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Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study
  1. Aldo Lopez1,
  2. Juliana Rodriguez2,3,
  3. Erick Estrada4,
  4. Alejandro Aragona5,
  5. Carlos Chavez6,
  6. Karina Amaro7,
  7. Cristiano De Padua8,
  8. Alfredo Borges Garnica9,
  9. Gabriel Rendón10,
  10. Adriana Alméciga2,
  11. Oscar Serrano11,
  12. Santiago Scasso12,
  13. Joel Laufer12,
  14. Diego Greif13,
  15. Fernando Taranto13,
  16. Jorge Hoegl14,
  17. Franco Calderaro di Ruggiero14 and
  18. René Pareja2,15
  1. 1 Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
  2. 2 Department of Gynecology Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
  3. 3 Department of Gynecology and Obstetrics. Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
  4. 4 Department of Gynecology and Obstetrics, Hospital General San Juan de Dios, Guatemala City, Guatemala, Guatemala
  5. 5 Hospital Municipal de Oncologia Marie Curie, Buenos Aires, Federal District, Argentina
  6. 6 Instituto Regional de Enfermedades Neoplásicas (IREN Sur), Arequipa, Peru
  7. 7 Hospital Nacional Cayetano Heredia, Lima, Lima, Peru
  8. 8 Hospital de Câncer de Barretos, Barretos, São Paulo, Brazil
  9. 9 Unidad de Terapia Antineoplásica (UTAN), Centro Médico Guerra Méndez, Valencia, Venezuela, Bolivarian Republic
  10. 10 Department of Gynecologic Oncology, Instituto de Cancerología- Las Américas-AUNA, Medellin, Antioquia, Colombia
  11. 11 Department of Gynecologic Oncology, Hospital Militar Centra, Bogotá, Colombia
  12. 12 Department of Gynecologic Oncology, Hospital Pereira Rossell, Montevideo, Uruguay
  13. 13 Department of Gynecology, Hospital de Clínicas Dr. Manuel Quintela, Universidad de la República, Montevideo, Uruguay
  14. 14 Servicio Oncológico Hospitalario del Instituto Venezolano de los Seguros Sociales, Caracas, Venezuela
  15. 15 Clínica de Oncología Astorga, Universidad Pontificia Bolivariana, Medellin, Colombia
  1. Correspondence to Dr René Pareja, Gynecology and Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Medellin 1234, Colombia; ajerapener{at}gmail.com

Abstract

Objective To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy.

Methods A multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes.

Results Thirty-three patients were included. Median age was 34 years (range 31–36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA–IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34–36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0–36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease.

Conclusion Neoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.

  • cervical cancer

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Footnotes

  • Twitter @mderickestrada, @oncologiahoy, @oncohoegl

  • Contributors AL, JR, RP designed the manuscript. AL, JR, RP, AAr, CC, KA, CDP, AB, GJRP, AAl,OS, SS, JL, DG, FT, JH, FC contributed with cases and checked the databases. EEE, JR analyzed the data. AL, JR, RP, EEE wrote the manuscript. All authors reviewed the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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