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Walsh, Elaine, Grainne O'Kane, Karen Anne Cadoo, Donna M. Graham, Grzegorz Korpanty, Derek Gerard Power, and Desmond Carney. "Cancer in pregnancy: To treat or not?" Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e12533-e12533. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e12533.
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e12533 Background: Cancer in pregnancy accounts for ~1 in 1,000 pregnancies. Studies show that cytotoxic agents are safe from the second trimester. Long-term follow up has not shown increased malformations or malignancies in children exposed to chemotherapy in utero. There is no evidence of worse outcomes among women diagnosed in pregnancy. Methods: We retrospectively identified women diagnosed with cancer in pregnancy over a 25-year period. Medical records were reviewed for demographics, diagnosis, gestation, timing of treatment and outcomes. We assessed if all cancers need to be treated in pregnancy or if treatment could be safely deferred to allow normal delivery. Results: Twenty-five women were diagnosed with cancer in pregnancy and referred to medical oncology. Of 25 women, 16 (64%) received chemotherapy during pregnancy. These included 13 cases of breast cancer, one Ewing’s sarcoma, one ovarian cancer, and one small cell of cervix. All 16 women received doxorubicin and cyclophosphamide. There were 15 live births and no abnormalities seen in children who received chemotherapy in utero. At a median follow-up of 6 years 11 mothers (69%) are disease free and 4 (25%) have recurrent disease. Of nine mothers who did not receive chemotherapy in pregnancy, seven received chemotherapy immediately post-partum. Six (86%) were diagnosed in early pregnancy (median gestation 13 weeks). There were three cases of Hodgkin lymphoma, two breast cancers, and one ovarian cancer. At a median follow-up of 12 years, all mothers remain disease free. There were no abnormalities seen in these children. Conclusions: We did not identify any adverse outcomes in mothers or infants exposed to chemotherapy during pregnancy. We identified a cohort of patients that do not need immediate treatment during pregnancy. In selected cases, it is safe and appropriate to delay chemotherapy until delivery of the baby. There were no adverse outcomes to mothers due to delayed treatment and no adverse outcomes to babies not exposed to chemotherapy in utero. A multi-disciplinary team is essential to individualize treatment planning. [Table: see text]
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Ricci, Caterina, Giovanni Scambia, and Rosa De Vincenzo. "Locally Advanced Cervical Cancer in Pregnancy: Overcoming the Challenge. A Case Series and Review of the Literature." International Journal of Gynecologic Cancer 26, no. 8 (October 2016): 1490–96. http://dx.doi.org/10.1097/igc.0000000000000795.
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ObjectiveCervical 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.MethodsIn 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.ResultsAll 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).ConclusionsEven 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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Amant, Frederic, Valentina Nekljudova, Charlotte Maggen, Fenja Seither, Patrick Neven, Elyce Cardonick, Sabine Schmatloch, et al. "Outcome of breast cancer patients treated with chemotherapy during pregnancy compared with non-pregnant controls." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 515. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.515.
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515 Background: Overall a diagnosis of breast cancer during pregnancy (BCP) appears not to impact maternal prognosis if standard treatment is offered. However, caution is warranted as gestational changes in pharmacokinetics with respect to the distribution, metabolism and excretion of drugs may lead to reduced chemotherapy concentration in pregnant patients. This cohort study was designed to focus on the maternal prognosis of BCP patients that receive chemotherapy during pregnancy. Methods: The outcome of BCP patients treated with chemotherapy during pregnancy was compared to non-pregnant breast cancer patients treated with chemotherapy, diagnosed after 2000, excluding postpartum diagnosis and with an age limit of 45 years. The data was registered by two multicentric registries (the International Network of Cancer, Infertility and Pregnancy and the German Breast Cancer Group) that collect both retro-and prospectively breast cancer data. 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 in order to account for the differences in baseline characteristics between pregnant patients and controls. Results: In total, 662 pregnant and 2081 non-pregnant patients, were eligible for analysis. Median age at diagnosis was 34 (range 22-47) years for pregnant and 38 (range 19-45) years for non-pregnant patients. 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. 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). A subgroup analysis of 339 women that received more than 60% of chemotherapy during pregnancy (cut-off at median) revealed a comparable survival compared to non-pregnant women (DFS: HR 0.81, 95%CI 0.62-1.06, p = 0.13; OS: HR 0.85 95% CI 0.58-1.23, p = 0.39). Conclusions: Pregnancy-induced alternations in chemotherapy concentration do not seem to affect maternal prognosis in breast cancer patients. These results support initiation of chemotherapy for BCP where indicated for oncological reasons.
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Devi, Renuka, Nithya Jagadeesan, and Saritha Kamala Raghavan. "A successful pregnancy outcome in a testicular cancer survivor: case report." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 5 (April 27, 2017): 2106. http://dx.doi.org/10.18203/2320-1770.ijrcog20171985.
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Testicular cancer is the most common cancer in young men. We report a successful pregnancy that was achieved by intracytoplasmic sperm injection (ICSI) using cryopreserved semen from a man with testicular cancer. He was treated for left testicular mixed germ cell tumor with left radical orchiectomy followed by chemotherapy. Three years post chemotherapy, the couple had two successive failures of intrauterine insemination (IUI) with cryopreserved semen. The couple then underwent Assisted reproduction with ICSI. Ten oocytes were retrieved following stimulation of which six oocytes fertilized and progressed. She had transfer of two healthy embryos and the remaining four embryos cryopreserved. Singleton pregnancy was achieved and she delivered a healthy girl baby at 38 weeks of gestation. Assisted reproduction with ICSI is a boon to the male patients with cancer and offers them a chance of fathering their own biological offspring.
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Maggen, Charlotte, Mathilde van Gerwen, Kristel Van Calsteren, Tineke Vandenbroucke, and Frédéric Amant. "Management of cancer during pregnancy and current evidence of obstetric, neonatal and pediatric outcome: a review article." International Journal of Gynecologic Cancer 29, no. 2 (January 18, 2019): 404–16. http://dx.doi.org/10.1136/ijgc-2018-000061.
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The diagnosis of cancer during pregnancy imposes a medical-ethical dilemma in weighing the risks of both mother and child. Increasing awareness of the feasibility of chemotherapy during pregnancy results in more pregnant patients receiving treatment for cancer. Information on obstetric and pediatric outcome of these high-risk pregnancies is greatly needed to guide physicians in patient counseling. In this review we present reported evidence for the incidence, diagnostic options, therapeutic management, obstetric risks, and neonatal outcome when cancer treatment is initiated during pregnancy. Decision-making when a cancer is diagnosed in a pregnant patient should be multidisciplinary, always taking the patient’s perspective into account. Cancer treatment during pregnancy is associated with low birth weight and preterm delivery, therefore frequent obstetric follow-up during oncological treatment in a specialized center is mandatory. Short-term clinical, cardiac, and cognitive outcome of children pre-natally exposed to cancer treatment is overall reassuring. Long-term follow-up of children is warranted to define the possible effect of pre-natal cancer treatment on general health, fertility outcome, and the risk of secondary cancers.
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Pariyar, J., B. Shrestha, BC Acharya, KS Sharma, J. Shrestha, S. Shrestha, S. Sundas, and S. Panthee. "Leukaemia with pregnancy managed at B. P. Koirala Memorial Cancer Hospital." Nepalese Journal of Cancer 2, no. 1 (September 30, 2018): 71–74. http://dx.doi.org/10.3126/njc.v2i1.25661.
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Abstract: Leukaemia during pregnancy is rare, occurring approximately one in every 75,000 to 100,000 pregnancies annually. Chemotherapeutic agents may have harmful effects to the developing baby though leukaemia itself rarely harms the baby. There is no evidence that pregnancy accelerates the progression of disease or affects the outcome. However, treatment dilemmas often occur.
Aims: To study the clinical presentation, treatment and outcome of leukaemia with pregnancy managed at B. P. Koirala Memorial Cancer Hospital (BPKMCH).
Methods: Descriptive study was conducted at BPKMCH. Case records of women with cancer and pregnancy from January 2006 to February 2013 were analyzed regarding their clinical details, treatment, follow-up and feto-maternal outcome.
Results: Six women, of 20 to 28 years had leukaemia with pregnancy among which four were chronic myeloid leukaemia (CML), one was acute lymphocytic leukaemia (ALL) and acute myeloid leukaemia (AML) each. All four cases of CML had conceived while on oral Imatinib; the three case diagnosed in the first trimester opted for immediate termination of pregnancy while the fourth one diagnosed at 22 weeks of pregnancy continued pregnancy and delivered at 34 weeks by emergency caesarean section for severe oligohydramnios. The ALL case diagnosed at 26 weeks of pregnancy wanted termination of pregnancy and immediate induction chemotherapy. The AML case diagnosed at 32 weeks of pregnancy desired to undergo induction chemotherapy with pregnancy but she defaulted treatment and had intrauterine fetal death and died due to postpartum haemorrhage. The baby, delivered to a mother exposed to Imatinib throughout pregnancy, till date has normal growth and development. Five mothers are in remission.
Conclusions: Leukaemia with pregnancy, more common in younger women is rare and posed treatment challenges. Definitive treatment should be individualized according to the desire of the pregnant woman and should include a multi- disciplinary team. Termination of pregnancy in favour of definitive chemotherapy to mother is better and easier during the first trimester of pregnancy. Because of teratogenic effects of chemotherapy, effective contraception be used during therapy to prevent pregnancy.
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IONESCU, Olivia, and Nicolae BACALBASA. "Gestational breast cancer. Surgical treatment, pregnancy and fetal outcome." Romanian Journal of Medical Practice 12, no. 2 (March 31, 2017): 16–22. http://dx.doi.org/10.37897/rjmp.2017.1.3.
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Background. Gestational breast cancer (GBC) is also known as pregnancy-associated breast cancer and it comprises all the breast cancers (BCs) which are diagnosed either during pregnancy or in the first year after delivery or during the lactation period. At present it has been confirmed that the breast malignancies are the most common forms of cancer in pregnant women with a constant increase in its incidence because of the continuous postpone in childbearing especially in women older than 40 years. However, when diagnosed during the pregnancy, the treatment modalities of the BC are complex and difficult to establish as it must be considered the impact of the treatment both on the child and the course of pregnancy. Purpose. Using an online search on Pubmed, our aim was to make a review of the treatment possibilities of a pregnant woman presenting a breast malignant tumor. We have concentrated our paper on the surgical treatment and the possibility of an oncoplastic reconstruction types, the facts of radiotherapy during pregnancy and the prognosis of the GBC particularly in women who opt to continue the pregnancy. A resume of the epidemiology of GBG is also presented. Method. The following key words have been on Pubmed introduced: ,,breast cancer’’, ,,pregnancy’’, ,,staging”, ,,chemotherapy” and ,,radiotherapy”. As mentioned above, we have tried to select the BC cases diagnosed and treated during pregnancy for which the decision of the patient was to continue the pregnancy in spite of the diagnosis. We further aimed to present the prognosis of the pregnancy-associated BC, namely the pregnancy and fetal outcome, and to investigate if the decision to terminate the pregnancy is associated with a survival benefit. Conclusion. The surgical treatment of pregnancy-associated BC does not differ from that of non-pregnancy BC. Axillary LN-dissection is permitted while the data on the safety of sentinel-LN are still poor. Elective termination of the pregnancy has no impact on the overall survival of the patient.
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Sarantaki, Antigoni, and Kyriaki Perisaki. "Breast Cancer: Treatment Effects on Fertility and Subsequent Pregnancy Outcomes." Medical Science and Discovery 8, no. 8 (August 19, 2021): 442–47. http://dx.doi.org/10.36472/msd.v8i8.587.
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Objective: Breast cancer is the most common cancer type in women of reproductive age. Given that most women postpone childbearing, breast cancer occurrence possibly perplexes their plans for starting a family. The treatment for breast cancer can affect their fertility and have adverse effects on a pregnancy that occurs during that period. The aim of this narrative review is primarily to explore the influence of breast cancer therapy on the ability of a woman diagnosed with breast cancer to gestate. Moreover, to determine the safer timing for childbearing after being treated for breast cancer and investigate the pregnancy outcome when conception is succeeded.
Childbearing after treatment for breast cancer is considered safe and pregnancy outcomes are favorable if conception happens 1 year after chemotherapy or at least 2 years after chemotherapy and radiation therapy. Counseling is of great significance and fertility preservation methods should be thoroughly discussed with women diagnosed with breast cancer, even prior to commencement of the treatment
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Ring, Alistair E., Ian E. Smith, Alison Jones, Catherine Shannon, Eleni Galani, and Paul A. Ellis. "Chemotherapy for Breast Cancer During Pregnancy: An 18-Year Experience From Five London Teaching Hospitals." Journal of Clinical Oncology 23, no. 18 (June 20, 2005): 4192–97. http://dx.doi.org/10.1200/jco.2005.03.038.
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Purpose The rare association between breast cancer and pregnancy means that few oncologists gain an expertise in this area. In particular, there are few published data concerning the use of chemotherapy for breast cancer during pregnancy. In this retrospective case series, we describe the experiences of five hospitals in London, United Kingdom, and how they manage this condition. Patients and Methods Retrospective searches were performed at five London hospitals in order to identify women who received chemotherapy for breast cancer while pregnant. Results Twenty-eight women were identified who had received chemotherapy for breast cancer during pregnancy. Twenty-four women received adjuvant or neoadjuvant chemotherapy for early breast cancer, and four women received palliative chemotherapy for metastatic disease. A total of 116 cycles of chemotherapy were administered during pregnancy. Sixteen women were treated with anthracycline-based chemotherapy and 12 received cyclophosphamide, methotrexate, and fluorouracil. All but one of the women were treated after the first trimester. One spontaneous abortion occurred in the woman treated during her first trimester; otherwise, there were no serious adverse consequences for the mothers or neonates. Conclusion These data provide evidence that in terms of peripartum complications and immediate fetal outcome, chemotherapy can be safely administered to women during the second and third trimesters of pregnancy.
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Abdel-Hady, El-Said, Reda Abdel-Hady Hemida, Anas Gamal, Maha El-Zafarany, Eman Toson, and Mohammed Attia El-Bayoumi. "Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy." Archives of Gynecology and Obstetrics 286, no. 2 (March 13, 2012): 283–86. http://dx.doi.org/10.1007/s00404-012-2287-5.
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Berends, Claudia, Charlotte Maggen, Christianne A. R. Lok, Mathilde van Gerwen, Ingrid A. Boere, Vera E. R. A. Wolters, Kristel Van Calsteren, et al. "Maternal and Neonatal Outcome after the Use of G-CSF for Cancer Treatment during Pregnancy." Cancers 13, no. 6 (March 10, 2021): 1214. http://dx.doi.org/10.3390/cancers13061214.
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Data on the use of Granulocyte colony-stimulating factor (G-CSF) in pregnant cancer patients are scarce. The International Network of Cancer, Infertility and Pregnancy (INCIP) reviewed data of pregnant patients treated with chemotherapy and G-CSF, and their offspring. Among 2083 registered patients, 42 pregnant patients received G-CSF for the following indications: recent chemotherapy induced febrile neutropenia (5; 12%), dose dense chemotherapy (28, 67%), poly chemotherapy (7, 17%), or prevention of neutropenia at delivery (2; 5%). Among 24 women receiving dose dense chemotherapy, three (13%) patients recovered from asymptomatic neutropenia within 5 days. One patient developed pancytopenia following polychemotherapy after which the pregnancy was complicated by chorioamnionitis and intrauterine death. Nineteen singleton livebirths (49%) were born preterm. Sixteen neonates (41%) were admitted to the Neonatal Intensive care Unit (NICU). No neonatal neutropenia occurred. Two neonates had congenital malformations. Out of 21 children in follow-up, there were four children with a motor development delay and two premature infants had a delay in cognitive development. In conclusion, the rate of maternal and neonatal complications are similar to those described in (pregnant) women treated with chemotherapy. Due to small numbers and limited follow-up, rare or delayed effects among offspring exposed to G-CSF in utero cannot be ruled out yet.
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Labrosse, Julie, Anne Lecourt, Alice Hours, Clara Sebbag, Aullene Toussaint, Enora Laas, Florence Coussy, et al. "Time to Pregnancy, Obstetrical and Neonatal Outcomes after Breast Cancer: A Study from the Maternity Network for Young Breast Cancer Patients." Cancers 13, no. 5 (March 3, 2021): 1070. http://dx.doi.org/10.3390/cancers13051070.
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Although an increasing number of young breast cancer (BC) patients have a pregnancy desire after BC, the time necessary to obtain a pregnancy after treatment and subsequent outcomes remain unknown. We aimed to determine the time to evolutive pregnancy in a cohort of BC survivors and subsequent obstetrical and neonatal outcomes. We analyzed BC patients treated at Institut Curie from 2005–2017, aged 18–43 years old (y.o.) at diagnosis having at least one subsequent pregnancy. 133 patients were included, representing 197 pregnancies. Mean age at BC diagnosis was 32.8 y.o. and at pregnancy beginning was 36.8 y.o. 71% pregnancies were planned, 18% unplanned and 86% spontaneous. 64% pregnancies resulted in live birth (n = 131). Median time from BC diagnosis to pregnancy beginning was 48 months and was significantly associated with endocrine therapy (p < 0.001). Median time to pregnancy was 4.3 months. Median time to evolutive pregnancy 5.6 months. In multivariate analysis, menstrual cycles before pregnancy remained significantly associated with time to pregnancy and endocrine therapy with time evolutive to pregnancy. None of the BC treatments (chemotherapy/endocrine therapy/trastuzumab) was significantly associated with obstetrical nor neonatal outcomes, that seemed comparable to global population. Our findings provide reassuring data for pregnancy counseling both in terms of delay and outcome.
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Danet, Chloé, Mélanie Araujo, Marie-Andrée Bos-Thompson, Ghyslaine Portolan, Sophie Gautier, Laurence Vanlemmens, Sophie Bonenfant, et al. "Pregnancy outcomes in women exposed to cancer chemotherapy." Pharmacoepidemiology and Drug Safety 27, no. 12 (October 31, 2018): 1302–8. http://dx.doi.org/10.1002/pds.4689.
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Ghaemmaghami, F., and M. Hasanzadeh. "Good fetal outcome of pregnancies with gynecologic cancer conditions: cases and literature review." International Journal of Gynecologic Cancer 16, Suppl 1 (January 2006): 225–30. http://dx.doi.org/10.1136/ijgc-00009577-200602001-00036.
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Gynecologic malignancies frequently occur in women of reproductive age and are estimated to complicate 1 in 1000 pregnancies. Cancer diagnosis may be delayed because of difficulties in distinguishing symptoms from physiologic changes in pregnancy. Another problem is applying the standard workup in pregnant women. These reports describe the good fetal outcome of pregnancies in patients with vulvar and ovarian carcinoma. Patients underwent multimodality treatment, and their infants were developmentally normal. Vulvar and ovarian cancer is a rare finding in pregnancy. Early diagnosis and appropriate treatment offer the best prognosis. Aggressive postoperative chemotherapy also continues to better the outcome.
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Ustaalioglu, Bala Basak Oven, Mahmut Gumus, Ali Unal, Kerim Cayir, Ozlem Sever, Ahmet Bilici, Emin Tamer Elkran, et al. "Malignancies Diagnosed During Pregnancy and Treated With Chemotherapy or Other Modalities (Review of 27 Cases): Multicenter Experiences." International Journal of Gynecologic Cancer 20, no. 5 (June 2010): 698–703. http://dx.doi.org/10.1111/igc.0b013e3181daaf3e.
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Background:Cancer is the second leading cause of death in women of reproductive age. The most common tumors diagnosed during pregnancy are breast and cervix cancer, Hodgkin lymphoma and non-Hodgkin lymphoma, leukemias, and malignant melanoma. The aim of therapy in pregnancy is to give optimal treatment to the mother without harm to the fetus. In the first trimester, organogenesis continues, so chemotherapy should not be given because of increasing risk of spontaneous abortion, fetal malformation, and mortality. We evaluated mostly seen tumors during pregnancy and assessed treatment type and outcome of pregnancy after chemotherapy in our population.Methods:We retrospectively analyzed 27 patients who have been treated during pregnancy or after the delivery because of several malignancies.Results:The tumors associated with pregnancy were breast cancer, hematologic malignancies, gynecologic malignancies, sarcomas, and others. The chemotherapy regimens were given in 17 of 27 patients in the second or third trimester of pregnancy. Four of the patients were diagnosed with cervical cancer, hemangiopericytoma, chronic myeloid leukemia, and breast cancer during the first trimester, so their pregnancies were ended by therapeutic abortion. Although 1 of the 3 fetuses who were exposed to chemotherapy in utero at the second or third trimester was born prematurely and low birth weight was diagnosed in the other 2 fetuses, fetal malformation was not seen in any of them. There were 7 normal and 9 cesarean deliveries. Twenty-three healthy babies survived from 27 pregnancies, of whom 17 babies were exposed to chemotherapeutic agents.Conclusions:We reported herein 27 patients with malignancies diagnosed during pregnancy; 17 patients received chemotherapy during the gestational period without any fetal or maternal abnormalities. Because of the low incidence of malignancy during pregnancy, our report is noteworthy.
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Katz, D., H. Mazeh, L. Divinsky, M. Temper, I. Ospovat, A. Salah, T. Hamburger, D. Galinsky, B. Uziely, and T. Peretz. "Fertility and pregnancy in patients under age 38 following chemotherapy for breast cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e11541-e11541. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11541.
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e11541 Background: Chemotherapy improves breast cancer outcome, but may impact fertility. Post chemotherapy fertility rates range between 10–90% among studies. Fertility post chemotherapy is most often assessed by rate of menstruation resumption- an indirect method of evaluating childbearing potential. It is noteworthy that future pregnancy is a woman's first concern not menses preservation. Variability in fertility rates along with limited data on post chemotherapy pregnancies led us to undertake this single institute retrospective study evaluating fertility and pregnancy post chemotherapy in ≤ 38 y old breast cancer patients. Methods: We reviewed medical records of 222 consecutive stage II-IIIB breast cancer patients diagnosed, treated and followed at Sharette Institute of Hadassah-Hebrew University Medical Center from 1990–2004. Inclusion criteria included age ≤ 38 years, ≥3 cycles of standard metothrexate or adriamycine based chemotherapy, metastasis-free 12 months post chemotherapy initiation or one year following GnRH analog withdrawal. Patients diagnosed with infertility prior to breast cancer diagnosis (data present for part of patients), bilateral oophorectomy or patients surviving ≤3 years from diagnosis were excluded. Patient pregnancy preference was not recorded. Fertility was defined as resumption of recurrent menses or pregnancy anytime during follow up. In case of recurrence, date of recurrence diagnosis was assigned as date of last follow up. Results: Cohort included 65 patients. Mean age 32.5±4 ys (20.3–38.5) Almost all patients (95.4%), 38 ys or younger, preserve menses following chemotherapy, and 33.9% become pregnant. Most of patients who did not conceive post chemotherapy (66.1%), were under a familial status not promoting pregnancy; 44% of all women who did not give birth post chemotherapy had at least 3 offspring at the time of diagnosis and 83% out of all women who did not have any offspring by the end of follow up were single. Conclusions: This data suggest that pregnancy potential may be even higher than our actual finding, since pregnancy is most probably not attempted by multiparous or most single patients, whom cultural constrains affect their decisions. It seems prudent to offer the subgroup of unmarried women fertility preservation. No significant financial relationships to disclose.
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Milbourne, Andrea, Charlotte C. Sun, Michelle A. Fanale, Richard L. Theriault, Sue A. Rimes, Jennifer Keating Litton, and Mildred M. Ramirez. "Pregnancy outcomes in women with cancer." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 6116. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.6116.
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6116 Background: Parenthood after cancer is a critical concern for many cancer patients (pts). Pregnancy (prg) during cancer is an emotional time for about 1/1000 pregnant women. No randomized controlled studies exist examining the impact of cancer treatment (tx) on the developing fetus nor on the woman with cancer. Methods: From 2002-2011, women presenting for cancer tx during prg were approached for this IRB-approved prospective database study. All pts provided written consent. Results: To date 143 pts are evaluable. The median age at diagnosis was 32.1 years and median gestational age (GA) at enrollment was 18.2 weeks. 95/143 (66.4%) are White, 19 (13.3%) are African American, 17 (11.9%) are Hispanic and 12 (8.4%) are Asian/Other. Primary cancers included breast (n=59, 41.3%), hematologic (n=29, 20.3%), melanoma (n=13, 9%), GYN (n=11, 8%), GI (n=8, 5.6%), head/neck (n=7, 6%) and other (n=16, 11%) (brain=4, GU=1, thyroid=3, head/neck=7, thoracic=1, sarcoma=6, unknown primary=1). 111/143 (77.6%) of prgs resulted in live births. Median birth weight was 6.5 lbs. Median follow-up time for pts was 32.3 months. To date, 3/19 pts who terminated prgs have died (1.6%). Most terminations occurred in the 1st trimester. To date, 79 pts (55.2%) are NED and 23 pts have died; of these 19 (1.7%) had live births. No major malformations were observed in the 74/143 (52%) of pts who received chemotherapy (CTx) during pregnancy. 57% received FAC/FEC; other regimens included ABVD (n=5), cytarabine (n=5), CHOP/R-CHOP, and platinum-based regimens. Median GA at the start of CTx was 19.7 wks. Median number of CTx cycles during prg was 4. Other pts underwent surgery (n=32), no tx (n=14), deferred tx until after delivery (n=17), radiation (2), transplant (3), other (1). Conclusions: Cancer diagnosis during prg is compatible with successful tx and prg outcome. Cancer tx during the 2nd and 3rd trimester can be safely given and in our pts did not result in adverse prg outcomes. Tx during the 1st trimester is usually not recommended. Thus cancer pts in their 1st trimester need to be extensively counseled about their disease as well as about the risks to the prg. In our pts continuation or termination of prg were not associated with an increased risk of death.
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Tang, Monica, and Kate Webber. "Fertility and pregnancy in cancer survivors." Obstetric Medicine 11, no. 3 (March 29, 2018): 110–15. http://dx.doi.org/10.1177/1753495x18757816.
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Summary Cancer survivors are increasing as improvements in cancer diagnosis and treatment translate to improved outcomes. As cancer survivors in their reproductive years contemplate pregnancy, it is important to understand the impact of cancer and its treatment on fertility and pregnancy outcomes. Cancer treatments such as chemotherapy and radiotherapy can affect patients’ fertility, and strategies are available to help preserve the future fertility of survivors. The potential impact of previous cancer diagnoses and treatments on pregnancy and maternal and fetal outcomes needs to be assessed and discussed with survivors, with support from materno-fetal medicine specialists and high-risk antenatal services as needed.
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Korakiti, Anna-Maria, Eleni Zografos, Mathilde van Gerwen, Frédéric Amant, Meletios-Athanasios Dimopoulos, and Flora Zagouri. "Long-Term Neurodevelopmental Outcome of Children after in Utero Exposure to Chemotherapy." Cancers 12, no. 12 (December 3, 2020): 3623. http://dx.doi.org/10.3390/cancers12123623.
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Pregnancy-related cancer management represents a real challenge for both the patients and the physicians. The long-term neurodevelopmental outcome of children in utero exposed to chemotherapeutic agents has only recently been addressed. This review aims to systematically integrate and highlight all existing data from the literature regarding the effect of prenatal exposure to chemotherapy on fetal brain growth and child development. All eligible studies are based on validated neurodevelopmental testing scales (e.g., Bayley Scales of Infant Development, Wechsler Preschool and Primary Scale of Intelligence) and/or well-defined questionnaires. Our systematic review including 17 studies demonstrates that no major consequences on the neurodevelopment of children after in utero exposure to anti-cancer drugs have been reported; nevertheless, longer and more thorough follow-up with large-scale multicenter prospective studies is certainly required in order to draw firm conclusions.
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Abdalla, Nabil, Magdalena Bizoń, Robert Piórkowski, Paweł Stanirowski, Krzysztof Cendrowski, and Włodzimierz Sawicki. "Does Chemotherapy for Gynecological Malignancies during Pregnancy Cause Fetal Growth Restriction?" BioMed Research International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/7543421.
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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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Aisner, J., P. H. Wiernik, and P. Pearl. "Pregnancy outcome in patients treated for Hodgkin's disease." Journal of Clinical Oncology 11, no. 3 (March 1993): 507–12. http://dx.doi.org/10.1200/jco.1993.11.3.507.
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PURPOSE This study attempted to determine the outcome of pregnancies in patients (or their partners) who were successfully treated for Hodgkin's disease and to assess the effect of treatment on the children of the treated parents. MATERIALS AND METHODS A questionnaire was distributed to and personal interviews were conducted with patients who were of reproductive age at the time of treatment with consecutive protocols of radiotherapy, chemotherapy, or both. Those premenopausal patients (or the sexual partners of patients) who attempted to conceive after successful treatment constituted the study population. Fertility assessment was based only on those patients identified as desiring children. RESULTS Among 391 adult patients, 221 patients (104 females and 117 males) of reproductive age were interviewed. Before treatment, 63 of the 221 patients had 135 pregnancies, which resulted in 118 children, 11 spontaneous abortions, five elective abortions, and one stillborn. After treatment, 94 patients (43 females and 51 males) actively attempted conception; 35 females and 25 partners of male patients had 84 pregnancies, which resulted in 68 living children. Among the 84 pregnancies, there were one premature birth at 29 weeks, three spontaneous abortions, 11 elective abortions, and two stillborn: one at 32 weeks and one set of twins. The children have been observed for a median of 11 years (minimum follow up > 4.5 years). Of those patients who desired children, 35 of 43 females became pregnant, whereas only 25 of the 51 partners of male patients became pregnant. At least five male patients with low sperm counts apparently fathered children. CONCLUSIONS This study demonstrates that both men and women have the potential for fertility after treatment regardless of treatment modality. The partners of male patients who were treated with combined modality treatment had a lower frequency of pregnancy than did the female patients who attempted conception and their frequency of pregnancy was also lower than the general population. There was no apparent increase in complications of pregnancy, spontaneous abortions, or congenital abnormalities after treatment compared with pregnancies in this patient group before treatment or with pregnancies in the general population.
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Surapaneni, Rakesh, Jolanta Jozefara, Karen Hendershott, Krystal Hunter, and Elyce Cardonick. "Breast cancer surgery during pregnancy." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 1127. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.1127.
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1127 Background: There is limited literature on breast surgery during pregnancy. We present prospective registry data on 88 breast cancer patients who underwent breast cancer surgery during pregnancy. Methods: The Cancer and Pregnancy Registry is a voluntary international registry that prospectively collects the clinical course, treatment, and disease outcome of women diagnosed with cancer during pregnancy and the perinatal and neonatal outcomes of their children. Results: We identified 88 patients who were diagnosed with breast cancer and had surgery while pregnant. 59 patients (67%) underwent Mastectomy while29 patients (32%) underwent breast conserving surgery (BCS). Out of 43 patients who underwent BCS as their first surgery 13 patients (30.23%) required subsequent mastectomy during pregnancy. 15 patients (34.88%) from the BCS group and 4 patients (8.69%) from the Mastectomy group had positive margins. There was no significant difference between patients who underwent mastectomy vs BCS based on Age (34.67 vs 34.72 P: 0.97), gestational age at surgery (14.05 vs 16.06 P: 0.23) or ER positivity (47.5% vs 46.4% P: 0.93). 2 patients had neo-adjuvant chemotherapy. 17 patients (19.31%) had sentinel lymph node biopsy. 37 patients (42%) had a pregnancy complication. There was no difference in the rate of complication based on mastectomy vs BCS(45.8% vs 34.5% P: 0.31). There was only 1 patient (from mastectomy group) that delivered within 2 weeks of surgery. Of the 17 patients (19.3%) with spontaneous preterm delivery, there was no difference between Mastectomy and BCS group (22% vs 13.2% P: 0.41). Of the 25 patients (28.4%) with birth complications, there was no significant difference between mastectomy vs BCS (30.5% vs 24.1% P: 0.53). There was also no difference in mean birth weight between the groups (2598 grams vs 2672.3 grams P: 0.57). Conclusions: The data supports the safety of breast cancer surgery during pregnancy. In addition, there were no identified adverse effects in patients who underwent BCS as opposed to mastectomy. Of note, only 19% of patients underwent sentinel node biopsy which is considered the standard of care in early breast cancer patients regardless of pregnancy status.
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Amant, Frédéric, Valentina Nekljudova, Charlotte Maggen, Fenja Seither, Patrick Neven, Elyce H. Cardonick, Sabine Schmatloch, et al. "Outcome of breast cancer patients treated with chemotherapy during pregnancy compared with non-pregnant controls." European Journal of Cancer 170 (July 2022): 54–63. http://dx.doi.org/10.1016/j.ejca.2022.04.014.
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Hourani, Mohammad, Rawan Bdair, Mawada Hussein, Ali Yousif, Lina Wahba, Abla AlAgha, Alaa Shoqeir, Fatima Alkindi, and Aydah Alawadhi. "Abstract P1-14-02: Breast cancer in pregnancy: A retrospective clinical study in a single large tertiary cancer center in the United Arab Emirates." Cancer Research 83, no. 5_Supplement (March 1, 2023): P1–14–02—P1–14–02. http://dx.doi.org/10.1158/1538-7445.sabcs22-p1-14-02.
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Abstract Introduction: Pregnancy associated breast cancer (PABC) is defined as any breast cancer (BC) diagnosed during pregnancy or one year postpartum. BC considered the most common type of malignancy in pregnant women, occurring approximately once in every 3000 pregnancies. In view of the fact that PABC is a relatively rare event surrounded by multiple variables, few studies address the best management and treatment options. Objectives: The aim of this study is to report the incidence, clinicopathological characteristics and treatment outcomes of PABC diagnosed over 20 years period treated in Tawam hospital. This will help clinician, researchers shed the light of the unmet needs for this entity of BC. Method: We reviewed all BC patients ≤ 40 years of age diagnosed between 2000 -2020 in Tawam hospital and identified those with PABC as the definition above. Information was obtained from the Tawam Cancer Registry and analyzed. A retrospective data analysis was conducted. The data analyzed using the SPSS software. The study was approved by the hospital Research Ethics Board. Results: a total of 67 patients were identified in the study with pregnancy associated BC among all BC patients age ≤ 40 years old which compromised 7.4% (67/911) from year 2000 till 2022. The clinical and the pathological characteristics of these patients are provided in table 1. Around 22 (32.8%) of the patients were diagnosed at the second trimester. Only 6 (8.6%) patients found to have inflammatory breast cancer diagnosis. 31(42%) patients had hereditary genetic testing done of which 5 (16.1%) patients found to have pathogenic genetic mutations. Pathogenic mutations identified including 3 (9.7%) patients with BRCA2 mutation, 1 patient had BRCA1 mutation, and 1 patient had TP53 mutation. Out of these 67 patients, 36 (65.5%) underwent modified radical mastectomy, 19 (34.5%) had lumpectomy, 37 (55.2%) had axillary lymph node dissection, 14 (20.8%) had sentinel lymph node biopsy, 13 (19.4%) had the surgery during the pregnancy and 45 (67.1%) had adjuvant radiation therapy post delivery. Regarding the chemotherapy, 29 (43.2%) patients received Neoadjuvant chemotherapy, 24 (35.8%) received Adjuvant chemotherapy, 11 (16.4%) were pregnant when they received chemotherapy. Only 7 (10.4%) patients had termination of their pregnancies, while 3 (4.4%) patients had spontaneous miscarriage. 47 (70.1%) patients delivered at our facility and 9 (13.4%) patients delivered at other facilities (unknown delivery details). In terms of delivery type, 24 (35.8%) patients had C-section surgery, and 23 (34.3%) patients had spontaneous vaginal delivery. All of the patients who had delivery in Tawam hospital, delivered healthy baby with no complications. Survival analysis and treatment outcome to be presented in the meeting. Conclusion: Our study showed that significant proportion of the patients with PABC diagnosed with HER2neu + disease, stage II-III disease, high grade tumors and nodal involvement on initial presentation. Patients were treated according to the standard of care with trend of favorable delivery outcomes. PABC is a unique entity of BC that requires careful planning and multidisciplinary approach with consideration of factors related to feral, pregnancy and maternal outcomes. Table 1: Clinical and Pathological Characteristics of Pregnancy Associated Breast Cancer (N=67) Citation Format: Mohammad Hourani, Rawan Bdair, Mawada Hussein, Ali Yousif, Lina Wahba, Abla AlAgha, Alaa Shoqeir, Fatima Alkindi, Aydah Alawadhi. Breast cancer in pregnancy: A retrospective clinical study in a single large tertiary cancer center in the United Arab Emirates [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-14-02.
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Mittra, Arjun, James Murray, Naoko Takebe, Alice P. Chen, and S. Percy Ivy. "Pregnancies in subjects on oncology clinical trials: Analysis from the Cancer Therapy Evaluation Program (CTEP) database." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18239-e18239. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18239.
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e18239 Background: The NCI Cancer Therapy Evaluation Program (CTEP) has developed guidance and reporting measures to balance inclusion of younger cancer patients on trials with minimizing potential risks. CTEP began mandating the use of 2 forms of contraception for all participants of child bearing potential starting in the early 2000s in trials of thalidomide in multiple myeloma. The development of oncology clinical trials using other known teratogens such as Hedgehog Inhibitors led to development of comprehensive guidance on enrolling women on clinical trials. In 2012, CTEP further updated its guidelines to develop a reporting system for pregnancies occurring on clinical trial. Methods: We performed a retrospective analysis of the CTEP Adverse Event Reporting System (AERS) to identify unanticipated pregnancies in subjects or their partners while on oncology clinical trials. Results: 33 events were identified between 2011 and 2018, including 21 female and 11 male. One female subject got pregnant twice on the same trial. In female subjects, there were 4 live births, 1 active pregnancy, 5 spontaneous abortions, 5 medical termination of pregnancy and 1 death of the mother due to cancer. Outcome of pregnancy was not reported for 6 female subjects. Of the live births: 3 received an immunotherapy checkpoint inhibitor, and 1 received trastuzumab. Of 5 spontaneous abortions: 3 received cytotoxic chemotherapy, one radiation and one trastuzumab. Of 12 male subjects whose partners got pregnant: 3 live births, 2 active pregnancy, no pregnancy loss. Outcome of pregnancy was not reported for 6 male subjects. Conclusions: Though uncommon, pregnancies on clinical trial still occur despite requiring subjects to use 2 effective forms of contraception. With the increasing number of younger subjects being included in clinical trials for cancer, information about pregnancy outcomes in patients being treated with experimental agents is scientifically valuable and important to collect from study subjects and their partners. Since not all anti-cancer agents are of equal teratogenic potential, it is vital that this data continues to be collected and reported, including long term follow up of the pregnancy and the health of the child.
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Simionescu, Anca A., Alexandra Horobeț, Lucian Belaşcu, and Dragoş Mircea Median. "Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania." Medicina 56, no. 10 (October 6, 2020): 522. http://dx.doi.org/10.3390/medicina56100522.
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Background and objectives: Breast cancer is among the most common cancer types encountered during pregnancy. Here, we aimed to describe the characteristics, management, and outcomes of women with pregnancy-associated breast cancer at a tertiary-level hospital in Romania. Material and Methods: We retrospectively and prospectively collected demographic, oncological, and obstetrical data for women diagnosed with cancer during pregnancy, and who elected to continue their pregnancy, between June 2012 and June 2020. Complete data were obtained regarding family and personal medical history and risks factors, cancer diagnosis and staging, clinical and pathological features (including histology and immunohistochemistry), multimodal cancer treatment, pregnancy management (fetal ultrasounds, childbirth, and postpartum data), and infant development and clinical evolution up to 2020. Cancer therapy was administered following national guidelines and institutional protocols and regimens developed for non-pregnant patients, including surgery and chemotherapy, while avoiding radiotherapy during pregnancy. Results: At diagnosis, 16.67% of patients were in an advanced/metastatic stage, while 75% were in early operable stages. However, the latter patients underwent neoadjuvant chemotherapy rather than up-front surgery due to aggressive tumor biology (triple negative, multifocal, or HER2+). No patient achieved complete pathological remission, but only one patient relapsed. No recurrence was recorded within 12 months among early-stage patients. Conclusions: In this contemporary assessment of real-world treatment patterns and outcomes among patients with pregnancy-associated breast cancer, our findings were generally consistent with globally observed treatment outcomes, underscoring the need for a multidisciplinary team and reference centers.
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ter Welle-Butalid, M. E. (Elena), I. J. H. (Ingeborg) Vriens, J. G. (Josien) Derhaag, E. M. (Edward) Leter, C. E. (Christine) de Die-Smulders, M. (Marjolein) Smidt, R. J. T. (Ron) van Golde, and V. C. G. (Vivianne) Tjan-Heijnen. "Counseling young women with early breast cancer on fertility preservation." Journal of Assisted Reproduction and Genetics 36, no. 12 (November 23, 2019): 2593–604. http://dx.doi.org/10.1007/s10815-019-01615-6.
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Abstract Purpose Women with early-stage breast cancer may still have a future child wish, while chemotherapy may impair fertility. To pursue on fertility preservation shortly after breast cancer diagnosis is complex. This review holds a critical reflection on all topics that need to be counseled to give them the opportunity to make a well-informed decision before starting any oncological treatment. Methods A comprehensive literature review was performed on papers published in English language on breast cancer in young women, risk of chemotherapy-induced infertility, fertility preservation techniques, impact of possible mutation carriership, and future pregnancy outcome. Results Below 40 years of age, the risk of permanent chemotherapy-induced ovarian function failure is approximately 20%, where taxanes do not significantly add to this risk. Overall, 23% of reported women who performed fertility preservation by cryopreserving oocytes or embryos returned for embryo transfer. Of these, 40% gave live birth. Both fertility preservation in women diagnosed with breast cancer and pregnancy after treatment seem safe with respect to breast cancer survival. Women who have a genetic predisposition for breast cancer like BRCA gene mutation should also be informed about the possibility of pre-implantation genetic diagnosis. Conclusions Women with an early stage of breast cancer and a possible future child wish should be referred to an expertise center in breast cancer, fertility preservation, and genetics in this complex decision-making process, shortly after diagnosis.
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Shami, N., A. Shaila, A. Shaharyar, and S. Asif. "Pregancy after bilateral dysgerminoma treated with conservative surgery and BEP chemotherapy." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 16039. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.16039.
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16039 Background: Pregnancy after treatment of germ cell tumours of ovary is common. However patients with bilateral dysgerminoma treated with unilateral oophorectomy, wedge biopsy of opposite ovary, and conservation of uterus face difficulty in conception. This study was conducted with the objective to evaluate the fertility status of ovarian dysgerminoma patients treated with conservative surgery and BEP chemotherapy. Methods: Patients of bilateral dysgerminoma who underwent conservative surgery and chemotherapy with cisplatin 20 mg / m2 and etoposide 100 mg / m2 day 1 to 5 and bleomycin 30 mg on day 1, 8 and 15 of three weekly cycles were eligible. A normal AFP and beta HCG at baseline was required. Post treatment CT scans of abdomen and pelvis were obtained. Patients were regularly followed on monthly basis. Pregnancy was allowed 2 years after completion of last cycle of chemotherapy. Results: From January 1998 to December 2003, 11 patients were enrolled. Medain age was 16 years (range 13–18). All patients had complete disappearance of disease after treatment. Treatment related amenorrhea did not last beyond one year. During a median follow up of 5 years, all patients conceived and a total of 14 pregnancies were completed successfully.Three patients required use of clomiphene citrate for ovulation induction. No patient was treated with gonadotrophins. Six patients underwent lower segment caesarean section for obstetric indications and seven delivered vaginally. All babies were healthy without the signs of birth abnormalities or retardation. Conclusions: With conservative surgery and BEP chemotherapy for treatment of bilateral dysgerminoma the fertility is retained with good pregnancy outcome, when conception occurs at least two years after the last dose of chemotherapy. No significant financial relationships to disclose.
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Sipe, Bradley H., Sarah G. Običan, Evita Henderson-Jackson, Nicole D. Riddle, Rikesh Makanji, Ricardo J. Gonzalez, and Andrew S. Brohl. "A Case of Retroperitoneal Synovial Sarcoma in Pregnancy Treated with Antepartum Doxorubicin plus Ifosfamide Chemotherapy." Case Reports in Oncological Medicine 2021 (July 16, 2021): 1–8. http://dx.doi.org/10.1155/2021/9982171.
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We report a case of a 25-year-old pregnant woman diagnosed with a large, unresectable retroperitoneal synovial sarcoma. Successful neoadjuvant treatment with doxorubicin plus ifosfamide prepartum and continuing postpartum resulted in significant disease response allowing for later tumor resection. Following the first prepartum chemotherapy cycle, a decreased amniotic fluid index was noted, representing a potential complication of chemotherapy. Induction of labor was performed at 33 weeks gestation with excellent outcome in the newborn. This case highlights the complex medical decision-making process in the setting of cancer diagnosed during pregnancy, balancing oncologic and obstetric concerns, and to our knowledge is only the second reported case of synovial sarcoma treated with neoadjuvant cytotoxic chemotherapy in the antepartum period.
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Xing, Naidong, Lihui Wang, Xinlei Sui, Chunru Zhao, Yan Huang, and Jin Peng. "The Safety of Chemotherapy for Ovarian Malignancy during Pregnancy." Journal of Clinical Medicine 11, no. 24 (December 19, 2022): 7520. http://dx.doi.org/10.3390/jcm11247520.
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Background: Data on epidemiologic features, treatments and outcomes in women diagnosed with ovarian malignancy during pregnancy are very sparse due to its low incidence. The goal of our study was to summarize the epidemiologic characteristics of pregnant women complicated with ovarian malignancy and investigate the safety and efficacy of chemotherapy during pregnancy. Methods: We retrospectively analyzed the clinicopathological data of eight patients suffering from ovarian malignancy during pregnancy in our institution from June 2011 to July 2021. Furthermore, a systematic literature search was conducted in PubMed up to 1 September 2021, which identified 92 cases with ovarian malignancy during pregnancy eligible for the analysis. Therefore, we collected the data of 100 pregnant patients complicated with ovarian malignancy, including clinical demographics, tumor characteristics, treatment interventions and outcomes. Results: In total, 100 pregnant patients complicated with ovarian malignancy were investigated and classified into three groups: 34 cases in the epithelial ovarian cancer (EOC) group, 38 cases in the germ cell tumors (GCTs) group and 28 cases in the sex cord-stromal tumors (SCSTs) group. The onset age of pregnant patients with epithelial ovarian cancer was significantly higher than that of other patients. Pelvic mass and abdominal pain were the common clinical presentations of pregnant patients with ovarian malignancy. For distinguishing epithelial ovarian cancer during pregnancy, the area under the curve (AUC) of CA-125 was 0.718 with an optimal cutoff value of 58.2 U/mL. Moreover, 53 patients underwent surgery during pregnancy, the majority of whom underwent unilateral adnexectomy in the second trimester. Furthermore, 43 patients received chemotherapy during pregnancy, and 28 delivered completely healthy newborns at birth; 13 neonates showed transient abnormalities without further complications; and 2 died during the neonatal period. Conclusions: Our study reveals the safety of chemotherapy for ovarian malignancy during pregnancy. However, large-sample prospective studies are still needed to further explore the safety of chemotherapy in pregnant patients with malignancy to choose the appropriate chemotherapy regimen and achieve the maximum benefit for patients.
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Abel, Mary Kathryn, Kaitlyn Wald, Nikita Sinha, Joseph M. Letourneau, Rhodel Simbulan, Evelyn Mok-Lin, Marcelle I. Cedars, and Mitchell P. Rosen. "Conception after chemotherapy: post-chemotherapy method of conception and pregnancy outcomes in breast cancer patients." Journal of Assisted Reproduction and Genetics 38, no. 7 (March 19, 2021): 1755–65. http://dx.doi.org/10.1007/s10815-021-02133-0.
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Ni Luh, Lany Christina Prajawati, Bayu Mahendra I Nyoman, Putra Wiradnyana AAG, Ariawati Ketut, and Sri Mahendra Dewi I Gusti Ayu. "Ovarian Cancer Immature Teratoma Type in Pregnancy: Management and Feto-Maternal Outcomes." Open Access Macedonian Journal of Medical Sciences 7, no. 6 (March 25, 2019): 1016–20. http://dx.doi.org/10.3889/oamjms.2019.129.
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BACKGROUND: Immature teratoma is malignant ovarian germ cell tumours (MOGCTs). The case in pregnancy is very rare which less than 1% of all ovarian teratoma cases. The aim is to reach optimal and comprehensive management for immature ovarian teratoma in pregnancy to gain the healthiest maternal and fetal outcomes.
CASE PRESENTATION: Thirty-one years old female G2P1A0, 8 weeks 1-day pregnancy, with left ovarian solid tumour 15 x 15 x 15 cm in size. At gestational age (GA) of 19 weeks 5 days, the size of the tumour was increasing rapidly to 30 x 30 x 30 cm. Alfa-fetoprotein raised to 699.9 IU/mL and LDH 579 U/L. The patient had gone primary conservative left oophorectomy, omentectomy, and ascites fluid cytology with histopathological conclusion grade II immature teratoma of left ovary containing the immature neuroepithelial and fat component: magnetic resonance imaging (MRI) at 25 weeks 3 days GA, no spreading. Amniocentesis performed at 27 weeks 2 days GA, the fetus had normal 46 chromosomes and sex XX without major structural abnormality. The patient had BEP chemotherapy start at 27 weeks 2 days GA. Patient in labour at 40 weeks 2 days GA. The female baby had spontaneous delivery with 2700 grams in body weight without congenital abnormality. Complete surgical staging performed at 58th days postpartum and histopathological result there was no malignant cell anymore, but post-chemotherapy ovarian atrophy feature had found on the contralateral ovary. The patient showed psychosocial problem including post-chemotherapy depression and premature ovarian failure (POF). Immunohistochemistry (IHC) ER and PR of teratoma tissue showed immature component had ER (-) and PR (+). Follow up of the baby was in good condition.
CONCLUSION: BEP chemotherapy become regimen choice for this case with fetal outcomes was good, but there was a POF sign on the mother. Survival of patient on this case is 62%, free recurrence survival post-BEP 84% and progressivity post complete surgical staging 8% without delay the chemotherapy.
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Habib, Asma, Md Mofazzel Hossain, and Fauzia Jahan. "Successful Pregnancy Outcome Within Short Period of Remission From Choriocarcinoma Treated with Single Agent Chemotherapy - A Case Report." Bangladesh Medical Journal 40, no. 3 (April 23, 2014): 29–32. http://dx.doi.org/10.3329/bmj.v40i3.18671.
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Gestational trophoblastic tumour/disease (GTT/GTD) is unique it cancer biology in that they result from aberrations of either a normal or an abnormal pregnancy. The most common antecedent pregnancy event to GTT is a complete or partial hydatidiform mole (HM). However, persistent trophoblastic disease or choriocarcinoma can follow a complete hydatidiform mole with an incident of approximately 8%, and after a partial hydatidiform mole with an incidence of approximately 0.5%. The exact proportion of cases of hydatidiform mole transforming to choriocarcinoma cannot be clearly estimated, approximately 3% to 5% of cases of complete hydatidiform mole. 1-3 Therefore, all patients with GTT need to be monitored so that the small proportion of persistent mole or choriocarcinoma can receive prompt treatment and elimination of their' disease. The recommendation stands as strict avoidance of pregnancy for at least one year after treatment of molar pregnancy or low risk non-metastatic gestational trophoblastic tumour. Pregnancy during this period of surveillance interferes with the sequential monitoring of abnormal trophoblastic activity by serum beta-human chorionic gonadotrophin levels and relapses become difficult to detect. The effect of single agent or combination chemotherapy on the totipotent oocytes usually wavers away during the recommended period of contraception. But in cases of pregnancy during the period of surveillance certain factors have been found to be associated with increased risk of relapse and teratogenic effects of the offspring. High risk/score (according to the FIGO scoring system ) and advanced stage Gestational trophoblastic tumour (GTT), short interval between pregnancy and remission from combination chemotherapy, poor compliance during the antenatal follow-up are linked with detrimental maternal and foetal outcome. Here we report a case of successful pregnancy outcome in a patient who conceived within 3 months of remission from choriocarcinoma treated by methotrexate as evidenced by 2 consecutive negative ?-human chorionic gonadotropin (?-hCG) values. DOI: http://dx.doi.org/10.3329/bmj.v40i3.18671 Bangladesh Medical Journal 2011 Vol.40(3):29-32
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Avilès, Agustin, Maria-Jesus Nambo, and Natividad Neri. "TREATMENT OF EARLY STAGES HODGKIN LYMPHOMA DURING PREGNANCY." Mediterranean Journal of Hematology and Infectious Diseases 10, no. 1 (January 1, 2018): 2018006. http://dx.doi.org/10.4084/mjhid.2018.006.
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Objetive. To assess maternal and fetal outcome of women who receiving chemotherapy during pregnancy to treat Hodgkin lymphoma(HL) in early stages (IA and IIA), we performed an retrospective analysis of 44 women with HL at early stage, diagnosed and treated between 1988 to 2010, in a tertiary reference cancer center.Methods:We analyze data of HL: clinical characteristics and treatment; and special attention to maternal and fetal complications ; children : physical development, assess scholar performance phsycological, cardiac and neurological function and intellegence tests.Results: Forty-four pregnant women were enrolled. Median age was 29.4 (range 21-37)years; most patients were stage IIA (86%), had mediastinal bulky disease (78%) and > 3 nodal sites involved; thus these patients were recorded to have a not favourable condition. Abortion was refused when proposed. All patients received combined chemotherapy: ABVD) ( adryamicin, bleomycin, vinblastine and dacarbazine), even during first trimester, at standar doses and schedules. Radiotherapy, when necessary was administered after delivery in 39 patients. No obstetrical complications were observed. Delivery ocurred between 31 to 36 weks in 10 patients (22%) and > 37 weeks in 34 cases (77%). Four newborns were low-weight: 2012 (median) (range:1750 -2350) g. No clinical malformations were observed and development of children were normal without evidence of cardiac, neurological damage. Behavior, scholar attendance and intellegence tests were normal. With a median follow-up of 120.4 (range 48-299) months, progression-free survival and overall survival were 93% and 95 %, respectively.Conclusion: Chemotherapy as initial therapy appear to be thes best therapeutic approach in these setting of patients, with a excelent outcome to both: mother and children. If radiotherapy is necessary, could be administered after delivery
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Enomoto, Sayako, Kosuke Yoshihara, Eiji Kondo, Akiko Iwata, Mamoru Tanaka, Tsutomu Tabata, Yoshiki Kudo, et al. "Trends in Pregnancy-Associated Cervical Cancer in Japan between 2012 and 2017: A Multicenter Survey." Cancers 14, no. 13 (June 23, 2022): 3072. http://dx.doi.org/10.3390/cancers14133072.
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Large-scale data on maternal and neonatal outcomes of pregnancy-associated cervical cancer in Japan are scarce, and treatment strategies have not been established. This multicenter retrospective observational study investigated clinical features and trends in pregnancy-associated cervical cancer treatments at 523 hospitals in Japan. We included cervical cancer cases that were histologically diagnosed (between 1 January 2012, and 31 December 2017), and their clinical information was retrospectively collected. Of 40 patients diagnosed with pregnancy-associated cervical cancer at ≥22 gestational weeks, 34 (85.0%) were carefully followed until delivery without intervention. Of 163 diagnosed at <22 gestational weeks, 111 continued and 52 terminated their pregnancy. Ninety patients with stage IB1 disease had various treatment options, including termination of pregnancy. The 59 stage IB1 patients who continued their pregnancy were categorized by the primary treatment into strict follow-up, conization, trachelectomy, and neoadjuvant chemotherapy groups, with no significant differences in progression-free or overall survival. The birth weight percentile at delivery was smaller in the neoadjuvant chemotherapy group than in the strict follow-up group (p = 0.029). Full-term delivery rate was relatively higher in the trachelectomy group (35%) than in the other groups. Treatment decisions for pregnancy-associated cervical cancer are needed after estimating the stage, considering both maternal and fetal benefits.
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Griffiths, Meaghan J., Amy L. Winship, and Karla J. Hutt. "Do cancer therapies damage the uterus and compromise fertility?" Human Reproduction Update 26, no. 2 (December 20, 2019): 161–73. http://dx.doi.org/10.1093/humupd/dmz041.
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Abstract BACKGROUND As cancer survival rates improve, understanding and preventing the adverse off-target and long-term impacts of cancer treatments, including impacts on fertility, have become increasingly important. Cancer therapy-mediated damage to the ovary and depletion of the primordial follicle reserve are well characterised. However, our knowledge of the full extent of damage to the rest of the female reproductive tract, in particular the uterus, is limited. OBJECTIVE AND RATIONALE Improving our understanding of the off-target effects of cancer therapies on the entire female reproductive tract is a critical step towards developing truly effective strategies to protect the fertility of cancer survivors. The objective of this narrative review was to critically evaluate the available literature regarding the capacity for the uterus to sustain a healthy pregnancy following exposure to radiotherapy or chemotherapy. SEARCH METHODS The authors performed PubMed (Medline) searches using the following key words: uterus, cancer survivors, radiotherapy, chemotherapy, pregnancy outcome, fertility preservation, infertility. There were no limits placed on time of publication. OUTCOMES Overall, there were major limitations to the current available literature, meaning that interpretations should be taken with caution. Despite these drawbacks, data suggest that the uterus may sustain off-target damage, with the extent of damage dependent on the type of cancer treatment and patient age. Specifically, uterine growth is stunted and resistant to hormone replacement therapy in prepubertal girls receiving abdominal, pelvic or whole-body radiotherapy. In contrast, females treated with radiotherapy post-puberty can benefit from hormone replacement therapy, as demonstrated by increased uterine volume and function. No live births have been reported in women previously exposed to radiotherapy after transplantation of cryopreserved ovarian tissue, even when menstruation returns. However, this technique has proven to be a successful fertility preservation method for women previously treated with chemotherapy. Obstetricians commonly report that women who maintain sufficient ovarian function can achieve pregnancy naturally following radiotherapy, but they have thin and/or fibrotic myometrium at delivery, compromising safe delivery and subsequent pregnancy. Furthermore, women exposed to either radiotherapy or chemotherapy have a higher prevalence of preterm birth and low birth weight infants, even in those with normal ovarian function or when oocyte donation is utilised. The mechanisms of potential uterine damage are poorly understood. While the myometrium, vasculature and endometrial progenitor cells are possibly targets, further studies are clearly required and well-controlled animal models could provide the best avenue for these types of future investigations. WIDER IMPLICATIONS Female cancer survivors experience greater rates of early pregnancy loss and complications, suggesting that cancer therapy-induced damage to the uterus contributes to infertility. Despite clinical reports dating back to 1989, we highlight a surprising lack of detail in the literature regarding the precise nature and extent of off-target damage inflicted to the uterus in response to cancer therapies. Young women requiring cancer treatment, and the clinicians treating them, must be equipped with accurate information to aid informed decision-making regarding cancer treatment regimens as well as the development and use of effective fertility preservation measures. As the current literature on the impacts of cancer treatments is limited, we hope that our narrative review on this subject will stimulate more research in this important field.
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Khatun, Shahla, Farzana Deeba, ABM Muksudul Alam, Roksana Ivy, and Farhana Parveen. "Fertility-sparing Surgery (FSS) in Epithelial Ovarian Cancer (EOC): A Case Report." Bangladesh Journal of Obstetrics & Gynaecology 35, no. 1 (March 31, 2020): 46–48. http://dx.doi.org/10.3329/bjog.v35i1.58264.
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Background: Epithelial ovarian cancer is the most common and lethal ovarian cancer. Now a days Fertility preservation is an important issue because of the constant shifting of childbearing age towards higher ages. The increasing incidence of epithelial ovarian cancer in women with active childbearing potential constitutes a therapeutic dilemma. Fertility sparing techniques are being increasingly incorporated in the therapeutic strategies in early stages of the disease. Established organ-preserving techniques in early stage epithelial ovarian cancer includes preservation of the contralateral ovary and uterus.
Aim: To report the case of a Epithelial Ovarian Cancer, who had conservative surgery followed by chemotherapy with a good fertility outcome.
Case presentation: A 31-year-old nulliparous woman with a right sided ovarian mucinous cystadenocarcinoma was treated by right adnexectomy and omentectomy followed by chemotherapy. A 3years follow-up showed no signs of relapse, and she completed a fullterm natural pregnancy which was delivered by caesarean section.
Conclusion: Fertility sparing surgery in early stage Epithelial Ovarian Cancer has good prognosis. However, due to the rarity of the disease in early stages, the fertility outcome of this group of patients has not been established.
Bangladesh J Obstet Gynaecol, 2020; Vol. 35(1): 46-48
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Chatbi, Zaineb, Saloua Sarsar, Hafsa Taheri, Hanane Saadi, and Ahmed Mimoni. "Pregnancy related breast cancer: report of three cases." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 4 (March 24, 2021): 1678. http://dx.doi.org/10.18203/2320-1770.ijrcog20211157.
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Pregnancy-related breast cancer is defined as breast cancer diagnosed during pregnancy or within a year after delivery. In current report, 3 cases of breast cancer, diagnosed during pregnancy are presented. Different diagnostic challenges, different therapeutic methods and major influences of breast cancer on obstetrical outcomes are also discussed in current report. In current case series, the three patients had ages of 36, 40 and 44 years old. They were all diagnosed as having breast cancer during pregnancy. Diagnosis was achieved using imaging, and histopathology through breast biopsy. The histological type was not otherwise specified breast cancer in all three cases. Delivery was vaginal in two cases and through caesarean section in one case. Interruption of pregnancy was performed in one case. A bad prognosis was observed in one patient with death after chemotherapy and surgery, and a favourable evolution was observed in the two other cases. The management of this complex entity must be multidisciplinary.
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Pariyar, J. "Gestational trophoblastic disease in Nepalese women managed in B. P. Koirala Memorial Cancer Hospital." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e16570-e16570. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e16570.
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e16570 Background: Gestational trophoblastic disease (GTD) is potentially curable disease. Its incidence varies in different countries with high incidence reported in Japan (2/1000 pregnancies) and Mexico (2.5/1000 pregnancies). No studies have been reported regarding epidemiology, management and outcome of GTD in Nepal. Methods: The study was a descriptive case series. Case records of GTD patients attending B.P. Koirala Memorial Cancer Hospital, Nepal from 2001 to 2007 were analyzed. The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and follow-up. Results: A total of 45 cases of gestational trophoblastic disease (GTD) were received from 26 districts of Nepal. The age of the patients ranged from 16 to 50 years with a mean age of 29.1 years (SD 9.4 years). Out of 45 cases 19 (43%) were of Tibeto-Burmese ethnic group and 15 (33%) belonged to Indo-Aryan ethnic group. There were 17 cases (37.8%) of hydatidiform mole, 6 were invasive mole (13.35%), 4 of persistent gestational trophoblastic tumour (8.8%) and 22 patients (48.8%) of choriocarcinoma. In 7 cases (15.5%) molar pregnancy had occurred in the first conception, another 7 cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. The most common presenting symptom was vaginal bleeding and 26 (57.8%) patients had anaemia. Theca Leuteal cyst was present in 11 (24.5%), 17 (37.8%) cases had lung metastasis, 4 (8.9%) had brain metastasis and another 4 (8.9%) had disseminated disease detecteted radiologically. Among the 45 cases 6 (13.3%) were treated with suction evacuation only; 9 (20%) underwent hysterectomy for uterine perforation, excessive hemorrhage and invasive mole. 28 (62.2%) cases underwent adjuvant chemotherapy among which 12 (26.6%) received single agent chemotherapy and 15 (33.3%) received EMA-CO regimen. Brain irradiation was required in a case with brain metastasis. Five (11.1%) cases with disseminated disease and high WHO risk score left the hospital against medical advice. There were 3 (6.7%) mortalities. 37 (82.1%) cases are in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. No significant financial relationships to disclose.
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Chadwick, Verity L., Georgia Mills, Pietro R. Di Ciaccio, Catherine Tang, Rachel Dear, John Moore, Sam Milliken, et al. "A Minority of Women of Child Bearing Potential Are Tested for Pregnancy before Chemoimmunotherapy: An Australian Cancer Centre Experience." Blood 138, Supplement 1 (November 5, 2021): 4940. http://dx.doi.org/10.1182/blood-2021-154028.
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Abstract Background: Chemotherapy is potentially harmful to the developing foetus and there is limited data on the foetal impact of immunotherapy except for rituximab. Therefore determining pregnancy status prior to initiation of chemo- and or immuno-therapy (CIT) should be standard of care. Repeat screening or testing during and after chemotherapy should be considered as women often cannot tell that they are pregnant due to overlapping symptoms of pregnancy, malignancy and treatment. This is of particular importance in women who are not on effective forms of contraception for personal choice or clinical reasons. Clinicians cannot presume that a patient's pregnancy status has been checked, or rely on any assumptions of abstinence, contraception or infertility based on secondary amenorrhoea. While CIT teratogenicity should be part of the informed consent discussion and it is recommended that pregnancy screening occur prior to CIT, there are no specific guidelines on this or on testing during CIT. It is our institutional standard to document consent using a standard tick box form to confirm a discussion of common and uncommon side effects of treatment, long term and life threating complications and impacts on fertility. Teratogenicity, pregnancy implications or contraception are not specified. We performed a retrospective review to evaluate the uptake of pregnancy screening prior to and during first-line CIT as well as an audit of documentation of contraception counselling in haematological and solid-organ malignancies at a large Australian tertiary cancer centre. Methods: We searched our electronic outpatient medical record database for Women of Child Bearing Potential (WoCBP) who were diagnosed with a malignancy and received outpatient based CIT between May 1 2015 and June 12 2020. WoCBP was defined as women 18-55 years of age with no record of menopause or definitive infertility. We captured patient demographics, disease details and CIT regimen. We collected result of any serum or urine b-HCG pregnancy tests done within 90 days prior to or during CIT administration and if positive, the pregnancy outcome. We captured any documentation regarding contraception prior to or during treatment. Results: A total of 415 WoCBP with a median age of 42 years (range 19-51) were included. The majority of women (79.3%) were treated for solid organ malignancies compared to haematological malignancies (20.7%) (Table 1). Only 17.1% were screened for pregnancy prior to its initiation. The average time between screening and CIT initiation was 19.5 days (range 0-90 days). Given the broad range of regimens and taking into consideration teratogenicity potential, CIT was categorised as immunotherapy alone (32.5%), chemotherapy containing an alkylating agent (25.8%) or an antimetabolite (3.9%), combination chemoimmunotherapy (15.2%) and other (22.7%). Rates of pregnancy screening within these categories is represented in Figure 1. One patient with early breast cancer had a positive pregnancy test during her 4 th cycle of adjuvant chemotherapy with paclitaxel, in the emergency department for a presentation of nausea, anorexia, abdominal pain and diarrhoea. The outcome in this case was an early spontaneous miscarriage estimated at 3-4 weeks gestation. This is the only patient who had a pregnancy test beyond the first cycle of CIT. Only 14.8% of patients had documentation of past or present contraception methods. None of the patients had documentation regarding counselling on recommended forms of contraception. Conclusion: A minority of WoCBP received a pregnancy test prior to commencing CIT for haematological or solid organ malignancy, and none intentionally received a test prior to subsequent chemotherapy cycles through the oncology/haematology service. Also none of the women had documented counselling on contraception. These results are concerning because missing a positive pregnancy test puts women at risk of foetal complications, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. Our results are consistent with the 2 other reports on this topic and are likely generalizable to other cancer centres. This highlights the urgent need for guidelines to increase the rate of pregnancy testing in WoCBP receiving CIT and contraception counselling prior to CIT. Figure 1 Figure 1. Disclosures Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
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Hariprasad, R., K. Ganessan, A. Gupta, L. Kumar, S. Kumar, N. Bhatla, A. Kriplani, and V. Kochupillai. "Gestational trophoblastic disease: Experience at a tertiary care center from a developing country." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 16041. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.16041.
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16041 Background: We retrospectively analyzed case records of patients diagnosed to have Gestational Trophoblastic Disease (GTD) to determine clinical characteristics, risk groups, treatment outcome, and reproductive function post treatment. Methods: Between Jan 1991 to Dec 2005, 102 patients (mean age: 28.2 years, range 19–50) were diagnosed to have GTD. 35 patients were nulliparous and 8 had prior molar pregnancy. Vaginal bleeding was the most common presenting symptom (77.5%). The antecedent pregnancy was vesicular mole in 50%, abortion - 34.3%, ectopic pregnancy - 4% and term pregnancy in 11.8% patients. The mean value of B hCG was 1225386 mIU/ml. The histopathology (n=85) was complete mole in 30, partial mole - 28, invasive mole- 9, PSTT -1 and choriocarcinoma in 17 patients. 68(66.7%) patients had non-metastatic disease. Sites of metastasis were - lung (38.2%), vagina (11%), brain (8.8%), liver (6.9%) and kidney, Urinary bladder and peritoneum in one patient each. According to modified WHO risk scoring - 78(76.5% had low risk and 24 (23.5%) were high risk. Results: Eighty-seven (85.3%) patients received chemotherapy using methotrexate with leucovorin (n=63), EMA/CO (n=19) and BEP (n=5). 77/87 (89.5%) achieved complete remission (CR) ; the response rate was higher in non-metastatic GTD (p<0.05). Two of 7(28.6%) patients with liver and 5/9 (55,6%) of brain metastasis achieved CR. Two patients had grade III oral mucositis and diarrhoea with methotrexate. One patient died of Methotrexate hypersensitivity. 19 patients received second line chemotherapy using EMA/CO (n=11), EMA/EP (n=2), BEP (n=1), actinomycin-D (n=1) and MAC (methotrexate, actinomycin D and Cyclophosphamide) n=1; 14 patients achieved CR. At a mean follow up of 180 months, 5-year survival for patients with low risk is 100% and that of high risk is 95%. Eight patients had recurrent disease including recurrent molar pregnancy in four. 16 patients had 24 successful deliveries after completion of treatment and 10 of them were primiparae. No fetal abnormalities were found. We did not observe second malignancy or other therapy related sequele. Conclusions: Present study confirms excellent outcome for patients with gestational trophoblastic disease. The potential for childbearing is well maintained. No significant financial relationships to disclose.
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Green, Daniel M., Jane M. Lange, Eve M. Peabody, Natalia N. Grigorieva, Susan M. Peterson, John A. Kalapurakal, and Norman E. Breslow. "Pregnancy Outcome After Treatment for Wilms Tumor: A Report From the National Wilms Tumor Long-Term Follow-Up Study." Journal of Clinical Oncology 28, no. 17 (June 10, 2010): 2824–30. http://dx.doi.org/10.1200/jco.2009.27.2922.
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Purpose This study was undertaken to evaluate the effect of prior treatment with radiation therapy or chemotherapy for unilateral Wilms tumor (WT) diagnosed during childhood on pregnancy complications, birth weight, and the frequency of congenital malformations in live-born offspring. Patients and Methods We reviewed pregnancy outcomes among female survivors and partners of male survivors of WT treated on National Wilms Tumor Studies 1, 2, 3, and 4 by using a maternal questionnaire and a review of both maternal and offspring medical records. Results We received reports of 1,021 pregnancies with duration of 20 weeks or longer, including 955 live-born singletons, for whom 700 sets of maternal and offspring medical records were reviewed. Rates of hypertension complicating pregnancy (International Classification of Diseases [ICD] code 642), early or threatened labor (ICD-644) and malposition of the fetus (ICD-652) increased with increasing radiation dose in female patients. The percentages of offspring weighing less than 2,500 g at birth and of those having less than 37 weeks of gestation also increased with dose. There was no significant trend with radiation dose in the number of congenital anomalies recorded in offspring of female patients. Conclusion Women who receive flank radiation therapy as part of the treatment for unilateral WT are at increased risk of hypertension complicating pregnancy, fetal malposition, and premature labor. The offspring of these women are at risk for low birth weight and premature (ie, < 37 weeks gestation) birth. These risks must be considered in the obstetrical management of female survivors of WT.
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Pariyar, Jitendra, B. Shrestha, J. Shrestha, J. Shrestha, BP Rauniyar, and SC Regmi. "Gestational Trophoblastic Disease: Review of Cases Managed at B P Koirala Memorial Cancer Hospital." Nepal Journal of Obstetrics and Gynaecology 8, no. 1 (October 9, 2013): 18–21. http://dx.doi.org/10.3126/njog.v8i1.8855.
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Aims: This study was done to analyze the clinical presentation and management outcomes of gestational trophoblastic disease managed at B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal. Methods: Descriptive study was conducted at B.P. Koirala Memorial Cancer Hospital. Case records of all gestational trophoblastic cases from January 2001 to December 2007 were analyzed regarding clinical details, investigations and treatment outcomes. Results: Forty-five cases of 16 to 50 years (mean 29.1 years) had gestational trophoblastic disease, among which 19 (43%) were of Tibeto- Burmese and 15 (33%) Indo-Aryan ethnic group. Hydatidiform mole, invasive mole and choriocarcinoma were observed in 17 (37.8%), six (13.3%) and 22 (48.8%) cases respectively. In seven cases (15.5%) molar pregnancy had occurred in primigravida, seven cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. Vaginal bleeding was the commonest presentation and 26 (57.8%) cases had anaemia. Eleven (24.5%) cases had theca luteal cyst, 17 (37.8%) had lung metastasis and 4 (8.9%) had brain metastasis. Chemotherapy was administered in 34 (75.5%) cases, among which 15 (33.3%) received single agent and 18 (40%) received multiagent chemotherapy. Hysterectomy was done in nine (20%) cases. Brain irradiation was done in a case with brain metastasis. Five (11.2%) cases with high WHO risk score left the hospital against medical advice. There were three (6.6%) mortalities. Thirty-seven (72.1%) cases were in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 18-21 DOI: http://dx.doi.org/10.3126/njog.v8i1.8855
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Bernardini, Federica, Gabriella Ferrandina, Caterina Ricci, Anna Fagotti, Francesco Fanfani, Anna Franca Cavaliere, Benedetta Gui, Giovanni Scambia, and Rosa De Vincenzo. "Neoadjuvant Chemotherapy in Pregnant Patients with Cervical Cancer: A Monocentric Retrospective Study." Current Oncology 29, no. 8 (August 14, 2022): 5702–14. http://dx.doi.org/10.3390/curroncol29080450.
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Background: To date, little and discordant data still exists on the management of cervical cancer (CC) during pregnancy. In this paper, we report our experience of the treatment of these patients analyzing the oncologic, obstetric, and neonatal outcomes. Methods: Between January 2010 and December 2021, 13 patients were diagnosed with CC during pregnancy. All patients underwent platinum-based neoadjuvant chemotherapy (NACT) and 11/13 patients underwent a cesarean radical hysterectomy (CRH). Results: All 13 patients were diagnosed with squamous-cell carcinoma, FIGO-2018 stage between IB2-IIIC1. The majority of patients had a partial (61.5%) or complete (15.4%) response to NACT. Most patients had a regular course of pregnancy and the obstetric complications observed were gestational diabetes mellitus in 23.1% and IUGR in 15.4% of cases. CRH was performed in the absence of major complications. Only 2 patients (15.4%) had disease recurrence and only 1 patient (7.7%) died of disease. All children are currently healthy. At birth, we observed mainly prematurity-related complications (38.5% respiratory distress syndrome and 7.7% neonatal jaundice) and only a case of congenital malformation (hypospadias). In our pediatric population, we reported a case of malignancy (acute myeloid leukemia). Conclusion: NACT seems to be safe and efficacious in controlling tumor burden during pregnancy. CRH following NACT appears to be feasible, avoiding repeated surgery and treatment delays. This approach is also reasonably safe from a maternal, obstetric, and neonatal point of view.
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Wang, Aihong, Guanyi Cui, Canhui Jin, Ying Wang, and Xiaoyu Tian. "Multicenter research on tumor and pregnancy outcomes in patients with early-stage cervical cancer after fertility-sparing surgery." Journal of International Medical Research 47, no. 7 (May 22, 2019): 2881–89. http://dx.doi.org/10.1177/0300060519845974.
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Objective To investigate tumor and pregnancy outcomes after fertility-sparing surgery for cervical cancer. Methods A total of 83 patients with cervical cancer who received fertility-sparing surgery at 10 gynecologic cancer research centers in Henan Province were enrolled from January 2010 to June 2016. Clinical data and follow-up results were collected. Of them, 78 had cervical squamous carcinoma and five had cervical adenocarcinoma. International Federation of Gynecology and Obstetrics (2009) staging showed that 26 patients had stage IA1, 11 had stage IA2, and 46 had stage IBI. Seventy-two patients underwent radical trachelectomy and retroperitoneal lymphadenectomy, whereas 11 underwent subradical trachelectomy and retroperitoneal lymphadenectomy. Moreover, 17 patients received one to two courses of preoperative neoadjuvant chemotherapy and five received two to four courses of postoperative chemotherapy. Eighty-three patients were followed up postoperatively (median follow-up duration, 36.2 months). Results With regard to tumor outcomes, one (1.2%) patient showed recurrence following fertility-sparing surgery. In 69 patients with planned pregnancy after treatment, 54 had 58 pregnancies, including 42 full-term births and eight premature births. Seventy-nine patients were satisfied with their quality of life. Conclusions Radical/subradical trachelectomy is safe and effective as fertility-sparing surgery for young patients with early cervical cancer, with good pregnancy outcomes.
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Cardonick, Elyce, Dzhamala Gilmandyar, and Robert A. Somer. "Maternal and Neonatal Outcomes of Dose-Dense Chemotherapy for Breast Cancer in Pregnancy." Obstetrics & Gynecology 120, no. 6 (December 2012): 1267–72. http://dx.doi.org/10.1097/aog.0b013e31826c32d9.
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Saura, Cristina, Olga Sánchez, Sandra Martínez, Carmen Domínguez, Rodrigo Dienstmann, Fiorella Ruíz-Pace, Maria Concepció Céspedes, et al. "Evolution of Angiogenic Factors in Pregnant Patients with Breast Cancer Treated with Chemotherapy." Cancers 13, no. 4 (February 23, 2021): 923. http://dx.doi.org/10.3390/cancers13040923.
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High prevalence of placental-derived complications, such as preeclampsia and intrauterine growth restriction, has been reported in women with breast cancer (BC) treated with chemotherapy during pregnancy (PBC-CHT). Aim: To ascertain whether PBC-CHT is associated with an imbalance of angiogenic factors, surrogate markers for placental insufficiency, that could explain perinatal outcomes. Methods: Prospective study between 2012 and 2016 in a single institution. Soluble fms-like tyrosine kinase (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng) in maternal blood were assessed throughout pregnancy in 12 women with BC and 215 controls. Results: Cancer patients were treated with doxorubicin-based regimes and with taxanes. Ten PBC-CHT (83%) developed obstetrical complications. At the end of the third trimester, significantly higher levels of sFlt-1; sFlt-1/PGF ratio, and sEng levels were observed in BC women as compared to controls. Moreover; there was a significant correlation between plasma levels of sFlt-1 and the number of chemotherapy cycles administered. Besides, more chemotherapy cycles correlated with lower birthweight and head circumference at birth. Conclusions: Women with BC treated during pregnancy showed an antiangiogenic state compatible with placental insufficiency. Angiogenic factors could be useful in the clinical obstetric management of these patients; although further studies will be required to guide clinical decision-making.
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Poggio, Francesca, Marco Tagliamento, Chiara Pirrone, Davide Soldato, Benedetta Conte, Chiara Molinelli, Maurizio Cosso, Piero Fregatti, Lucia Del Mastro, and Matteo Lambertini. "Update on the Management of Breast Cancer during Pregnancy." Cancers 12, no. 12 (December 3, 2020): 3616. http://dx.doi.org/10.3390/cancers12123616.
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The diagnosis of breast cancer during pregnancy represents a challenging situation for the patient, her caregivers and physicians. Pregnancy adds complexity to oncological treatment planning, as many therapies can be potentially dangerous to the fetus. Therefore, a multidisciplinary approach is needed to offer a proper care for obtaining the best possible outcomes for the mother and the future child. Breast surgery is feasible throughout the pregnancy while radiotherapy should be postponed after delivery. Administration of chemotherapy is considered safe and can be given during the second and third trimesters, while it is contraindicated in the first trimester due to the high risk of fetal malformations. Endocrine therapy and targeted agents are not recommended during the whole pregnancy period; however, limited data are available on the use of the majority of new anticancer drugs in this context. The aim of the current review is to provide an update on the current state of art about the management of women diagnosed with breast cancer during pregnancy.
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Warr, D., J. C. Street, and A. D. Carides. "Can prognostic factors identify women receiving anthracycline plus cyclophosphamide-based chemotherapy (MEC) who do not require an NK1 receptor antagonist?" Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e20502-e20502. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20502.
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e20502 Background: Age, alcohol use, and history of sickness associated with pregnancy or motion have been identified as risk factors for chemotherapy-induced emesis. This post hoc analysis addressed two questions: 1) Can prognostic factors identify a low risk group for whom ondansetron (OND) plus dexamethasone [D] alone provide a high level of protection (≥80% no emesis)? 2) Does the NK1 receptor antagonist aprepitant improve antiemetic outcome regardless of emetic risk? Methods: The analysis was based upon outcomes in patients with breast cancer enrolled in a Phase III double-blind, placebo-controlled trial randomized to Day 1 OND 8 mg and D 20 mg before chemotherapy and OND 8 hours later and OND 8 mg bid Days 2–3 vs. Day 1 aprepitant 125 mg PO, OND 8 mg, and D 12 mg before chemotherapy and OND 8 mg 8 hours later and aprepitant 80 mg PO qd Days 2–3. Multivariate logistic regression models were used to assess the impact on emesis of the regimen with aprepitant, and previously reported risk factors, including age (<55 and ≥55 years), ethanol use (0–4 or ≥5 drinks/week), history of pregnancy-related morning sickness, and history of motion sickness, using a modified intent-to-treat approach. Results: 856 patients were assessed for efficacy. Treatment with aprepitant (p<0.0001), older age (p=0.006), ethanol use (p=0.0048), and no history of morning sickness (p=0.0007) were all significantly associated with reduced likelihood of emesis; motion sickness was not a risk factor. The Table below shows the probability of no emesis associated with the presence of 0, 1, 2, or all of these factors in the aprepitant and active control arms. Conclusions: 1) The low-risk group identified by this analysis is of questionable utility because it comprised less than 3% of patients. 2) We could not confirm that motion sickness was a significant risk factor. 3) Aprepitant improved the control of emesis irrespective of the number of risk factors for emesis. [Table: see text] [Table: see text]
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Blagden, S. P., M. A. Foskett, R. A. Fisher, D. Short, S. Fuller, E. S. Newlands, and M. J. Seckl. "The effect of early pregnancy following chemotherapy on disease relapse and foetal outcome in women treated for gestational trophoblastic tumours." British Journal of Cancer 86, no. 1 (January 2002): 26–30. http://dx.doi.org/10.1038/sj.bjc.6600041.
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