Patterns of Interaction Between Diffuse Low-Grade Glioma and Pregnancy: An Institutional Case Series

Kavouridis, Vasileios K.; Calvachi, Paola; Cho, Charles H.; Smith, Timothy R.

doi:10.1016/j.wneu.2021.02.136

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…Yet, only few cases of malignant transformation have been described. 8,9,20,21 Here, a contrast enhancement occurred in 3 patients, with 2 patients dying within 2 years after delivery despite adjuvant treatment. Overall, 7 patients (43.7%) died at a median time from delivery of 3.9 years (range 1.25-5.9 years) with an OS of 5.75 years.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, even if still debated, several series have suggested that pregnancy might facilitate glioma progression and early clinical deterioration (see elsewhere 5 for a recent systematic review). Beyond the fact that these studies were retrospective, however, they combined GIIG and high-grade gliomas, 6,7 mixed patients pregnant at diagnosis and after diagnosis, [6][7][8] included previously treated and untreated patients, [9][10][11] or did not detail the long-term follow-up after delivery. 12 Here, we report a consecutive and homogeneous series of women who have been pregnant after surgical resection of a GIIG with stable disease (i.e., no or slow growth of the tumor, no contrast enhancement, controlled epilepsy) before pregnancy and without ongoing oncologic treatment.…”

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Factors Associated With Long-term Survival in Women Who Get Pregnant After Surgery for WHO Grade II Glioma

Duffau

2022

Neurology

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Background and Objectives:Women with a WHO grade II glioma (GIIG) often question clinicians on the effects of pregnancy on their disease. Previous reports have indicated a higher risk of glioma progression during and after pregnancy. Here, the aim was to investigate post-pregnancy outcomes and predictive factors impacting overall survival in female patients who underwent GIIG surgery.Methods:Inclusion criteria were adult women who have been pregnant after a GIIG resection and with a stable oncological status at the time of pregnancy (no ongoing oncological treatment, no contrast enhancement, no debilitating clinical condition). Relevant cases were identified from a databank (1998-2021) of patients who underwent surgical resection for a histologically-confirmed GIIG in our department.Results:Among 345 GIIG women within their reproductive years (age<45y), 16 patients (4.6%, mean age at delivery: 30.9±5.1 years) were pregnant (twice in 5 cases). The mean interval between the last oncological treatment (surgery alone in 11 patients while followed by chemotherapy and/or radiotherapy in 5 patients) and pregnancy was 3.5 years (range 0.75-10 years). Two patients experienced seizures during pregnancy. The delivery was vaginal and uneventful in all cases but one (1 caesarean). All children had normal mental and physical development. The glioma behavior changed in 7 patients (43.7%), with an acceleration of the velocity of diameter expansion (VDE) and/or the occurrence of a contrast enhancement during or within the 3 months after pregnancy, resulting in medical treatment and/or reoperation in the early post-partum period in 7 cases. The median clinical follow-up from delivery was 5.3 years (range 1.25-11.6 years). Four other patients received delayed adjuvant therapy for glioma progression. Seven patients (43.7%) died at a median time from delivery of 3.9 years (range 1.25-5.9 years). Overall, the median survival from delivery was 5.75 years. Crucially, patients who underwent a complete surgical resection and patients with stable lesions before pregnancy lived longer (log rank, p=0.046 and p=0.0026, respectively).Conclusions:Tumor residual volume and tumor speed growth are strong predictive factors conditioning post-pregnancy long-term survival in patients with GIIG. Identifying patients at risk is critical to provide relevant counsel to GIIG women with a desire for motherhood.

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Section: Discussionmentioning

confidence: 99%