Perinatal complications in female survivors of cancer: a systematic review and meta-analysis

Kooi, Anne-Lotte L F van der; Kelsey, Tom; Heuvel‐Eibrink, Marry van den; Laven, Joop; Wallace, William H.; Anderson, Richard A.

doi:10.1016/j.ejca.2019.01.104

Cited by 43 publications

(35 citation statements)

References 46 publications

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“…In addition to primary ovarian insufficiency (POI), female survivors of cancer who are treated with abdominopelvic radiotherapy (AP RT) or total body irradiation (TBI) are at risk of damage to the uterus. This may impact on its function and manifest as infertility or adverse obstetric outcomes including preterm birth (PTB) and low birthweight (LBW), foetal growth restriction (FGR), uterine rupture, stillbirth and pre-eclampsia ( Larsen et al , 2004 ; Signorello et al , 2006 ; Ataman et al , 2016 ; Marklund et al , 2018 ; van de Loo et al , 2019 ; van der Kooi et al , 2019 ). Tumours requiring AP RT include tumours of the rectum, anus, cervix and bladder, desmoid tumours and sarcomas.…”

Section: Introductionmentioning

confidence: 99%

Clinical summary guide: reproduction in women with previous abdominopelvic radiotherapy or total body irradiation

Rozen

Rogers

Chander

et al. 2020

Human Reproduction Open

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STUDY QUESTION What is the evidence to guide the management of women who wish to conceive following abdominopelvic radiotherapy (AP RT) or total body irradiation (TBI)? SUMMARY ANSWER Pregnancy is possible, even following higher doses of post-pubertal uterine radiation exposure; however, it is associated with adverse reproductive sequelae and pregnancies must be managed in a high-risk obstetric unit. WHAT IS KNOWN ALREADY In addition to primary ovarian insufficiency, female survivors who are treated with AP RT and TBI are at risk of damage to the uterus. This may impact on its function and manifest as adverse reproductive sequelae. STUDY DESIGN, SIZE, DURATION A review of the literature was carried out and a multidisciplinary working group provided expert opinion regarding assessment of the uterus and obstetric management. PARTICIPANTS/MATERIALS, SETTING, METHODS Reproductive outcomes for postpubertal women with uterine radiation exposure in the form of AP RT or TBI were reviewed. This included Pubmed listed peer-reviewed publications from 1990 to 2019, and limited to English language.. MAIN RESULTS AND THE ROLE OF CHANCE The prepubertal uterus is much more vulnerable to the effects of radiation than after puberty. Almost all available information about the impact of radiation on the uterus comes from studies of radiation exposure during childhood or adolescence. An uncomplicated pregnancy is possible, even with doses as high as 54 Gy. Therefore, tumour treatment doses alone cannot at present be used to accurately predict uterine damage. LIMITATIONS, REASONS FOR CAUTION Much of the data cannot be readily extrapolated to adult women who have had uterine radiation and the publications concerning adult women treated with AP RT are largely limited to case reports. WIDER IMPLICATIONS OF THE FINDINGS This analysis offers clinical guidance and assists with patient counselling. It is important to include patients who have undergone AP RT or TBI in prospective studies to provide further evidence regarding uterine function, pregnancy outcomes and correlation of imaging with clinical outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study received no funding and there are no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

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Section: Introductionmentioning

confidence: 99%

Clinical summary guide: reproduction in women with previous abdominopelvic radiotherapy or total body irradiation

Rozen

Rogers

Chander

et al. 2020

Human Reproduction Open

View full text Add to dashboard Cite

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“…The high prevalence of PTB is in line with the previous studies. [4][5][6]9 The perinatal outcomes of childhood cancer survivors in Japan reported a high incidence of PTB in pregnancies after radiotherapy. 15 The risk of PTB increases only after high doses of uterine radiation.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8] A recent metaanalysis examined the risks of perinatal complications in female cancer survivors diagnosed before the age of 40 years and reported a two-fold increase in the risk of PTB after radiotherapy with respect to perinatal complications that occur after cancer treatment. 9 Cancer treatment may affect the prospects for pregnancy in the future, and cancer survivors have been reported to be less likely than the general population to become pregnant. 10,11 Nevertheless, many female survivors have the potential to become pregnant.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in children, adolescents, and young adults that survived cancer: A nationwide survey in Japan

Yasuoka

Iwama

Ota

et al. 2021

J of Obstet and Gynaecol

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Aim: Recent advances in cancer treatment have improved the prognosis of child, adolescent, and young adult (CAYA) cancer survivors. This study aimed to examine the current status of pregnancy outcomes among female cancer survivors in Japan. Methods: The first questionnaire was sent to 633 major tertiary institutions certified by the Japan Society of Obstetrics and Gynecology to identify institutions managing cases of pregnant cancer survivors between January 2011 and December 2015. The second questionnaire was sent only to institutions with pregnant cancer survivors during the study period. Results: We analyzed 2242 singleton deliveries of cancer survivors based on the responses received in the second questionnaire (199/255 responses; 78.0%). The three most frequent types of malignant tumors were uterine cervical (23.4%), breast (17.6%), and thyroid cancers (17.5%). Conception was aided by the use of assisted reproductive technology in 17.0% of the patients. The proportions of mothers aged 35-39.9 and ≥ 40 years were 36.5% and 11.8%, respectively. The prevalence of preterm birth (PTB) at <37, <34, and < 32 weeks' gestation were 16.7%, 6.8%, and 4.3%, respectively. The proportion of infants with low birth weight (LBW) was 18.9%. Conclusion:The present study findings suggest that advanced maternal age was common among pregnant cancer survivors and these survivors often gave birth to PTB and LBW infants in Japan. The likelihood of adverse pregnancy outcomes should be considered by healthcare providers when planning counseling and perinatal care for cancer survivors.

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“…29 Similarly, a recent metanalysis has shown a slightly higher risk of congenital abnormalities in babies born from women with prior cancer history; however, this result was considered being likely an artefact of the analysis. 30 In terms of risk of developing pregnancy complications (including abortion, caesarean delivery, postpartum haemorrhage, preterm birth, small for gestational age, low birth weight), a higher risk for post-treatment pregnancies of adult women with prior cancer history has been described, 25 26 30-35 while this has not been shown for male patients and their healthy partners. 25 Notably, off-target effects of chemotherapy and radiotherapy in Figure 1 Proposed algorithm for managing fertility preservation in male and female patients with cancer i .…”

Section: Conceiving After Cancermentioning

confidence: 99%

Section: Conceiving After Cancermentioning

confidence: 99%

Gender-specific aspects related to type of fertility preservation strategies and access to fertility care

et al. 2020

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Survivorship is an area of paramount importance to be addressed as early as possible after cancer diagnosis by all health care providers. On this regard, cancer care in young patients often poses several age-related considerations among which fertility and pregnancy-related issues have a crucial role. According to the available guidelines on the topic, all patients with cancer diagnosed during their reproductive years should be provided a proper oncofertility counselling before starting anticancer treatments. This is an important step in order to inform patients about the potential treatment-induced gonadotoxicity and the available strategies for fertility preservation so that they can be referred as early as possible to fertility specialists if potentially interested in these options.In this manuscript, we aim to provide an up to date overview on the available efficacy and safety data with the main strategies for fertility preservation in male and female cancer patients in order to help optimising the oncofertility counselling performed by healthcare providers involved in cancer care and dealing with young patients. In male patients with cancer, sperm cryopreservation is the standard technique for fertility preservation. Oocyte/embryo cryopreservation, ovarian tissue cryopreservation and temporary ovarian suppression with luteinising hormone-releasing hormone agonists during chemotherapy are the main options in female patients with cancer.A multidisciplinary management building a strong network between fertility and oncology/haematology units is crucial to properly address fertility care in all young patients with cancer, at both diagnosis and during oncologic follow-up. Discussing fertility and pregnancy-related issues with young patients with cancer has to be considered mandatory nowadays keeping in mind that returning to a normal life (including the possibility to have a family and to live with as few side effects as possible) should be considered an important ambition in cancer care in the 21st century .

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Perinatal complications in female survivors of cancer: a systematic review and meta-analysis

Cited by 43 publications

References 46 publications

Clinical summary guide: reproduction in women with previous abdominopelvic radiotherapy or total body irradiation

Clinical summary guide: reproduction in women with previous abdominopelvic radiotherapy or total body irradiation

Pregnancy outcomes in children, adolescents, and young adults that survived cancer: A nationwide survey in Japan

Gender-specific aspects related to type of fertility preservation strategies and access to fertility care

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