Chemotherapy in the Treatment of Locally Advanced Cervical Cancer and Pregnancy

Marana, Heitor Ricardo Cosiski; Andrade, Jurandyr Moreira de; Mathes, Ângelo do Carmo da Silva; Duarte, Geraldo; Cunha, Sérgio Pereira da; Bighetti, Sérgio

doi:10.1006/gyno.2000.6055

Cited by 72 publications

(31 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5 Some studies have suggested that chemotherapy should be used during the second trimester of pregnancy in order to make it possible to wait for fetal pulmonary maturity, with definitive treatment applied after delivery. 25,[42][43][44][45] Caluwaerts et al reported the case of a woman in the 17 th week of pregnancy with a diagnosis of stage IB1 cervical carcinoma who was treated with cisplatin (six cycles of 75 mg/m 2 for 10 days). She then underwent cesarean section followed by radical hysterectomy and lymphadenectomy at 32 weeks of gestation, without adjuvant therapy.…”

Section: Pregnancy Of More Than 20 Weeksmentioning

confidence: 99%

Diagnosis and treatment of cervical cancer during pregnancy

et al. 2009

Self Cite

View full text Add to dashboard Cite

CONTEXT AND OBJECTIVE: One third of all cervical carcinomas occur during the reproductive period. Cervical carcinoma is the second greatest cause of death due to cancer during this phase. The estimated frequency of cervical cancer during pregnancy is one case for every 1,000 to 5,000 pregnancies.The aim here was to provide information about the difficulties in diagnosing and managing cervical neoplasia during pregnancy. MATERIALS:A systematic review of the literature was undertaken through the PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO) databases, using the following words: pregnancy, cervical cancer, diagnosis and management. RESULTS:There was a consensus in the literature regarding diagnosis of cervical carcinoma and management of preneoplastic lesions during pregnancy.However, for management of invasive carcinoma, there was great divergence regarding the gestational age taken as the limit for observation rather than immediate treatment. CONCLUSION:All patients with cytological abnormalities should undergo colposcopy, which will indicate and guide biopsy. Conization is reserved for patients with suspected invasion. High-grade lesions should be monitored during pregnancy and reevaluated after delivery. In cases of invasive carcinoma detected up to the 12 th week of pregnancy, patient treatment is prioritized. Regarding diagnoses made during the second trimester, fetal pulmonary maturity can be awaited, and the use of chemotherapy to stabilize the disease until the time of delivery appears to be viable. RESUMOCONTEXTO E OBJETIVO: Um terço dos carcinomas de colo ocorrem no período reprodutivo, sendo que esta é a segunda causa de morte por câncer nessa fase. A freqüência estimada do carcinoma de colo uterino na gravidez é de um caso para cada 1.000 a 5.000 gestações. O objetivo foi informar sobre as dificuldades frente ao diagnóstico e manejo da neoplasia cervical durante a gravidez. MATERIAIS E MÉTODOS:Revisão sistemática da literatura foi realizada no PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO), usando as seguintes palavras: gestação, câncer cervical, diagnóstico e manejo. RESULTADOS:A literatura apresenta consenso quanto ao diagnóstico do carcinoma cervical e a conduta das lesões pré-neoplásicas durante a gestação.No manejo do carcinoma invasor há grande divergência quanto à idade gestacional considerada como limite para a adoção da observação em vez do tratamento imediato.CONCLUSÃO: Toda paciente com citologia alterada deve realizar colposcopia, a qual indicará e a biópsia. A conização é reservada para pacientes com suspeita de invasão. As lesões de alto grau devem ser acompanhadas durante a gestação e reavaliadas após o parto. Em casos de carcinoma invasor em gestantes com até 12 semanas o tratamento da paciente é priorizado. Nos diagnósticos ocorridos no segundo tr...

show abstract

Section: Pregnancy Of More Than 20 Weeksmentioning

confidence: 99%

Diagnosis and treatment of cervical cancer during pregnancy

et al. 2009

Self Cite

View full text Add to dashboard Cite

show abstract

“…Otros autores han reportado su experiencia con quimioterapia neoadyuvante en estadíos localmente avanzados durante el 2° y 3° trimestre del embarazo, sin embargo, se trata de casos clínicos y se requiere mayor evidencia para proponerlo como una alternativa terapéutica (17,18).…”

Section: Tabla II Grupo 2 Distribución Según Estadío Clínico Y Momenunclassified

Cáncer Cervicouterino Y Embarazo: Experiencia Del Instituto Nacional Del Cáncer

C.¹,

N.³

et al. 2004

Rev. chil. obstet. ginecol.

View full text Add to dashboard Cite

RESUMENSe presenta la experiencia en el manejo de pacientes con diagnóstico de cáncer cervicouterino concomitante con embarazo, ingresadas al Instituto Nacional del Cáncer entre los años 1982 y 2004. Se estudiaron las fichas clínicas de 48 pacientes; evaluando edad, paridad, estadío clínico al momento del diagnóstico, tratamiento y resultados. La sobrevida se analizó según Kaplan-Meier con una mediana de seguimiento de 66 meses. A diferencia de las casuísticas de países desarrollados, el embarazo si se asoció a un peor pronóstico del cáncer cervicouterino, especialmente en los estadíos curables de la enfermedad. PALABRAS CLAVES: Cáncer cervicouterino y embarazo SUMMARYWe report our experience in the management of patients with diagnosis of cervical cancer during pregnancy from 1984 to 2004 at the National Cancer Institute of Santiago, Chile. Clinical reports of 48 patients were recluted. Age, parity, clinical stage, treatment and results were evaluated. Survival was analyzed according to Kaplan-Meier; median follow up was 66 months. In comparison with publications of developed countries, pregnancy was associated with a worse prognosis, especially in curable stages. KEY WORDS: Uterine cervix carcinoma and pregnancy Trabajos Originales*Trabajo leído en la sesión del 21 de septiembre de 2004 de la Sociedad Chilena de Obstetricia y Ginecología. INTRODUCCIÓNEl carcinoma de cuello uterino es el cáncer más frecuentemente diagnosticado durante el embarazo, con incidencias que según la población estudiada, van de 1 en 1.200 a 1 en 10.000 embarazos (1, 2, 3). En una serie de 1.675 pacientes, publicada en 1982 en Estados Unidos, mostró que 1 de 34 casos de cáncer cérvico uterino era diagnosticado durante el embarazo (4). Actualmente en ese país, entre 1 y 3% de los casos se diagnostican en el embarazo (5). Desde esa fecha hasta hoy se han logrado avances en el tratamiento del cáncer cérvico uterino, sin embargo, tanto la paciente embarazada como el equipo médico siguen enfrentando dilemas de manejo para cada caso en particular.Según lo revisado en la literatura, no existe evidencia de que la sobrevida sea diferente cuando se compara con la de pacientes sin embarazo de la misma edad, estadío y tipo histológico (2, 5, 6, 7). La cirugía y/o radioterapia son los tratamien-

show abstract

“…Postponed therapy for stage IB1 cancer patients did not promote tumor recurrence in cases with no pelvic lymph node metastasis visible by laparoscopy (Nisker and Shubat, 1983;Greer et al, 1989;Alouini et al, 2008;Lee et al, 2008). Furthermore, it has been reported that tumor growth can be well controlled by neoadjuvant chemotherapy with little adverse effects on pregnancy (Marana et al, 2001;Caluwaerts et al, 2006;Boyd et al, 2009;Chun et al, 2010;Favero et al, 2010;Rabaiotti et al, 2010;Smyth et al, 2010). However, the majority of published data on cervical cancer associated with pregnancy consist of case reports or retrospective studies based on small sample sizes.…”

Section: Introductionmentioning

confidence: 99%

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Zhang

Yong-liang

Yang

2015

J. Zhejiang Univ. Sci. B

View full text Add to dashboard Cite

Abstract:This study was designed to investigate the therapeutic approaches and prognosis for cervical cancer associated with pregnancy. Clinical information, therapeutic strategies, and follow-up results of 20 patients with cervical cancer associated with pregnancy from Jan. 2000 to June 2009 in the Zhejiang Cancer Hospital were retrospectively analyzed. The International Federation of Gynecology and Obstetrics (FIGO) stages were: in situ (n=1), stage IA1 (n=1), stage IB1 (n=5), stage IB2 (n=1), stage IIA (n=8), stage IIB (n=3), and stage IIIB (n=1). Eight patients were in the first trimester of pregnancy, four in the second, two in the third, and six at postpartum when diagnosed. The therapeutic strategies were either single or combined modalities, including surgery, radiotherapy, and chemotherapy. Fourteen patients survived, five patients died (four of remote metastasis and one of uremia), and one patient was lost to follow-up. One newborn from a patient at stage IIA carcinoma in the third trimester with postponed therapy six weeks after diagnosis survived. Retarded fetal growth was observed in one patient receiving neoadjuvant chemotherapy and cesarean section. Out of the six postpartum patients, three underwent cesarean section and survived, whereas only one out of the three who underwent vaginal delivery survived. The remaining two died of remote metastasis. Therefore, personalized treatment is necessary for cervical cancer associated with pregnancy. Cervical cancer patients in the third trimester of pregnancy can continue the pregnancy for a short period of time. There may be potential risk for the fetus by chemotherapy during pregnancy. Cesarean section is the preferred mode of delivery for pregnant cervical cancer patients.

show abstract

Chemotherapy in the Treatment of Locally Advanced Cervical Cancer and Pregnancy

Cited by 72 publications

References 7 publications

Diagnosis and treatment of cervical cancer during pregnancy

Diagnosis and treatment of cervical cancer during pregnancy

Cáncer Cervicouterino Y Embarazo: Experiencia Del Instituto Nacional Del Cáncer

Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution

Contact Info

Product

Resources

About