Oncological management of pregnancy-associated cancers: analysis from the French CALG (Cancer Associé à La Grossesse) network

Abstract

Background: Pregnancy-associated cancers constitute a major medical challenge. The objective of this study was to describe their epidemiological, oncological and obstetrical outcomes from the French CALG (Cancer Associ e a La Grossesse) network. Material and methods: Retrospective analysis of patients diagnosed with a cancer associated with pregnancy between January 2015 and December 2018 after advice from the CALG network. Results: Of 218 patients, 197 (90%) were diagnosed with a cancer during pregnancy and 21 the year following delivery. Requests to the CALG network increased from 36 cases in 2015 to 77 cases in 2018. The disease was diagnosed at local and regional stages in 77% of cases. Breast cancer was the most frequent (56%), followed by ovarian (12%) and uterine cervical cancers (10%). Of the 218 patients, 157 (72%) underwent a treatment during pregnancy. Surgery and chemotherapy during pregnancy were performed in 83 patients (83/218, 38%) and 101 patients (46%) at a median term of 17 (IQR 11-24) and 25 (IQR 18-30) WG, respectively. Eighteen (8.5%) of the women had a pregnancy termination, two (1%) an abortion, one (0.5%) a miscarriage, one (0.5%) had a stillbirth and one (0.5%) patient died during pregnancy. The remaining 174 patients (88%) were allowed to continue the pregnancy. Eight recurrences and four deaths were observed with a median follow-up time of 2.6 years (IQR 2.2-3.8). Conclusions: Our data further describe the incidence and management of pregnancy-associated cancers in western Europe allowing comparisons with other regions.

Personalized treatment of malignant tumors during pregnancy

“…It is considered that malignancy is found in 0.05-0.1% of all pregnancies, with the most common, are breast cancer, ovarian cancer, cervical cancer, Hodgkin and nonHodgkin lymphomas (NHLs). [2][3][4] Although the combination of pregnancy and cancer is not rare, each case is challenging for the patient and clinician. [3][4][5] When cancer is detected in a pregnant woman, the doctor usually faces a dilemma of setting the equilibrium between the benefits of providing proper management for the sake of the mother, on the 1 hand, and the possible harmful effects for the fetus, on the other.…”