Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting
Language English Country England, Great Britain Media print
Document type Journal Article, Research Support, Non-U.S. Gov't, Review
PubMed
31435648
DOI
10.1093/annonc/mdz228
PII: S0923-7534(19)60973-7
Knihovny.cz E-resources
- Keywords
- cancer, chemotherapy, cognitive, gynecologic, offspring, pregnancy,
- MeSH
- Humans MeSH
- International Cooperation MeSH
- Pregnancy Complications, Neoplastic therapy MeSH
- Genital Neoplasms, Female therapy MeSH
- Prognosis MeSH
- Practice Guidelines as Topic standards MeSH
- Societies, Medical MeSH
- Pregnancy MeSH
- Prenatal Exposure Delayed Effects etiology prevention & control MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
Clinic of Obstetrics and Gynecology University of Milan Bicocca San Gerardo Hospital Monza Italy
Department of Development and Regeneration University Hospitals Leuven Leuven Belgium
Department of Gynecologic Oncology European Institute of Oncology IRCCS Milan Italy
Department of Gynecologic Oncology La Paz University Hospital Madrid Spain
Department of Gynecologic Surgery Institute de Cancérologie Gustave Roussy Villejuif France
Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
Department of Obstetrics and Gynecology Cooper University Health Care Camden USA
Department of Obstetrics and Gynecology Mainz University Medical Center Mainz Germany
Department of Oncology KU Leuven Leuven Belgium
Princess Máxima Center for Pediatric Oncology Utrecht the Netherlands
References provided by Crossref.org
Pregnancy and Cancer: the INCIP Project
