Locally Advanced Cervical Cancer in Pregnancy: Overcoming the Challenge. A Case Series and Review of the Literature

Ricci, Caterina; Scambia, Giovanni; Vincenzo, Rosa De

doi:10.1097/igc.0000000000000795

Cited by 24 publications

(21 citation statements)

References 41 publications

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“…After subsequent review of the remaining 49 articles, 12 were excluded due to the type of articles: 10 were reviews and the other 2 were books. In the end, 37 papers remained 2,17–52. In order to gather more publications, additional searches on the reference lists of these 37 papers were also performed.…”

Section: Resultsmentioning

confidence: 99%

“…It should be noted that the extent of cancer development may exceed the controllable areas of surgery when NACT is inefficient during pregnancy. In this study, two cases were initially treated with chemotherapy at gestational ages of 1317 and 1046 weeks, and negative response to chemotherapy was obtained in one of the two women after a week following the first cycle treatment of cisplatin. Therefore, radical hysterectomy and pelvic lymph-node dissection were performed at 2 weeks after chemotherapy, resulting in no live birth for this patient 46.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis

Song¹,

Liu²,

Lin³

et al. 2018

DDDT

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PurposeTo evaluate the efficacy and safety of neoadjuvant platinum-based chemotherapy during pregnancy in women with cervical cancer.MethodsThe PubMed, Embase, and Cochrane Library databases were fully searched to find eligible studies regarding platinum use during pregnancy in women with cervical cancer from January 1980 to September 2018. Data were extracted from the selected studies independently by two authors. Descriptive statistics were calculated for categorical data (frequency and percentage) and numeration data (mean and SD for normally distributed data and median and range for abnormally distributed data). Survival analyses were performed using Kaplan–Meier survival curves and log-rank tests to estimate overall survival and progression-free survival for all patients.ResultsA total of 39 studies including 88 cervical cancer patients with platinum administration during pregnancy were selected in this meta-analysis, and 64 women provided International Federation of Gynecology and Obstetrics stage information. Among the latter, 56 of 64 (87.5%) were diagnosed with early stages (I and IIA) and the remaining 8 of 64 (12.5%) had advanced stages (IIB, III, and IV). In relation to cisplatin, 86 pregnant women were identified, whereas only 2 pregnant women with carboplatin application were retrieved. Overall, 88 newborns were delivered from 84 pregnancies, including two sets of twins and one set of triplets, among which 71 neonates (71 of 88, 80.7%) were completely healthy at birth. All children were healthy at the end of follow-up (median 17 months, range 0–149.5 months), except one who was diagnosed with retroperitoneal embryonal rhabdomyosarcoma at 5 years old and one who had acute myeloid leukemia at 22 months of age. At the end of follow-up (range 4.75–156 months), 16 of 81 (19.8%) patients were diagnosed with recurrence of cervical cancer, and 11 (90%) of those died because of cancer relapse. Neither median overall survival nor median progression-free survival were reached.ConclusionOur results demonstrated that neoadjuvant platinum-based chemotherapy could be a favorable choice for the management of patients with cervical cancer during the second and third trimesters. To reduce the side effects of chemotherapy, cisplatin might be good to use as monotherapy in these patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis

Song¹,

Liu²,

Lin³

et al. 2018

DDDT

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“…Chemotherapy exposure after the first trimester showed comparable effects on the fetal malformations compared with the general population [9][10][11][12][13][14][15]. Generally, chemotherapy is feasible after 14 weeks of gestation, which is not suggested beyond 35 weeks because a 3week-window between the last cycle of chemotherapy and delivery is of significance for the recovery of maternal and fetal marrow [2].…”

Section: Discussionmentioning

confidence: 99%

A case of successful maintained pregnancy after neoadjuvant chemotherapy plus radical surgery for stage IB3 cervical cancer diagnosed at 13 weeks

Guo

Zhang

et al. 2020

BMC Pregnancy Childbirth

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Background: Cervical cancer during pregnancy is rare. The management for stage IB3 during pregnancy remains unclear and challenging. We report a successful preserved pregnancy in a stage IB3 patient who was treated with neoadjuvant chemotherapy (NACT) plus radical surgery. Case presentation: A 36-year-old pregnant woman was diagnosed with a 5-cm-diameter stage IB3 squamous cell carcinoma of the uterine cervix at 13 gestational weeks. The patient received 5 courses of systemic chemotherapy with carboplatin and paclitaxel every 3 weeks, followed by caesarean section and radical hysterectomy. Both the mother and infant are in good general condition. Conclusion: This case suggests that NACT plus radical surgery could be one method to maintain pregnancy in stage IB3 cervical cancer diagnosed as early as 13 gestational weeks.

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“…Other cases reported cervical cancer occurring during the last trimester of pregnancy, albeit with different stages of disease; these include 7 cases, stage IB1 to IB2, which were treated either by cesarean section with surgery in the same time before chemoradiation therapy [12,13], or by neoadjuvant chemotherapy before surgery and adjuvant treatment [10,11,14,15]. Finally, three cases reported stage IIA cervical cancer during the first trimester of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Invasive cervical cancer diagnosed in an 8-month pregnant woman: a case report

Leproux¹,

Awazu²,

Boughalem³

et al. 2020

J. Mol. Clin. Med.

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Gynecologic and skin cancers are those most frequently encountered during pregnancy. Cervical cancer during pregnancy is rare, and concerns remain about its management. We report the case of a 33 years-old women, in whom an invasive stage IIA cervical cancer was diagnosed during her eighth month of pregnancy. At 36 weeks of gestation, a caesarian section was realized. After nodal staging surgery without para-aortic lymphadenectomy, adjunctive chemoradiation therapy was initiated. Thereafter, facing tumor progression, hysterectomy or brachytherapy was no longer possible due to extensive cervix necrosis. The patient died 15 months after the diagnosis of cervical cancer. Knowledge is limited regarding cervical cancer management during pregnancy. A more aggressive therapeutic approach may be considered with radical hysterectomy, brachytherapy and lymphadenectomy.

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Locally Advanced Cervical Cancer in Pregnancy: Overcoming the Challenge. A Case Series and Review of the Literature

Abstract: Even if there are no standardized practices in the treatment of cervical cancer in pregnancy, in our opinion, neoadjuvant chemotherapy can be a very useful strategy for patients and physicians facing the challenge.

Cited by 24 publications

References 41 publications

Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis

Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis

A case of successful maintained pregnancy after neoadjuvant chemotherapy plus radical surgery for stage IB3 cervical cancer diagnosed at 13 weeks

Invasive cervical cancer diagnosed in an 8-month pregnant woman: a case report

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