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Review Articles
Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting
  1. Frédéric Amant, MD, PhD*,
  2. Michael J. Halaska, MD, PhD†,
  3. Monica Fumagalli, MD‡,
  4. Karina Dahl Steffensen, MD§,
  5. Christianne Lok, MD, PhD∥,
  6. Kristel Van Calsteren, MD, PhD,
  7. Sileny N. Han, MD*,
  8. Olivier Mir, MD#,
  9. Robert Fruscio, MD, PhD**,
  10. Cathérine Uzan, MD, PhD†,‡,
  11. Cynthia Maxwell, MD†,‡,
  12. Jana Dekrem, MSc*,
  13. Goedele Strauven, MSc*,
  14. Mina Mhallem Gziri, MD, PhD*,
  15. Vesna Kesic, MD, PhD§§,
  16. Paul Berveiller, MD, PhD∥∥,
  17. Frank van den Heuvel, MD, PhD¶¶,
  18. Petronella B. Ottevanger, MD, PhD##,
  19. Ignace Vergote, MD, PhD*,
  20. Michael Lishner, MD, PhD***,
  21. Philippe Morice, MD, PhD†,‡ and
  22. Irena Nulman, MD, PhD†††
  1. *Department of Oncology, Katholieke Universiteit Leuven and Gynecologic Oncology, University Hospitals Leuven, Belgium;
  2. †Gynecologic Oncology, 2nd Medical Faculty, Charles University, Prague, Czech Republic;
  3. ‡Neonatal Intensive Care, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;
  4. §Radiotherapy and Clinical Oncology, Vejle Hospital, Vejle, Denmark;
  5. ∥Gynecological Oncology, Center for Gynecological Oncology Amsterdam, Amsterdam, The Netherlands;
  6. Obstetrics, University Hospitals Leuven, Katholieke Universiteit Leuven, Belgium;
  7. #Medical Oncology, Cochin Teaching Hospital, Paris Descartes University, Paris, France;
  8. **Obstetrics and Gynecology, Ospedale San Gerardo, Monza, Italy;
  9. ††Gynecologic Surgery, Institute de Cancérologie Gustave Roussy, Villejuif, France;
  10. ‡‡Maternal Fetal Medicine Unit, Mt Sinai Hospital, Toronto, Ontario, Canada;
  11. §§Obstetrics and Gynecology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia;
  12. ∥∥Department of Gynecology and Obstetrics, Hôpital Trousseau, Assistance-Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France;
  13. ¶¶Radiation Oncology, University Hospitals Leuven, Katholieke Universiteit Leuven, Belgium;
  14. ##Medical Oncology, Radboudziekenhuis, Nijmegen, The Netherlands;
  15. ***Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; and
  16. †††Clinical Pharmacology and Toxicology, Motherisk Program, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
  1. Address correspondence and reprint requests to Frédéric Amant, MD, PhD, Department of Oncology, Katholieke Universiteit Leuven and Gynecologic Oncology, University Hospitals Leuven, Belgium. E-mail: Frederic.amant{at}uzleuven.be.

Abstract

Objectives This study aimed to provide timely and effective guidance for pregnant women and health care providers to optimize maternal treatment and fetal protection and to promote effective management of the mother, fetus, and neonate when administering potentially teratogenic medications. New insights and more experience were gained since the first consensus meeting 5 years ago.

Methods Members of the European Society of Gynecological Oncology task force “Cancer in Pregnancy” in concert with other international experts reviewed the existing literature on their respective areas of expertise. The summaries were subsequently merged into a complete article that served as a basis for discussion during the consensus meeting. All participants approved the final article.

Results In the experts’ view, cancer can be successfully treated during pregnancy in collaboration with a multidisciplinary team, optimizing maternal treatment while considering fetal safety. To maximize the maternal outcome, cancer treatment should follow a standard treatment protocol as for nonpregnant patients. Iatrogenic prematurity should be avoided. Individualization of treatment and effective psychologic support is imperative to provide throughout the pregnancy period. Diagnostic procedures, including staging examinations and imaging, such as magnetic resonance imaging and sonography, are preferable. Pelvic surgery, either open or laparoscopic, as part of a treatment protocol, may reveal beneficial outcomes and is preferably performed by experts. Most standard regimens of chemotherapy can be administered from 14 weeks gestational age onward. Apart from cervical and vulvar cancer, as well as important vulvar scarring, the mode of delivery is determined by the obstetrician. Term delivery is aimed for. Breast-feeding should be considered based on individual drug safety and neonatologist–breast-feeding expert’s consult.

Conclusions Despite limited evidence-based information, cancer treatment during pregnancy can succeed. State-of-the-art treatment should be provided for this vulnerable population to preserve maternal and fetal prognosis.

Supplementary Information Supplementary data on teratogenic effects, ionizing examinations, sentinel lymph node biopsy, tumor markers during pregnancy, as well as additional references and tables are available at the extended online version of this consensus article, go to http://links.lww.com/IGC/A197.

  • Cancer
  • Pregnancy
  • Chemotherapy
  • Consensus
  • Gynecologic

https://doi.org/10.1097/IGC.0000000000000062

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    Footnotes

    • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).

    • The authors declare no conflicts of interest.