Gynecologic cancers in pregnancy: Guidelines based on a third international consensus meeting: Annals of Oncology

F. Amant, P. Berveiller, I.A. Boere, E. Cardonick, R. Fruscio, M. Fumagalli, M.J. Halaska, A. Hasenburg, A.L.V. Johansson, M. Lambertini, C.A.R. Lok, C. Maggen, P. Morice, F. Peccatori, P. Poortmans, K. Van Calsteren, T. Vandenbroucke, M. Van Gerwen, M. Van Den Heuvel-Eibrink, F. ZagouriI. Zapardiel

Research output: Contribution to journalArticle

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. © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Original languageEnglish
Pages (from-to)1601-1612
Number of pages12
JournalAnn. Oncol.
Volume30
Issue number10
DOIs
Publication statusPublished - 2019

Keywords

  • cancer
  • chemotherapy
  • cognitive
  • gynecologic
  • offspring
  • pregnancy
  • anthracycline
  • bleomycin
  • carboplatin
  • cisplatin
  • etoposide
  • paclitaxel
  • breast feeding
  • cancer chemotherapy
  • cancer hormone therapy
  • cancer prognosis
  • cancer registry
  • cancer surgery
  • cesarean section
  • child care
  • clinical protocol
  • consensus
  • diagnostic imaging
  • drug targeting
  • female genital tract cancer
  • fetus development
  • follow up
  • gestational age
  • health care personnel
  • human
  • hysterectomy
  • long term care
  • maternal care
  • medical expert
  • medical society
  • multidisciplinary team
  • newborn care
  • ovary cancer
  • practice guideline
  • priority journal
  • psychological aspect
  • psychotherapy
  • Review
  • treatment planning
  • uterine cervix cancer
  • vaginal delivery
  • vulva cancer

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  • Cite this

    Amant, F., Berveiller, P., Boere, I. A., Cardonick, E., Fruscio, R., Fumagalli, M., Halaska, M. J., Hasenburg, A., Johansson, A. L. V., Lambertini, M., Lok, C. A. R., Maggen, C., Morice, P., Peccatori, F., Poortmans, P., Van Calsteren, K., Vandenbroucke, T., Van Gerwen, M., Van Den Heuvel-Eibrink, M., ... Zapardiel, I. (2019). Gynecologic cancers in pregnancy: Guidelines based on a third international consensus meeting: Annals of Oncology. Ann. Oncol., 30(10), 1601-1612. https://doi.org/10.1093/annonc/mdz228