumor debulking and shunting of hydrocephalus). The second one asked to deliver the baby as soon as possible (despite the risks of prematurity) to receive the standard treatments of GBM. The two patients survived, respectively, 16 and 46 months after delivery. The first patient’s son is in good clinical conditions; the second one suffered problems linked to prematurity. Conclusions: Standard treatment of GBM in a pregnant woman could improve the mother’s survival but can expose the fetus to several potential risks. Ethically, relatives should understand that mother has anyway a poor prognosis and, at the same time, fetus prognosis depends on mother’s condition and therapy. It is not possible to warrant absence of risk for both. Considering the absence of guidelines and the relatively poor current data available about management of GBM in a pregnant woman, after a deep explanation of the situation, we think that the will of the mother and her relatives should prevail.
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Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari, Italy
| | - Artan Doda
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari, Italy
| | - Giampiero Muggianu
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari, Italy
| | - Giosuè Dipellegrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari, Italy
| | - Riccardo Boccaletti
- Department of Neurosurgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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5
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Marital status is associated with survival of patients with astrocytoma. J Clin Neurosci 2018; 56:79-87. [DOI: 10.1016/j.jocn.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/10/2018] [Accepted: 07/08/2018] [Indexed: 12/23/2022]
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6
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Xie JC, Yang S, Liu XY, Zhao YX. Effect of marital status on survival in glioblastoma multiforme by demographics, education, economic factors, and insurance status. Cancer Med 2018; 7:3722-3742. [PMID: 30009575 PMCID: PMC6089174 DOI: 10.1002/cam4.1688] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/20/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022] Open
Abstract
The relationship between marital status and glioblastoma multiforme (GBM) has not been addressed in depth. Here, we aimed to investigate the association between marital status and survival in GBM. We searched the Surveillance, Epidemiology, and End Results (SEER) database and extracted the data of eligible patients diagnosed with GBM after 2004. Marital status was classified as married, divorced/separated, widowed, and single. A Kaplan-Meier test was conducted to compare the survival curves of different groups. Multivariate Cox regression was performed to evaluate overall survival (OS) and cause-specific survival (CSS) in different groups. Subgroup analysis was applied according to demographics, typical education and income levels in the locale, and insurance status. A total of 30 767 eligible patients were included. The median OS values were 9, 7, 3, 9 months in married, divorced/separated, widowed, and single patients, respectively. After adjustment for other covariates, married patients had better OS and CSS than other patients had. In addition to marital status, demographic factors, disease progression factors, local educational level, and insurance status were also associated with survival in GBM. Furthermore, subgroup analyses revealed the protective effect of marriage in most of the comparisons. Notably, the protective effect of marriage becomes more and more apparent as time goes on. The advantageous effect of marriage on GBM survival is especially prominent in patients who are male, older than 60 years of age, White, or living in middle-income counties. In conclusion, marital status is an independent prognostic factor for GBM.
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Affiliation(s)
- Jun-Chao Xie
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuai Yang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xue-Yuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan-Xin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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7
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Roux A, Pallud J. Gravidanza e gliomi diffusi di basso grado. Neurologia 2018. [DOI: 10.1016/s1634-7072(17)87847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Peeters S, Pagès M, Gauchotte G, Miquel C, Cartalat-Carel S, Guillamo JS, Capelle L, Delattre JY, Beauchesne P, Debouverie M, Fontaine D, Jouanneau E, Stecken J, Menei P, De Witte O, Colin P, Frappaz D, Lesimple T, Bauchet L, Lopes M, Bozec L, Moyal E, Deroulers C, Varlet P, Zanello M, Chretien F, Oppenheim C, Duffau H, Taillandier L, Pallud J. Interactions between glioma and pregnancy: insight from a 52-case multicenter series. J Neurosurg 2017; 128:3-13. [PMID: 28298039 DOI: 10.3171/2016.10.jns16710] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to provide insight into the influence of gliomas on gestational outcomes, the impact of pregnancy on gliomas, and the identification of patients at risk. METHODS In this multiinstitutional retrospective study, the authors identified 52 pregnancies in 50 women diagnosed with a glioma. RESULTS For gliomas known prior to pregnancy (n = 24), we found the following: 1) An increase in the quantified imaging growth rates occurred during pregnancy in 87% of cases. 2) Clinical deterioration occurred in 38% of cases, with seizures alone resolving after delivery in 57.2% of cases. 3) Oncological treatments were immediately performed after delivery in 25% of cases. For gliomas diagnosed during pregnancy (n = 28), we demonstrated the following: 1) The tumor was discovered during the second and third trimesters in 29% and 54% of cases, respectively, with seizures being the presenting symptom in 68% of cases. 2) The quantified imaging growth rates did not significantly decrease after delivery and before oncological treatment. 3) Clinical deterioration resolved after delivery in 21.4% of cases. 4) Oncological treatments were immediately performed after delivery in 70% of cases. Gliomas with a high grade of malignancy, negative immunoexpression of alpha-internexin, or positive immunoexpression for p53 were more likely to be associated with tumor progression during pregnancy. Deliveries were all uneventful (cesarean section in 54.5% of cases and vaginal delivery in 45.5%), and the infants were developmentally normal. CONCLUSIONS When a woman harboring a glioma envisions a pregnancy, or when a glioma is discovered in a pregnant patient, the authors suggest informing her and her partner that pregnancy may impact the evolution of the glioma clinically and radiologically. They strongly advise a multidisciplinary approach to management. ■ CLASSIFICATION OF EVIDENCE Type of question: association; study design: case series; evidence: Class IV.
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Affiliation(s)
- Sophie Peeters
- 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.,2Paris Descartes University, Sorbonne Paris Cité, Paris
| | - Mélanie Pagès
- 2Paris Descartes University, Sorbonne Paris Cité, Paris.,3Department of Neuropathology, Sainte-Anne Hospital, Paris
| | | | | | | | | | - Laurent Capelle
- 8Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Jean-Yves Delattre
- 9Department of Neuro-oncology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris
| | | | | | - Denys Fontaine
- 11Department of Neurosurgery, Centre Hospitalier Universitaire de Nice.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Emmanuel Jouanneau
- 12Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Bron
| | - Jean Stecken
- 13Department of Neurosurgery, Regional Hospital, Orléans
| | | | - Olivier De Witte
- 15Laboratory of Experimental Neurosurgery and Multidisciplinary Research Institute, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire-Université Libre de Bruxelles,Belgium
| | - Philippe Colin
- 16Department of Radiation, Polyclinique Courlancy, Reims.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Didier Frappaz
- 17Department of Pediatric and Adult Neuro Oncology, Centre Léon Bérard et Institut Hematology Oncology Pediatric, Lyon
| | | | - Luc Bauchet
- 19Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Manuel Lopes
- 20Department of Neurosurgery, Argonay Private Hospital, Argonay
| | - Laurence Bozec
- 21Department of Medical Oncology, Institut Curie-Hôpital René Huguenin, Saint-Cloud
| | - Elisabeth Moyal
- 22Institut Claudius Regaud, Département de Radiothérapie, Toulouse
| | | | - Pascale Varlet
- 2Paris Descartes University, Sorbonne Paris Cité, Paris.,3Department of Neuropathology, Sainte-Anne Hospital, Paris.,26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France
| | - Marc Zanello
- 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.,2Paris Descartes University, Sorbonne Paris Cité, Paris
| | - Fabrice Chretien
- 2Paris Descartes University, Sorbonne Paris Cité, Paris.,3Department of Neuropathology, Sainte-Anne Hospital, Paris
| | - Catherine Oppenheim
- 2Paris Descartes University, Sorbonne Paris Cité, Paris.,24Department of Neuroradiology, Sainte-Anne Hospital, Paris.,26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France
| | - Hugues Duffau
- 19Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Luc Taillandier
- 7Department of Neurology, CHU Caen.,25Réseau d'Etude des Gliomes, REG, Groland; and
| | - Johan Pallud
- 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.,2Paris Descartes University, Sorbonne Paris Cité, Paris.,25Réseau d'Etude des Gliomes, REG, Groland; and.,26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France
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9
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Pereira CE, Lynch JC. Management strategies for neoplastic and vascular brain lesions presenting during pregnancy: A series of 29 patients. Surg Neurol Int 2017; 8:27. [PMID: 28303207 PMCID: PMC5339909 DOI: 10.4103/2152-7806.200575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/12/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event, but when it happens, it jeopardizes the lives of both the mother and infant. It also creates challenges of a neurosurgical, obstetric, and ethical nature. A multidisciplinary approach should be used for their care. METHODS Between 1986 and 2015, 12 pregnant women diagnosed with brain tumors and 17 women with intracranial vascular lesion underwent treatment at the Neurosurgery Department of the Servidores do Estado Hospital and Rede D'Or/São Luis. The Neurosurgery Department teamed up with Obstetrics Anesthesiology Departments in establishing the procedures. The patients' records, surgical descriptions, imaging studies, and histopathological material were reviewed. RESULTS Among 12 patients presenting with brain tumors, there were neither operative mortality nor fetal deaths. Among the vascular lesions, aneurysm rupture was responsible for bleeding in 6 instances. Arteriovenous malformation was diagnosed in 7 patients. In this subgroup, the maternal and fetal mortality rates were 11.7% and 23.7%, respectively. CONCLUSIONS We can assert that the association between a brain tumor and vascular lesions with pregnancy is a very unusual event, which jeopardizes both the lives of the mother and infant. It remains incompletely characterized due to the rare nature of these potentially devastating events. Knowing the exact mechanism responsible for the interaction of pregnancy and with these lesions will improve the treatment of these patients.
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Affiliation(s)
| | - Jose Carlos Lynch
- Neurosurgical and Obstetrics Departments of Servidores do Estado Hospital, RJ, Brazil
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10
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Al-Rasheedy IM, Al-Hameed FM. Advanced case of glioblastoma multiforme and pregnancy. An ethical dilemma. ACTA ACUST UNITED AC 2016; 20:388-91. [PMID: 26492122 PMCID: PMC4727635 DOI: 10.17712/nsj.2015.4.20150069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common and malignant form of the glial tumors. Advanced and treated GBM is rarely associated with pregnancy for many reasons. Glioblastoma multiforme presenting during pregnancy carries unique challenges to the patient, baby, family, and health care providers. We describe an unusual case of advanced GBM that was treated with maximum doses of chemotherapy and radiations, and she became pregnant and presented at eighteenth weeks of gestation. Her medical management was associated with a significant ethical dilemma. We managed to deliver the baby safely through cesarean section at week 28 despite the critical condition of the mother. Unfortunately, the mother died 2 weeks post delivery. We concluded that although recurrent and treated GBM is rarely associated with pregnancy and carries dismal prognosis, but if it occurs, it can still be carried, and a multidisciplinary team work is the key for successful outcome.
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Affiliation(s)
- Intisar M Al-Rasheedy
- Department of Medical Oncology, Princess Norah Oncology Center, Jeddah, Kingdom of Saudi Arabia
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11
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Watanabe T, Nagamine H, Ishiuchi S. Progression of cerebellar chronic encapsulated expanding hematoma during late pregnancy after gamma knife radiosurgery for arteriovenous malformation. Surg Neurol Int 2015; 5:S575-9. [PMID: 25593781 PMCID: PMC4287896 DOI: 10.4103/2152-7806.148054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/04/2014] [Indexed: 12/02/2022] Open
Abstract
Background: The etiology and appropriate management strategy of chronic encapsulated expanding hematoma during pregnancy after gamma knife radiosurgery for arteriovenous malformation (AVM) remain unclear. Case Description: A 34-year-old female developed chronic encapsulated expanding hematoma during late pregnancy, after angiographic disappearance of cerebellar AVM following two courses of gamma knife radiosurgery. The present case implicates pregnancy as a potential promoter of growth and enlargement of chronic encapsulated expanding hematoma, which may become life-threatening and require surgical intervention. Conclusion: Immediate surgical management after delivery may be associated with a favorable outcome, so close follow-up management and patient education are very important in women planning pregnancy.
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Affiliation(s)
- Takashi Watanabe
- Department of Neurosurgery, Faculty of Clinical Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hideki Nagamine
- Department of Neurosurgery, Faculty of Clinical Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shogo Ishiuchi
- Department of Neurosurgery, Faculty of Clinical Medicine, University of the Ryukyus, Okinawa, Japan
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12
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Taylan E, Akdemir A, Zeybek B, Ergenoglu AM, Yeniel AO. Recurrent brain tumor with hydrocephalus in pregnancy. J Obstet Gynaecol Res 2014; 41:464-7. [DOI: 10.1111/jog.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Enes Taylan
- Department of Obstetrics and Gynecology; Ege University School of Medicine; Izmir Turkey
| | - Ali Akdemir
- Department of Obstetrics and Gynecology; Ege University School of Medicine; Izmir Turkey
| | - Burak Zeybek
- Department of Obstetrics and Gynecology; Ege University School of Medicine; Izmir Turkey
| | - Ahmet Mete Ergenoglu
- Department of Obstetrics and Gynecology; Ege University School of Medicine; Izmir Turkey
| | - Ahmet Ozgur Yeniel
- Department of Obstetrics and Gynecology; Ege University School of Medicine; Izmir Turkey
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13
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Recurrent gliosarcoma in pregnancy. Case Rep Neurol Med 2014; 2014:953184. [PMID: 24900931 PMCID: PMC4036604 DOI: 10.1155/2014/953184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/16/2014] [Accepted: 04/23/2014] [Indexed: 12/17/2022] Open
Abstract
Gliosarcoma is a rare tumor of the central nervous system and it constitutes about 1 to 8% of all malignant gliomas. In this report we are presenting a recurrent gliosarcoma case during a pregnancy in a 30-year-old woman. This is the first report presenting gliosarcoma in the pregnancy.
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14
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Yust-Katz S, de Groot JF, Liu D, Wu J, Yuan Y, Anderson MD, Conrad CA, Milbourne A, Gilbert MR, Armstrong TS. Pregnancy and glial brain tumors. Neuro Oncol 2014; 16:1289-94. [PMID: 24615863 DOI: 10.1093/neuonc/nou019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Improvements in brain tumor treatments have led to an increase in the number of young women with brain tumors who are now considering pregnancy. The aim of this study is to evaluate the influence of pregnancy on brain tumor biology. METHODS In this institutional review board-approved retrospective study, we searched the institution's database for patients with glial brain tumors who were pregnant at the time of diagnosis or became pregnant during the course of their illness. We identified 34 such patients and reviewed their charts to determine each patient's clinical course and pregnancy outcome. RESULTS Fifteen patients were diagnosed with a primary brain tumor during pregnancy: 3 with glioblastomas, 6 with grade III gliomas, and 6 with grade II gliomas. Pregnancy was terminated in only 2 of these patients, and the remainder delivered healthy babies. Twenty-three patients became pregnant after diagnosis (4 patients were pregnant at diagnosis and again after diagnosis). Of the patients who became pregnant after diagnosis, the 5 with grade I tumors had stable disease during and after pregnancy. However, of the 18 patients with grade II or III gliomas, 8 (44%) had confirmed tumor progression during pregnancy or within 8 weeks of delivery. CONCLUSIONS In contrast to grade I gliomas, the tumor biology of grades II and III gliomas may be altered during pregnancy, leading to an increased risk of tumor progression. These findings support the need for increased tumor surveillance and patient counseling and for additional data collection to further refine these results.
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Affiliation(s)
- Shlomit Yust-Katz
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Diane Liu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Jimin Wu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Ying Yuan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Mark D Anderson
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Charles A Conrad
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Andrea Milbourne
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Mark R Gilbert
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
| | - Terri S Armstrong
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., J.F.d.G., M.D.A., C.A.C., M.R.G., T.S.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.L., J.W., Y.Y.); Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.)
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15
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Abstract
A variety of changes in the eye can occur during pregnancy. These can be physiological, pathologic related to the pregnancy, or pathologic unrelated to the pregnancy. Pregnancy also can affect preexisting conditions. Pregnant women often discuss changes in their health first with their obstetrician; therefore, knowledge of common ophthalmic complaints during pregnancy is of particular concern for the practicing obstetrician. We reviewed the literature for ophthalmic and neuro-ophthalmic conditions that occur during pregnancy or in the postpartum period. Results are presented anatomically, first discussing general ophthalmologic conditions, then neuro-ophthalmic conditions follow. Effects of ocular medications on the fetus are reviewed.
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16
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Zwinkels H, Dörr J, Kloet F, Taphoorn MJB, Vecht CJ. Pregnancy in women with gliomas: a case-series and review of the literature. J Neurooncol 2013; 115:293-301. [DOI: 10.1007/s11060-013-1229-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/10/2013] [Indexed: 11/28/2022]
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