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Huang H, Quan Y, Qi X, Liu P. Neoadjuvant chemotherapy with paclitaxel plus cisplatin before radical surgery for locally advanced cervical cancer during pregnancy: A case series and literature review. Medicine (Baltimore) 2021; 100:e26845. [PMID: 34397891 PMCID: PMC8360442 DOI: 10.1097/md.0000000000026845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Despite the development of human papillomavirus vaccines and significant improvement in cervical cancer screening over the past few years, cervical cancer remains the fourth most common cancer in women of childbearing age after breast cancer, melanoma, and thyroid cancer. PATIENT CONCERNS In this case report, the patients are all cervical cancer with stage IB2 and IB3 during pregnancy, the management constitutes a major medical challenge related to the impact of treatment on both maternal and fetal outcomes. Neoadjuvant chemotherapy (NACT) is an innovative option for cervical cancer patients with stage IB2 and IB3 before cesarean delivery and radical hysterectomy, and many chemotherapeutic agents are available, cisplatin plus paclitaxel yielded good maternal and fetal outcomes to the authors' knowledge. DIAGNOSES Masses were discovered in the cervix of 4 pregnant women with a history of vaginal bleeding. Biopsy examination of the masses revealed cervical carcinoma, which was staged in accordance with the International Federation of Gynecology and Obstetrics (i.e., FIGO) system. INTERVENTIONS The patients were treated with paclitaxel plus cisplatin, followed by cesarean delivery and radical hysterectomy. OUTCOMES The 4 patients were treated successfully, with no recurrence during follow-up periods of 14 to 56 months, and all of the children were doing well with no anomalies. LESSONS Although further data are required, in pregnant women with invasive cervical cancer, NACT with cisplatin plus paclitaxel followed by cesarean delivery and radical hysterectomy was a practical treatment option.
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Affiliation(s)
- Huiqiong Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Zagouri F, Korakiti AM, Zakopoulou R, Kyriazoglou A, Zografos E, Haidopoulos D, Apostolidou K, Papatheodoridi MA, Dimopoulos MA. Taxanes during pregnancy in cervical cancer: A systematic review and pooled analysis. Cancer Treat Rev 2019; 79:101885. [PMID: 31442939 DOI: 10.1016/j.ctrv.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cervical cancer is one of the most common malignancies diagnosed during pregnancy. Taxanes administration has been established as theurapetic regimen in non pregrant women. OBJECTIVES This systemic review and meta-analysis aims to synthesize all available data from cervical cancer series in pregnant women and evaluate the efficacy and safety of taxanes during pregnancy. SEARCH STRATEGY Eligible articles were identified by a search of ClinicalTrial.gov and MEDLINE databases for the period 01/01/2000 up to 31/11/2017; The algorithm consisted of a predefined combination of the words "cervical", "cancer", "taxanes" and "pregnancy". SELECTION CRITERIA PRISMA guidelines were applied in this study. The literature search and data extraction from all studies that examined the efficacy and safety of taxanes in pregnancy, were done by two independent investigators. Quantitative synthesis of the published articles was performed. DATA COLLECTION AND ANALYSIS Overall eight articles were retrieved. In all cases (14 pregnancies, 14 newborns) the use of taxanes in combination with platinum derivatives resulted in the birth of alive neonates, with not any miscarriage. The taxane derivative used in all cases was paclitaxel, combined with Cisplatin (13 pregnancies) and Carboplatin (one pregnancy). RESULTS Complete and partial response was achieved in 7.2% and 92.9% of cervical cancer patients. In the majority of cases chemotherapy was well tolerated. The median progression-free survival was 48.5 months. CONCLUSION Taxanes administration during the 2nd and 3rd trimester of pregnancy is a safe choice.
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece.
| | - Anna-Maria Korakiti
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece
| | | | - Eleni Zografos
- Department of Basic Medical Sciences, Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Haidopoulos
- 1(st) Department of Obstetrics & Gynecology, "Alexandra" Hospital, University of Athens, Medical School, Greece
| | - Kleoniki Apostolidou
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece
| | | | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Medical School, Greece
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Perrone AM, Bovicelli A, D'Andrilli G, Borghese G, Giordano A, De Iaco P. Cervical cancer in pregnancy: Analysis of the literature and innovative approaches. J Cell Physiol 2019; 234:14975-14990. [DOI: 10.1002/jcp.28340] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/20/2019] [Accepted: 01/24/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Anna Myriam Perrone
- Department of Obstetrics and Gynecology Unit of Oncologic Gynecology, S. Orsola‐Malpighi Hospital, University of Bologna Bologna Italy
| | - Alessandro Bovicelli
- Department of Obstetrics and Gynecology Unit of Oncologic Gynecology, S. Orsola‐Malpighi Hospital, University of Bologna Bologna Italy
| | - Giuseppina D'Andrilli
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University Philadelphia Pennsylvania
| | - Giulia Borghese
- Department of Obstetrics and Gynecology Unit of Oncologic Gynecology, S. Orsola‐Malpighi Hospital, University of Bologna Bologna Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University Philadelphia Pennsylvania
- Department of Human Pathology and Oncology University of Siena Siena Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology Unit of Oncologic Gynecology, S. Orsola‐Malpighi Hospital, University of Bologna Bologna Italy
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Song Y, Liu Y, Lin M, Sheng B, Zhu X. Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 13:79-102. [PMID: 30587930 PMCID: PMC6304076 DOI: 10.2147/dddt.s186966] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose To evaluate the efficacy and safety of neoadjuvant platinum-based chemotherapy during pregnancy in women with cervical cancer. Methods The PubMed, Embase, and Cochrane Library databases were fully searched to find eligible studies regarding platinum use during pregnancy in women with cervical cancer from January 1980 to September 2018. Data were extracted from the selected studies independently by two authors. Descriptive statistics were calculated for categorical data (frequency and percentage) and numeration data (mean and SD for normally distributed data and median and range for abnormally distributed data). Survival analyses were performed using Kaplan–Meier survival curves and log-rank tests to estimate overall survival and progression-free survival for all patients. Results A total of 39 studies including 88 cervical cancer patients with platinum administration during pregnancy were selected in this meta-analysis, and 64 women provided International Federation of Gynecology and Obstetrics stage information. Among the latter, 56 of 64 (87.5%) were diagnosed with early stages (I and IIA) and the remaining 8 of 64 (12.5%) had advanced stages (IIB, III, and IV). In relation to cisplatin, 86 pregnant women were identified, whereas only 2 pregnant women with carboplatin application were retrieved. Overall, 88 newborns were delivered from 84 pregnancies, including two sets of twins and one set of triplets, among which 71 neonates (71 of 88, 80.7%) were completely healthy at birth. All children were healthy at the end of follow-up (median 17 months, range 0–149.5 months), except one who was diagnosed with retroperitoneal embryonal rhabdomyosarcoma at 5 years old and one who had acute myeloid leukemia at 22 months of age. At the end of follow-up (range 4.75–156 months), 16 of 81 (19.8%) patients were diagnosed with recurrence of cervical cancer, and 11 (90%) of those died because of cancer relapse. Neither median overall survival nor median progression-free survival were reached. Conclusion Our results demonstrated that neoadjuvant platinum-based chemotherapy could be a favorable choice for the management of patients with cervical cancer during the second and third trimesters. To reduce the side effects of chemotherapy, cisplatin might be good to use as monotherapy in these patients.
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Affiliation(s)
- Yizuo Song
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China,
| | - Yi Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China,
| | - Min Lin
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China,
| | - Bo Sheng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China,
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China,
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Guo P, Liu P, Yang J, Ren T, Xiang Y. Villoglandular adenocarcinoma of cervix: pathologic features, clinical management, and outcome. Cancer Manag Res 2018; 10:3955-3961. [PMID: 30310316 PMCID: PMC6165782 DOI: 10.2147/cmar.s165817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The objective of the study was to investigate the management and prognosis of patients with villoglandular adenocarcinoma (VGA) of the uterine cervix. Materials and methods The clinical presentation, pathology, management, and prognosis of 41 patients with VGA or other types of cervical adenocarcinoma (ADC) were retrospectively reviewed. Results During the patient follow-up period, the proportion of VGA was 8.1% in the cervical ADC cohort (41/507). The median age of the patients with VGA was 41.0 years. The most common presenting symptom was cervical contactive bleeding. There were 38 patients classified as FIGO stage IA1-IB. The median follow-up period was 38.5 months. There were no patient deaths, and only one patient showed recurrence. One of the patients delivered a healthy baby at 34 weeks of gestation prior to treatment with radical hysterectomy. The HPV HC2 test results showed that most patients were positive for HPV infection. HPV 16, 18, and 56 were positive in the 8 patients with HPV type test results. There were significant differences in the grade, depth of stromal invasion, lymph node metastasis, and recurrence between the VGA cases of FIGO stage I and the other types of cervical ADC of FIGO stage I (p<0.05). Conclusion This study confirmed that VGA is a type of well-differentiated cervical cancer characterized by shallow stromal invasion, less lymph node metastasis. VGA is associated with less recurrence than other types of cervical ADC.
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Affiliation(s)
- Peng Guo
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China, .,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Pengfei Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China,
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China,
| | - Tong Ren
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China,
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China,
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Ricci C, Scambia G, De Vincenzo R. Locally Advanced Cervical Cancer in Pregnancy: Overcoming the Challenge. A Case Series and Review of the Literature. Int J Gynecol Cancer 2018; 26:1490-6. [PMID: 27575627 DOI: 10.1097/igc.0000000000000795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Cervical cancer is the most common gynecological cancer occurring in pregnancy, creating a complex situation both for patient and physician. Neoadjuvant chemotherapy is an innovative way of managing cervical cancer in pregnancy. METHODS In our paper, we report a retrospective case series of 4 women treated with chemotherapy for invasive cervical cancer during pregnancy in our center over the last 5 years, and we summarize the available literature and guidelines. RESULTS All the cases were locally advanced cervical cancers that received chemotherapy with platinum and/or taxanes. All patients showed a good response to chemotherapy and a radical surgery was performed with no additional morbidities at the cesarean delivery time in 3 of 4 cases. Three of 4 patients are alive and have a good outcome with no recurrence of disease up to date. One patient died because of recurrent disease 2 years after the first-line treatment during pregnancy. All babies are alive and well up to date (maximum follow-up, 63 months). CONCLUSIONS Even if there are no standardized practices in the treatment of cervical cancer in pregnancy, in our opinion, neoadjuvant chemotherapy can be a very useful strategy for patients and physicians facing the challenge.
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Affiliation(s)
- Caterina Ricci
- Polo Salute della Donna e del Bambino, Fondazione Policlinico Universitario "A. Gemelli," Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
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Does Chemotherapy for Gynecological Malignancies during Pregnancy Cause Fetal Growth Restriction? BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28626764 PMCID: PMC5463150 DOI: 10.1155/2017/7543421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cancer and pregnancy rarely coincide. Gynecological cancers are among the most common malignancies to occur during pregnancy, and chemotherapy with or without surgery is the primary treatment option. The main concern of administering chemotherapy during pregnancy is congenital malformation, although it can be avoided by delaying treatment until after organogenesis. The dose, frequency, choice of chemotherapeutic agents, time of treatment commencement, and method of administration can be adjusted to obtain the best maternal treatment outcomes while simultaneously minimizing fetal toxicity. Use of chemotherapy after the first trimester, while seemingly safe, can cause fetal growth restriction. However, the exact effect of chemotherapy on such fetal growth restriction has not been fully established; information is scarce owing to the rarity of malignancy occurring during pregnancy, the lack of uniform treatment protocols, different terminologies for defining certain fetal growth abnormalities, the influence of mothers' preferred options, and ethical issues. Herein, we present up-to-date findings from the literature regarding the impact of chemotherapy on fetal growth.
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Ilancheran A. Neoadjuvant chemotherapy in cervical cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:102-7. [DOI: 10.1016/j.bpobgyn.2015.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022]
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