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Amant F, Nekljudova V, Maggen C, Seither F, Neven P, Cardonick EH, Schmatloch S, Van Calsteren K, Cordes T, de Haan J, Lok CAR, Flock F, Boere IA, Gziri MM, Solbach C, Lefrère H, Schneeweiss A, Witzel I, Seiler S, Loibl S. Outcome of breast cancer patients treated with chemotherapy during pregnancy compared with non-pregnant controls. Eur J Cancer 2022; 170:54-63. [PMID: 35594612 DOI: 10.1016/j.ejca.2022.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/25/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND A diagnosis of breast cancer during pregnancy (PrBC) does not impact prognosis if standard treatment is offered. However, caution is warranted as gestational changes in pharmacokinetics may lead to reduced chemotherapy concentration. METHODS Survival of PrBC patients treated with chemotherapy during pregnancy was compared to non-pregnant breast cancer patients treated with chemotherapy, diagnosed after 2000, excluding patients older than 45 years or with a postpartum diagnosis. The data was registered in two multicenter registries (the International Network of Cancer, Infertility and Pregnancy and the German Breast Group). Cox proportional hazards regression was used to compare disease-free (DFS) and overall survival (OS) between both groups, adjusting for age, stage, grade, hormone receptor status, human epidermal growth factor 2 status and histology, weighted by propensity scoring to account for the differences in baseline characteristics between pregnant patients and controls. RESULTS In total, 662 pregnant and 2081 non-pregnant patients were selected. Pregnant patients were more likely to have stage II breast cancer (60.1% vs 56.1%, p = 0.035), grade 3 tumors (74.0% vs 62.2%, p < 0.001), hormone receptor-negative tumors (48.4% vs 34.0%, p < 0.001) or triple-negative breast cancer (38.9% vs 26.9%, p < 0.001). Median follow-up was 66 months. In multivariable analysis, DFS and OS were comparable for pregnant and non-pregnant patients (DFS: HR 1.02, 95% CI 0.82-1.27, p = 0.83; OS: HR 1.08, 95% CI 0.81-1.45, p = 0.59). CONCLUSION Outcome of women with breast cancer treated with chemotherapy during pregnancy is comparable to young non-pregnant women. These results support chemotherapy for PrBC when indicated.
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Affiliation(s)
- Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Gynecologic Oncology, Centre for Gynecologic Oncology Amsterdam, Amsterdam University Medical Centers, Netherlands; Department of Gynecologic Oncology, Centre for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, Netherlands.
| | | | - Charlotte Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Obstetrics and Prenatal Medicine, Vrije Universiteit Brussel (VUB), University Hospital of Brussels, Brussels, Belgium
| | | | - Patrick Neven
- Multidisciplinary Breast Center, Universitair Ziekenhuis, Leuven, Belgium
| | - Elyce H Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ, USA
| | | | - Kristel Van Calsteren
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | | | - Jorine de Haan
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Centre for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Felix Flock
- Department of Obstetrics and Gynecology, Klinikum Memmingen, Germany
| | - Ingrid A Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Mina M Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | | | | | | | - Isabell Witzel
- Department of Gynecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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van Gerwen M, Maggen C, Cardonick E, Verwaaijen EJ, van den Heuvel-Eibrink M, Shmakov RG, Boere I, Gziri MM, Ottevanger PB, Lok CAR, Halaska M, Shao LT, Struys I, van Dijk-Lokkart EM, Van Calsteren K, Fruscio R, Zola P, Scarfone G, Amant F. Association of Chemotherapy Timing in Pregnancy With Congenital Malformation. JAMA Netw Open 2021; 4:e2113180. [PMID: 34106263 PMCID: PMC8190627 DOI: 10.1001/jamanetworkopen.2021.13180] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Chemotherapy during the first trimester of pregnancy should be avoided owing to the risk of congenital malformations. However, the precise gestational age at which chemotherapy can be initiated safely remains unclear. OBJECTIVE To assess congenital malformation rates associated with gestational age at initiation of chemotherapy among pregnant women with cancer. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study evaluated all pregnant women who received chemotherapy between 1977 and 2019 registered in the International Network on Cancer, Infertility and Pregnancy (INCIP) database. Data were analyzed from February 15 to June 2, 2020. EXPOSURES Cancer treatment with chemotherapy during pregnancy. MAIN OUTCOMES AND MEASURES Analysis was focused on major and minor structural malformations in offspring, defined by EUROCAT, detected during pregnancy or at birth. RESULTS A total of 755 women in the INCIP database who underwent cancer treatment with chemotherapy during pregnancy were included in analysis. The median (range) age at cancer diagnosis was 33 (14-48) years. Among offspring, the major congenital malformation rate was 3.6% (95% CI, 2.4%-5.2%), and the minor congenital malformation rate was 1.9% (95% CI, 1.0%-3.1%). Chemotherapy exposure prior to 12 weeks gestational age was associated with a high rate of major congenital malformations, at 21.7% (95% CI, 7.5%-43.7%; odds ratio, 9.24 [95% CI, 3.13-27.30]). When chemotherapy was initiated after gestational age 12 weeks, the frequency of major congenital malformations was 3.0% (95% CI, 1.9%-4.6%), which was similar to the expected rates in the general population. Minor malformations were comparable when exposure occurred before or after gestational age 12 weeks (4.3% [95% CI, 0.1%-21.9%] vs 1.8% [95% CI, 1.0-3.0]; odds ratio, 3.13 [95% CI, 0.39-25.28]). Of 29 women who received chemotherapy prior to 12 weeks gestation, 17 (58.6%) were not aware of pregnancy, and 6 (20.7%) experienced a miscarriage (3 women [10.3%]) or decided to terminate their pregnancy (3 women [10.3%]). CONCLUSIONS AND RELEVANCE This cohort study found that chemotherapy was associated with an increased risk of major congenital malformations only in the first 12 weeks of pregnancy. The risk of congenital malformations when chemotherapy was administered during the first trimester and the high number of incidental pregnancies during cancer treatment in the INCIP registry underscore the importance of contraceptive advice and pregnancy testing at the start of chemotherapeutic treatment in young women with cancer.
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Affiliation(s)
- Mathilde van Gerwen
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, New Jersey
| | | | | | - Roman G. Shmakov
- National Medical Research Centre for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov, Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Ingrid Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mina M. Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, Université Catholique de Louvain, Sint-Lambrechts-Woluwe, Belgium
| | - Petronella B. Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Christianne A. R. Lok
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute, Amsterdam, the Netherlands
- Center for Gynecological Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michael Halaska
- University Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Long Ting Shao
- Cooper Medical School, Rowan University, Camden, New Jersey
| | - Ilana Struys
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Elisabeth M. van Dijk-Lokkart
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics, University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Robert Fruscio
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Milan, Italy
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giovanna Scarfone
- Gynecological Oncology Unit, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico, Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Frédéric Amant
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynecological Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Morlando M, Schwickert A, Stefanovic V, Gziri MM, Pateisky P, Chalubinski KM, Nonnenmacher A, Morel O, Braun T, Bertholdt C, Van Beekhuizen HJ, Collins SL. Maternal and neonatal outcomes in planned versus emergency cesarean delivery for placenta accreta spectrum: A multinational database study. Acta Obstet Gynecol Scand 2021; 100 Suppl 1:41-49. [PMID: 33713033 DOI: 10.1111/aogs.14120] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/30/2021] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Placenta accreta spectrum (PAS) is a condition often resulting in severe maternal morbidity. Scheduled delivery by an experienced team has been shown to improve maternal outcomes; however, the benefits must be weighed against the risk of iatrogenic prematurity. The aim of this study is to investigate the rates of emergency delivery seen for antenatally suspected PAS and compare the resulting outcomes in the 15 referral centers of the International Society for PAS (IS-PAS). MATERIAL AND METHODS Fifteen centers provided cases between 2008 and 2019. The women included were divided into two groups according to whether they had a planned or an emergency cesarean delivery. Delivery was defined as "planned" when performed at a time and date to suit the team. All the remaining cases were classified as "emergency". Maternal characteristics and neonatal outcomes were compared between the two groups according to gestation at delivery. RESULTS In all, 356 women were included. Of these, 239 (67%) underwent a planned delivery and 117 (33%) an emergency delivery. Vaginal bleeding was the indication for emergency delivery in 41 of the 117 women (41%). There were no significant differences in terms of blood loss, transfusion rates or major maternal morbidity between planned and emergency deliveries. However, the rate of maternal intensive therapy unit admission was increased with emergency delivery (45% vs 33%, P = .02). Antepartum hemorrhage was the only independent predictor of emergency delivery (aOR: 4.3, 95% confidence interval 2.4-7.7). Emergency delivery due to vaginal bleeding was more frequent with false-positive cases (antenatally suspected but not confirmed as PAS at delivery) and the milder grades of PAS (accreta/increta). The rate of infants experiencing any major neonatal morbidity was 25% at 34+1 to 36+0 weeks and 19% at >36+0 weeks. CONCLUSIONS Emergency delivery in centers of excellence did not increase blood loss, transfusion rates or maternal morbidity. The single greatest risk factor for emergency delivery was antenatal hemorrhage. When adequate expertise and resources are available, to defer delivery in women with no significant antenatal bleeding and no risk factors for pre-term birth until >36+0 weeks can be considered to improve fetal outcomes. Further studies are needed to investigate this fully.
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Affiliation(s)
- Maddalena Morlando
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy.,Department of Woman, Child and of General and Specialized Surgery, University "Luigi Vanvitelli", Naples, Italy
| | - Alexander Schwickert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Berlin, Germany
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mina M Gziri
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Petra Pateisky
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Kinga M Chalubinski
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Nonnenmacher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Berlin, Germany
| | - Olivier Morel
- Women's Division, Nancy Regional and University Hospital Center (CHRU), Université de Lorraine, Nancy, France.,Diagnosis and International Adaptive Imaging (IADI), Inserm, Université de Lorraine, Nancy, France
| | - Thorsten Braun
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Obstetrics, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of 'Experimental Obstetrics', Berlin, Germany
| | - Charline Bertholdt
- Women's Division, Nancy Regional and University Hospital Center (CHRU), Université de Lorraine, Nancy, France.,Diagnosis and International Adaptive Imaging (IADI), Inserm, Université de Lorraine, Nancy, France
| | | | - Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.,Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
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Vandenbroucke T, Verheecke M, van Gerwen M, Van Calsteren K, Halaska MJ, Fumagalli M, Fruscio R, Gandhi A, Veening M, Lagae L, Ottevanger PB, Voigt JU, de Haan J, Gziri MM, Maggen C, Mertens L, Naulaers G, Claes L, Amant F. Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy. Eur J Cancer 2020; 138:57-67. [PMID: 32858478 PMCID: PMC7532701 DOI: 10.1016/j.ejca.2020.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
Abstract
Background Data on the long-term effects of prenatal exposure to maternal cancer and its treatment on child development are scarce. Methods In a multicenter cohort study, the neurologic and cardiac outcomes of 6-year-old children born to women diagnosed with cancer during pregnancy were compared with the outcome of children born after an uncomplicated pregnancy. Assessment included clinical evaluation, comprehensive neuropsychological testing, electrocardiography and echocardiography. Results In total, 132 study children and 132 controls were included. In the study group, 97 children (73.5%) were prenatally exposed to chemotherapy (alone or in combination with other treatments), 14 (10.6%) to radiotherapy (alone or in combination), 1 (0.8%) to trastuzumab, 12 (9.1%) to surgery alone and 16 (12.1%) to no treatment. Although within normal ranges, statistically significant differences were found in mean verbal IQ and visuospatial long-term memory, with lower scores in the study versus control group (98.1, 95% confidence interval [CI]: 94.5–101.8, versus 104.4, 95% CI: 100.4–108.4, P = 0.001, Q < 0.001 [Q refers to the false discovery rate adjusted P value], and 3.9, 95% CI: 3.6–4.3, versus 4.5, 95% CI: 4.1–4.9, P = 0.005, Q = 0.045, respectively). A significant difference in diastolic blood pressure was found, with higher values in chemotherapy-exposed (61.1, 95% CI: 59.0 to 63.2) versus control children (56.0, 95% CI 54.1 to 57.8) (P < 0.001, Q < 0.001) and in a subgroup of 59 anthracycline-exposed (61.8, 95% CI: 59.3 to 64.4) versus control children (55.9, 95% CI: 53.6 to 58.1) (P < 0.001, Q = 0.02). Conclusions Children prenatally exposed to maternal cancer and its treatment are at risk for lower verbal IQ and visuospatial long-term memory scores and for higher diastolic blood pressure, but other cognitive functions and cardiac outcomes were normal at the age of 6 years. Clinical trial registration The study is registered at ClinicalTrials.gov, NCT00330447. Cancer treatment including chemotherapy is possible during pregnancy. Children are at risk for lower verbal IQ and visuospatial long-term memory scores. Other cognitive functions and cardiac outcomes were normal at the age of 6 years. We documented ototoxicity in three children exposed to cisplatin. Follow-up until adulthood is recommended.
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Affiliation(s)
- Tineke Vandenbroucke
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Magali Verheecke
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Mathilde van Gerwen
- Center for Gynecologic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Michael J Halaska
- Department of Obstetrics and Gynecology, 3rd Medical Faculty Charles University, Prague, Czech Republic; Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca and San Gerardo Hospital, Monza, Italy
| | - Amarendra Gandhi
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium; Data Scientist, Knowledge Center, SD Worx, Antwerp, Belgium
| | - Margreet Veening
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lieven Lagae
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Jens-Uwe Voigt
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Jorine de Haan
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location VU University Medical Center, the Netherlands
| | - Mina M Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Charlotte Maggen
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Gunnar Naulaers
- Department of Neonatology, University Hospitals Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium; Center for Gynecologic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC, Location Amsterdam Medical Center and University of Amsterdam, the Netherlands.
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5
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Maggen C, Lok CA, Cardonick E, van Gerwen M, Ottevanger PB, Boere IA, Koskas M, Halaska MJ, Fruscio R, Gziri MM, Witteveen PO, Van Calsteren K, Amant F. Gastric cancer during pregnancy: A report on 13 cases and review of the literature with focus on chemotherapy during pregnancy. Acta Obstet Gynecol Scand 2019; 99:79-88. [PMID: 31529466 PMCID: PMC6972614 DOI: 10.1111/aogs.13731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 12/14/2022]
Abstract
Introduction Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. Material and methods Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. Results In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6‐30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. Conclusions The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account.
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Affiliation(s)
- Charlotte Maggen
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Christianne A Lok
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper, University Health Care, Camden, NJ, USA
| | - Mathilde van Gerwen
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Ingrid A Boere
- Department of Medical Oncology, Erasmus MC Cancer, Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martin Koskas
- Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France
| | - Michael J Halaska
- Faculty Hospital Kralovske, Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Mina M Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | - Petronella O Witteveen
- Department of Medical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics, University Hospitals Leuven, Leuven and Department of Development and regeneration, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium.,Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Center for Gynecological Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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6
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Verheecke M, Cortès Calabuig A, Finalet Ferreiro J, Brys V, Van Bree R, Verbist G, Everaert T, Leemans L, Gziri MM, Boere I, Halaska MJ, Van Houdt J, Amant F, Van Calsteren K. Corrigendum to 'Genetic and microscopic assessment of the human chemotherapy-exposed placenta reveals possible pathways contributive to fetal growth restriction'[YPLAC 64C (2018) 61-70]. Placenta 2018; 69:117. [PMID: 30054016 DOI: 10.1016/j.placenta.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Verheecke
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | | | - V Brys
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - R Van Bree
- Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - G Verbist
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - T Everaert
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - L Leemans
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - M M Gziri
- Department of Obstetrics and Gynecology, Cliniques Universitaires St. Luc, Hippokrateslaan 10, 1200 Brussels, Belgium
| | - I Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University, Faculty Hospital Kralovske Vinohrady, Srobarova 1150/50, 100 34, Prague 10, Czech Republic
| | - J Van Houdt
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - F Amant
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Gynaecologic Oncology, Center for Gynaecologic Oncology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - K Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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7
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Verheecke M, Cortès Calabuig A, Finalet Ferreiro J, Brys V, Van Bree R, Verbist G, Everaert T, Leemans L, Gziri MM, Boere I, Halaska MJ, Vanhoudt J, Amant F, Van Calsteren K. Genetic and microscopic assessment of the human chemotherapy-exposed placenta reveals possible pathways contributive to fetal growth restriction. Placenta 2018; 64:61-70. [PMID: 29626982 DOI: 10.1016/j.placenta.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Fetal growth restriction (FGR) carries an increased risk of perinatal mortality and morbidity. A major cause of FGR is placental insufficiency. After in utero chemotherapy-exposure, an increased incidence of FGR has been reported. In a prospective cohort study we aimed to explore which pathways may contribute to chemotherapy-associated FGR. METHODS Placental biopsies were collected from 25 cancer patients treated with chemotherapy during pregnancy, and from 66 control patients. Differentially expressed pathways between chemotherapy-exposed patients and controls were examined by whole transcriptome shotgun sequencing (WTSS) and Ingenuity Pathway Analysis (IPA). Immunohistochemical studies for 8-OHdG and eNOS (oxidative DNA damage), proliferation (PCNA) and apoptosis (Cleaved Caspase 3) were performed. The expression level of eNOS, PCNA and IGFBP6 was verified by real-time quantitative Reverse Transcription Polymerase Chain Reaction (RT-qPCR). RESULTS Most differential expressed genes between chemotherapy-exposed patients and controls were related to growth, developmental processes, and radical scavenging networks. The duration of chemotherapy exposure had an additional impact on the expression of genes related to the superoxide radicals degeneration network. Immunohistochemical analyses showed a significantly increased expression of 8-OHdG (P = 0.003) and a decreased expression of eNOS (P=0.015) in the syncytiotrophoblast of the placenta of cancer patients. A decreased expression of PCNA was detected by immunohistochemistry as RT-qPCR (NS). CONCLUSION Chemotherapy exposure during pregnancy results in an increase of oxidative DNA damage and might impact the placental cellular growth and development, resulting in an increased incidence of FGR in this specific population. Further large prospective cohort studies and longitudinal statistical analyses are needed.
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Affiliation(s)
- M Verheecke
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | | | - V Brys
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - R Van Bree
- Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - G Verbist
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - T Everaert
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - L Leemans
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - M M Gziri
- Department of Obstetrics and Gynecology, Cliniques Universitaires St. Luc, Hippokrateslaan 10, 1200 Brussels, Belgium
| | - I Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University, Prague 5, Faculty Hospital Kralovske Vinohrady, Srobarova 1150/50, 100 34, Prague 10, Czech Republic
| | - J Vanhoudt
- Genomics Core, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - F Amant
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Gynaecologic Oncology, Center for Gynaecologic Oncology, Amsterdam, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - K Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Dresen RC, Han SN, Michielsen K, De Keyzer F, Gziri MM, Amant F, Vandecaveye V. Whole-body diffusion-weighted MRI for staging of women with cancer during pregnancy: a pilot study. Cancer Imaging 2015. [PMCID: PMC4601647 DOI: 10.1186/1470-7330-15-s1-p50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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