Cancer During Pregnancy: An Analysis of 215 Patients Emphasizing the Obstetrical and the Neonatal Outcomes

Abstract

A B S T R A C T PurposeThe aim of this study was to assess the management and the obstetrical and neonatal outcomes of pregnancies complicated by cancer. Patients and MethodsIn an international collaborative setting, patients with invasive cancer diagnosed during pregnancy between 1998 and 2008 were identified. Clinical data regarding the cancer diagnosis and treatment and the obstetric and neonatal outcomes were collected and analyzed. ResultsOf 215 patients, five (2.3%) had a pregnancy that ended in a spontaneous miscarriage and 30 (14.0%) pregnancies were interrupted. Treatment was initiated during pregnancy in 122 (56.7%) patients and postpartum in 58 (27.0%) patients. The most frequently encountered cancer types were breast cancer (46%), hematologic malignancies (18%), and dermatologic malignancies (10%). The mean gestational age at delivery was 36.3 Ϯ 2.9 weeks. Delivery was induced in 71.7% of pregnancies, and 54.2% of children were born preterm. In the group of patients prenatally exposed to cytotoxic treatment, the prevalence of preterm labor was increased (11.8%; P ϭ .012). Furthermore, in this group a higher proportion of small-for-gestational-age children (birth weight below 10th percentile) was observed (24.2%; P ϭ .001). Of all neonates, 51.2% were admitted to a neonatal intensive care unit, mainly (85.2%) because of prematurity. There was no increased incidence of congenital malformations. ConclusionPregnant cancer patients should be treated in a multidisciplinary setting with access to maternal and neonatal intensive care units. Prevention of iatrogenic prematurity appears to be an important part of the treatment strategy.

First trimester placental growth factor and soluble fms-like tyrosine kinase 1 are significantly related to PAPP-A levels

“…However, this proportion of premature deliveries is lower than previously reported in all cancers in another European pregnancy population. 9 In our study population, preterm deliveries were more common if the decision was taken to start chemotherapy after delivery, although most patients reported no additional obstetrical complications. In the group who received chemotherapy during pregnancy, the pro portion of preterm deliveries …”

“…By contrast with other studies, our fi ndings show that infants exposed to chemotherapy in utero had a lower birthweight at the same gestational age than did infants not exposed to chemotherapy, a fi nding that was not aff ected by the amount of chemotherapy given and one that we believe is clinically irrelevant (because such low birthweight would not aff ect an otherwise healthy baby). 9 More complications were reported in the group of infants exposed to chemotherapy than in the group not exposed to chemotherapy. However, most complications were reported in babies who were delivered prematurely, irrespective of exposure to chemotherapy.…”

“…Some Belgian and UK patients were included in a previously published report. 8,9 However, most cases were reported prospectively, with birthweight, height, hair loss, blood count, and Apgar scores captured directly, whereas any other observations were reported with free text. In view of the multicentric and observational nature of the study, missing data were unavoidable, especially for the follow-up period, and we cannot exclude the possibility that there might be a reporting bias in favour of the group unexposed to chemotherapy in utero (children who were exposed might have been monitored more closely than those who were not).…”

“…Also, Belgian and UK groups were asked to provide data partly published. 8,9 Patients could be registered retrospectively if they were diagnosed before the initiation of the GBG registry in (April, 2003) and prospectively if their diagnosis was made thereafter. In the same timeframe, although independent from the German initiative, an international online registry for all cancers diagnosed during preg nancy was initiated in Belgium.…”

Radiation treatment planning and delivery strategies for a pregnant brain tumor patient

“…While breast cancer and hematologic malignancies make up the preponderance of cancers seen in a pregnant population, other tumor types are found with some frequency, including brain tumors 3. Common brain malignancies (e.g., gliomas) found in a patient population of child‐bearing age are often treated with shaped radiation fields or arcs that enter the patient's head from many angles, including so‐called “vertex” beams.…”