Multiagent chemotherapy for sarcoma diagnosed during pregnancy

Abstract

A 21-year-old, gravida 1, para O, woman presented at approximately 25 weeks gestation with a large Ewing's sarcoma involving her iliac wing. She was treated with multiagent chemotherapy before a successful Cesarean delivery of a normal infant at approximately 34 weeks gestation. Four years later both the mother and child are doing well. The literature regarding sarcoma occurring during pregnancy and that regarding multiagent chemotherapy in pregnant patients is reviewed. Chemotherapy should be instituted early in the course of many malignant sarcomas, despite pregnancy, to prevent the occurrence of metastases.

Soft Tissue and Bone Sarcomas in Association with Pregnancy

“…Tumors might occupy the space reserved for the fetus and uterus, as occurred in our patients with Ewing's sarcoma and pubic osteosarcoma, and also as reported by others (20). The tumor and the fetus share the same limited space in the pelvis and abdominal cavity.…”

“…Haerr & Pratt (20) reported a case of Ewing's sarcoma similar to ours, in a 21-year-old pregnant woman during the 25th week of gestation. Evaluation was based on plain x rays of the pelvis and of the chest, whole lung tomograms and ultrasound of the pelvis, radionuclide bone scan and open biopsy.…”

“…More sporadically, and probably because of the relative rarity, sarcoma of the bone or soft tissues (16,(20)(21)(22)(23)(24)(25) may present during gestation.…”

“…However, if the planned treatment is only palliative, or there is no effective treatment (metastatic sarcoma, particularly chondrosarcoma) the well-being of the fetus may be more important. Cesarean section should be performed when pregnancy is to be terminated urgently or in order to administer chemotherapy, as also noted elsewhere (20), or when the tumor involves the pubis (21), or the uterus and cervix.…”

“…Second, there is the estimated immediate risk to the fetal life, health and expected postnatal growth, physical and mental maturation, and genetic aberrations leading to future malignant transformation (late sequelae), in performing diagnostic procedures such as ancillary tests, biopsy and oncological treatments (25). In this context it is intriguing to mention the case of Haerr & Pratt (20) where plain films of the pelvis and chest, radionuclide bone scan and lung tomograms were performed, without having any deleterious effects on the fetus and newborn, seen within up to 4 years of follow-up. The age of the fetus, the state of the organogenesis, the fetal lung maturity, and the time needed to complete the pregnancy and to have a mature baby may determine its future risk.…”