Breast Cancer during Pregnancy: An Interdisciplinary Approach in Our Institution

Pîrvulescu, Cristina; Mau, Christine; Schultz, Holger; Sperfeld, Antje; Renner-Lützkendorf, Heike; Loibl, S.; Freitag, Ulrike; Klühs, Gabriele; Fleige, Barbara; Untch, Michael

doi:10.1159/000341383

Cited by 10 publications

(12 citation statements)

References 13 publications

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“…On the other hand, it is important to mention that very few cases reported long-term follow-ups for the newborns. Regarding the fetal kidney, the treatment in the second and third trimesters leads to oligohydramnios to anhydramnios (incidence up to 61.1%), with the incidence increasing with duration of treatment [61,[68][69][70][71]. These results have been imputed mainly to the inhibitory effect of trastuzumab on HER-2, which is highly expressed on the fetal kidney responsible for the production of amniotic fluid.…”

Section: Biological and Hormonal Treatmentmentioning

confidence: 99%

Current approaches in the clinical management of pregnancy-associated breast cancer—pros and cons

et al. 2018

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Malignancies are one of the leading causes of mortality in women during their reproductive life. Treatment of gynecological malignant tumors during pregnancy is possible but not simple, since it creates a conflict between care of the mother and the fetus. BC is the most prevalent malignancy diagnosed in pregnancy, ranking up to 21% of all pregnancy-related malignancies. Due to its stets increasing prevalence, aggressive cancer subtype, and severe ethical and psychological aspects linked to the disease, experts raise an alarm for an acute necessity to improve the overall management of the PABC-the issue which has strongly motivated our current paper. Comprehensive research data and clinical experience accumulated in recent years have advanced our understanding of the disease complexity. PABC treatment must be individualized with an emphasis on optimal care of the mother, while observing standard treatment protocols with regard to safety of the fetus. Treatment protocols should be elaborated based on the individualized patient profile, bearing in mind the acute danger to the mother, maximizing the therapy efficacy and minimizing harmful effects to the fetus. Complex consulting on treatment options, their impacts on pregnancy and potential teratogenic effects requires tight "doctor-patient" collaboration. Complications that may arise due to the treatment of breast cancer in pregnancy require a multiprofessional expertise including oncologists, neonatologists, perinatologists, obstetricians, teratologists, and toxicologists, and an extensive psychological support throughout the pregnancy and after giving birth. Thereby, specifically psychological aspects of PABC diagnosis and follow-up are frequently neglected, being not yet adequately explored in the entire disease management approach. Herewith, we update the status quo regarding the currently available diagnostic modalities, complex treatment algorithms, and novel clinical approaches which altogether argue for an urgent necessity of a paradigm shift moving away from reactive to predictive, preventive, and personalized medical approach in the overall management of PABC meeting the needs of young populations, persons at high risk, affected patients, and families as the society at large.

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Section: Biological and Hormonal Treatmentmentioning

confidence: 99%

Current approaches in the clinical management of pregnancy-associated breast cancer—pros and cons

et al. 2018

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“…W przypadku konieczności użycia produktów radiofarmaceutycznych u kobiety karmiącej należy poinformować pacjentkę o konieczności przerwania karmienia piersią lub okresowego zaprzestania karmienia z podaniem długości tego okresu. (18,19) . Chemioterapię, wskazaną u pacjentek z niekorzystnymi czynnikami prognostycznymi, uważa się za metodę względnie by NCRP, but corresponds to an annual background radiation dose absorbed by a human.…”

Section: Diagnosis Of Breast Cancer In Pregnancyunclassified

“…Breast-conserving treatment (BCT), which, according to the accepted standards, always requires adjuvant radiation therapy of the breast, may be performed only in the last trimester, which allows to safely delay irradiation until after birth. If systemic treatment is necessary, radiotherapy is introduced 3-6 weeks after its completion (18,19) . Chemotherapy, which is indicated in patients with unfavorable prognostic factors, is considered to be relatively safe in the second and the third trimester.…”

Section: Diagnosis Of Breast Cancer In Pregnancymentioning

confidence: 99%

Diagnosis and treatment of breast cancer in pregnancy

Żyromska

Adamczak-Sobczak

Szablewska

2017

Curr. Gynecol. Oncol.

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Rak piersi współistniejący z ciążą stanowi 10-20% wszystkich nowotworów piersi u kobiet poniżej 30. roku życia. Jego diagnostyka i leczenie wymagają uwzględnienia ryzyka poszczególnych metod postępowania dla zarodka lub płodu. Za badania bezwzględnie przeciwwskazane w ciąży uważa się tomografię komputerową i pozytonową tomografię emisyjną. Standardem leczenia jest zabieg operacyjny: mastektomia radykalna, którą można przeprowadzić na każdym etapie ciąży, lub operacja oszczędzająca pierś, zalecana wyłącznie w III trymestrze. Chemioterapię opartą na doksorubicynie i antracyklinach uważa się za względnie bezpieczną w II i III trymestrze. Przeciwwskazane są: leczenie hormonalne, stosowanie trastuzumabu i bifosfonianów. Szczególne ograniczenia dotyczą stosowania radioterapii. Skutki wewnątrzmacicznej ekspozycji na promieniowanie zależą od okresu ciąży, dawki promieniowania oraz mocy dawki. Narażenie na promieniowanie w okresie preimplantacji może prowadzić do śmierci zarodka lub popromiennej karcynogenezy. W okresie organogenezy istnieje ryzyko opóźnienia wzrostu płodu oraz powstania malformacji narządowych. Ekspozycja na promieniowanie pomiędzy 8. a 25. tygodniem ciąży wiąże się z ryzykiem rozwoju upośledzenia umysłowego, mikrocefalii i karcynogenezy. Powyżej 25. tygodnia ciąży stwarza wyłącznie ryzyko karcynogenezy. Oszacowano, że zastosowanie u kobiet ciężarnych terapeutycznych dawek radioterapii na obszar klatki piersiowej wiąże się z niedopuszczalną ekspozycją płodu na promieniowanie. Jedyną metodą napromieniania dopuszczalną w ciąży, w I i II trymestrze, jest śródoperacyjna radioterapia wiązką elektronową na obszar loży po guzie piersi. Decyzja o podjęciu i kontynuacji leczenia onkologicznego u ciężarnych kobiet powinna być poprzedzona szczegółową analizą potencjalnych korzyści i ryzyka oraz uwzględniać wolę pacjentki. Słowa kluczowe: ciąża, radioterapia, rak piersi, promieniowanie, wytyczne Pregnancy-associated breast cancer accounts for 10-20% of all breast cancers in women under the age of 30 years. The diagnosis and treatment of this type of cancer require an assessment of the risk of different management methods for the embryo or fetus. Computed tomography and positron emission tomography are absolutely contraindicated in pregnancy. Surgical management, i.e. radical mastectomy, which may be performed at any stage of pregnancy, or breast conserving treatment, which is recommended only in the third trimester, is standard treatment. Doxorubicin/anthracycline-based chemotherapy is considered relatively safe in the second and the third trimester. Hormonal treatment, trastuzumab and bisphosphonates are contraindicated. Special restrictions have been introduced for radiation therapy. The consequences of intrauterine exposure to radiation depend on the stage of pregnancy, radiation dose and dose rate. Preimplantation radiation can cause death of the embryo or radiation-induced carcinogenesis. There is a risk of delayed fetal growth and organ malformations in the period of organogenesis. Exposure to radiation betwee...

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“…In case a systemic treatment is needed, RT begins 3–6 weeks after CHTH. Therefore, a sparing surgery (with dissection) is preferably carried out in the second and third trimester of pregnancy [ 19 , 20 ]. In these cases, radiation therapy is performed after birth.…”

Section: Treatment Of Tumours Occurring During Pregnancymentioning

confidence: 99%

Cancer treatment in pregnant women

Basta

Bąk²,

Roszkowski³

2015

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In general, strategies for the treatment of cancer in pregnancy should not differ significantly from the treatment regimens in non-pregnant women. However, this is difficult due to either the effects of anticancer drugs on the developing foetus or the possibility of long-term complications after the exposure to drugs and radiation.The decision about the introduction and continuation of treatment in the event of pregnancy should be preceded by a detailed analysis of the potential benefits and risks. There are no data to suggest that pregnancy termination alters the biological behaviour of the tumour or patient prognosis in the presence of appropriate antineoplastic therapy. All patients should be given appropriate advice and informed that there are insufficient scientific data to determine any generally accepted consensus. It is very important to always respect the will of the patient, and the moral judgment of the physician should have no impact on the decisions taken by the woman. If the woman decides to undergo active treatment and maintain her pregnancy, it is necessary to carry out consultations with experts in the field appropriate to the type of cancer. This paper presents a basic review of the literature on the targeted therapies currently used in selected cancers diagnosed during pregnancy: breast cancer, cervical cancer, Hodgkin's disease, melanoma, thyroid cancer, ovarian cancer, and colorectal cancer.

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Breast Cancer during Pregnancy: An Interdisciplinary Approach in Our Institution

Cited by 10 publications

References 13 publications

Current approaches in the clinical management of pregnancy-associated breast cancer—pros and cons

Current approaches in the clinical management of pregnancy-associated breast cancer—pros and cons

Diagnosis and treatment of breast cancer in pregnancy

Cancer treatment in pregnant women

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