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Ann Oncol. 2019 Oct 1;30(10):1601-1612. doi: 10.1093/annonc/mdz228.

Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting.

Author information

1
Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium. Electronic address: Frederic.amant@uzleuven.be.
2
Department of Obstetrics and Gynecology, Centre Hospitalier de Poissy-Saint-Germain-en-Laye, Poissy, France.
3
Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
4
Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, USA.
5
Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy.
6
Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
7
Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.
8
Department of Obstetrics and Gynecology, Mainz University Medical Center, Mainz, Germany.
9
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
10
Department of Medical Oncology, IRCCS Policlinico San Martino Hospital, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.
11
Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands.
12
Department of Oncology, KU Leuven, Leuven, Belgium.
13
Department of Gynecologic Surgery, Institute de Cancérologie Gustave Roussy, Villejuif, France.
14
Department of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy.
15
Department of Radiation Oncology, Institut Curie and Paris Sciences & Lettres - PSL University, Paris, France.
16
Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium.
17
Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
18
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
19
Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, Athens, Greece.
20
Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain.

Abstract

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.

KEYWORDS:

cancer; chemotherapy; cognitive; gynecologic; offspring; pregnancy

PMID:
31435648
DOI:
10.1093/annonc/mdz228

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