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Frédéric Amant,
Gunter von Minckwitz,
Sileny N Han,
Marijke Bontenbal,
Alistair E Ring,
Jerzy Giermek,
Hans Wildiers,
Tanja Fehm,
Sabine C Linn,
Bettina Schlehe, [......],
Kristel Van Calsteren,
Brigitte Rack,
Valentina Nekljudova,
Nadia Harbeck,
Michael Untch,
Petronella O Witteveen,
Kathrin Schwedler,
Christoph Thomssen,
Ben Van Calster,
Sibylle Loibl
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ABSTRACT: PURPOSEWe aimed to determine the prognosis of patients with breast cancer diagnosed during pregnancy (BCP). PATIENTS AND METHODS
In this cohort study, a multicentric registry of patients with BCP (from Cancer in Pregnancy, Leuven, Belgium, and GBG 29/BIG 02-03) compiled pro- and retrospectively between 2003 and 2011 was compared with patients who did not have associated pregnancies, using an age limit of 45 years. Patients with a diagnosis postpartum were excluded. The main analysis was performed using Cox proportional hazards regression of disease-free survival (DFS) and overall survival (OS) on exposure (pregnant or not), adjusting for age, stage, grade, hormone receptor status, human epidermal growth factor 2 status, histology, type of chemotherapy, use of trastuzumab, radiotherapy, and hormone therapy.ResultsThe registry contained 447 women with BCP, mainly originating from Germany and Belgium, of whom 311 (69.6%) were eligible for analysis. The nonpregnant group consisted of 865 women. Median age was 33 years for the pregnant and 41 years for the nonpregnant patients. Median follow-up was 61 months. The hazard ratio of pregnancy was 1.34 (95% CI, 0.93 to 1.91; P = .14) for DFS and 1.19 (95% CI, 0.73 to 1.93; P = .51) for OS. Cox regression estimated that the 5-year DFS rate for pregnant patients would have increased from 65% to 71% if these patients had not been pregnant. Likewise, the 5-year OS rate would have increased from 78% to 81%. CONCLUSION
The results show similar OS for patients diagnosed with BCP compared with nonpregnant patients. This information is important when patients are counseled and supports the option to start treatment with continuation of pregnancy.
Journal of Clinical Oncology 04/2013; · 18.37 Impact Factor
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ABSTRACT: Placental growth factor (PlGF), a homolog of vascular endothelial growth factor (VEGF), exerts pleiotropic functions in cancer by affecting tumor cells as well as endothelial and inflammatory cells. Moreover, PlGF expression correlates with tumor stage, recurrence, metastasis and patient outcome in different types of cancer. Recently, administration of anti-PlGF therapy reduced tumor growth and metastasis in preclinical tumor models. In the present study, we evaluated the diagnostic and prognostic value of systemic and local expression of PlGF in primary endometrial carcinomas. PlGF levels in tumor lysates (n=128) and serum (n=88) of patients with primary endometrial cancer were determined using ELISA. PlGF mRNA expression in endometrial carcinoma tissues was quantified by quantitative qRT-PCR. Results were compared to endometrial cancer stage and grade. Systemic PlGF levels were not altered in patients with endometrial cancer (FIGO stage I-II-III) as compared to healthy controls. Only in FIGO stage IV patients, serum PlGF levels were slightly increased. Local PlGF mRNA and protein expression in endometrial tumors progressively increased with tumor grade. In endometrioid carcinomas, PlGF mRNA expression was significantly increased in endometrioid grade 3 tumors as compared to normal endometrial tissue. PlGF protein expression was significantly increased in endometrioid grade 2 and 3 carcinomas and in serous carcinomas as compared to normal endometrial tissue. Our study showed that systemic/serum PlGF levels cannot be used as a diagnostic or prognostic marker in endometrial cancer. However, the increased local expression of PlGF, primarily in high-grade carcinomas, underscores the possibility for preclinical assessment of anti-PlGF therapy in endometrial cancer.
Oncology Reports 12/2012; · 1.84 Impact Factor
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Diego A Garcia-Dios,
Diether Lambrechts,
Lieve Coenegrachts,
Ingrid Vandenput,
An Capoen,
Penelope M Webb,
Kaltin Ferguson,
Anecs,
Lars A Akslen,
Bart Claes,
Ignace Vergote,
Philippe Moerman,
Johan Van Robays,
Janusz Marcickiewicz,
Helga B Salvesen,
Amanda B Spurdle, Frédéric Amant
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ABSTRACT: OBJECTIVE: Endometrial cancer patients may benefit from systemic adjuvant chemotherapy, alone or in combination with targeted therapies. Prognostic and predictive markers are needed, however, to identify patients amenable for these therapies. METHODS: Primary endometrial tumors were genotyped for >100 hot spot mutations in genes potentially acting as prognostic or predictive markers. Mutations were correlated with tumor characteristics in a discovery cohort, replicated in independent cohorts and finally, confirmed in the overall population (n=1,063). RESULTS: PIK3CA, PTEN and KRAS mutations were most frequently detected, respectively in 172 (16.2%), 164 (15.4%) and 161 (15.1%) tumors. Binary logistic regression revealed that PIK3CA mutations were more common in high-grade tumors (OR=2.03; P=0.001 for grade 2 and OR=1.89; P=0.012 for grade 3 compared to grade 1), whereas a positive TP53 status correlated with type II tumors (OR=11.92; P<0.001) and PTEN mutations with type I tumors (OR=19.58; P=0.003). Conversely, FBXW7 mutations correlated with positive lymph nodes (OR=3.38; P=0.045). When assessing the effects of individual hot spot mutations, the H1047R mutation in PIK3CA correlated with high tumor grade and reduced relapse-free survival (HR=2.18; P=0.028). CONCLUSIONS: Mutations in PIK3CA, TP53, PTEN and FBXW7 correlate with high tumor grade, endometrial cancer type and lymph node status, whereas PIK3CA H1047R mutations serve as prognostic markers for relapse-free survival in endometrial cancer patients.
Gynecologic Oncology 12/2012; · 3.89 Impact Factor
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ABSTRACT: OBJECTIVE: To evaluate physicians' attitudes and knowledge regarding the treatment possibilities for patients with cancer in pregnancy. STUDY DESIGN: A 30-item questionnaire was mailed electronically to physicians across Europe, who were potentially involved in care of pregnant patients and/or cancer, using the membership directories of different professional societies. RESULTS: 142 surveys were eligible for analysis. A median of 2 (range 0-100) patients with cancer in pregnancy were treated per center in 2010. The vast majority of respondents (94%) agreed that management of pregnant patients with cancer should be decided by a multidisciplinary team. When cancer is diagnosed in the first or early second trimester of pregnancy, 44% of respondents prefer termination of pregnancy: if the patient wishes to preserve the pregnancy, 77% consider deliberate delay and treatment later in pregnancy. When cancer is diagnosed in the late second or third trimester of pregnancy, 58% prefer preterm delivery in order to start cancer treatment in the postpartum period: 37% would not give chemotherapy or radiotherapy during pregnancy. Treatment during pregnancy with the aim of a term delivery is preferred by 41% of respondents. Univariate logistic regression analysis found a trend that non-academic hospitals prefer termination of pregnancy (odds ratio [OR]=0.68; 95% CI, 0.28-1.63; P=0.39), and also no treatment during pregnancy (OR=0.70; 95% CI, 0.33-1.50; P=0.36). CONCLUSION: Termination of pregnancy, delay of maternal treatment and iatrogenic preterm delivery are frequently applied strategies in the management of pregnant cancer patients. These results suggest that current treatment is not in line with recent evidence, and there is room for improvement on the oncologic treatment of pregnant women. Centralization of treatment is needed.
European journal of obstetrics, gynecology, and reproductive biology 11/2012; · 1.97 Impact Factor
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ABSTRACT: OBJECTIVE: To evaluate the "Leuven" weekly paclitaxel/carboplatinum (TC) regimen in recurrent ovarian cancer in a retrospective study. METHODS: Eighteen courses of paclitaxel (60mg/m(2)) and carboplatinum (AUC 2.7) were administered weekly. Platinum-resistance was defined as progression during or within 6months after platinum-based chemotherapy. RESULTS: Sixty-three patients were included with a median number of prior treatment regimens of 4 (range 0-10). Forty-three patients were platinum resistant and 20 were platinum sensitive (14 intermediate sensitive and 5 sensitive). One patient in the platinum resistant group and 2 patients in the platinum sensitive group achieved complete remission, 15 patients in the platinum resistant and 5 patients in the platinum sensitive group achieved partial remission according to RECIST. In the entire patient population evaluable for response (n=62), the median progression free survival (PFS) was 6.7months; the median overall survival (OS) was 9.7months. Median PFS was 6months for the platinum resistant and 8months for the platinum sensitive group. The median OS was 9months in the platinum resistant and 11months in the platinum sensitive group. Toxicity was mostly bone marrow related with neutropenia grade 3/4 in 67% and neutropenic fever in 6% of patients. Dose reduction was necessary in 24% of patients. Nausea, vomiting and fatigue were the most frequent non-hematological side effects. CONCLUSION: Weekly paclitaxel and carboplatin is an effective regimen for patients with recurrence of ovarian cancer with a response rate of 37% in platinum resistant disease and a manageable toxicity profile.
Gynecologic Oncology 10/2012; · 3.89 Impact Factor
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ABSTRACT: Chemotherapy and particularly anthracycline exposure are associated with acute and chronic cardiotoxicity. Few data exist on the effect of cardiac function after in utero exposure to maternal chemotherapy. Our recently published multicenter prospective study showed no significant changes in systolic function using conventional echocardiographic parameters. The purpose of this study was to further investigate whether early functional changes can be detected using tissue Doppler imaging (TDI) and two-dimensional (2D) speckle tracking echocardiography (STE). Sixty-two children (median/range age 1.7 (1-9.8) years) exposed to chemotherapy during fetal life were enrolled and compared to 62 age- and gender-matched controls. TDI velocities were measured at the basal interventricular septum (IVS) and right and left ventricular (LV) free walls. LV global longitudinal and circumferential systolic strains were derived using 2D STE. We found small but significant differences between the groups (patients versus controls) in LV fractional shortening [35 (29-46)% versus 39 (28-53)%, p < 0.001], LV ejection fraction [66 (57-79)% versus 70 (57-83)%, p < 0.001], LV posterior wall thickness z score [-0.15 (-2.32-1.81) versus -0.10 (-1.9-2.0), p < 0.001], and IVS thickness z score [-1.06 (-2.6-1.3) versus -0.5 (-2.1-1.7), p < 0.001]. No significant differences in TDI velocities or LV global strains were observed. Within the patient group, the cardiac functional parameters did not correlate to the number of cycles of anthracycline or the cumulative anthracycline dose. Children exposed to fetal chemotherapy have a lower normal fractional shortening and mildly lower left ventricular wall thickness. Tissue Doppler and strain measurements are within normal range and not statistically different from normal controls. The long-term implications of these findings will be further studied in this prospective cohort study.
European Journal of Pediatrics 10/2012; · 1.88 Impact Factor
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International Journal of Cancer 09/2012; · 5.44 Impact Factor
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ABSTRACT: Chemotherapy and especially anthracyclines are associated to cardiotoxicity. To assess this potential risk during pregnancy a clinical case-control trial was conducted. Maternal cardiac function, fetal Doppler and fetal cardiac function were evaluated before and after chemotherapy. Maternal cardiac function was assessed by echocardiography before and after the third cycle of anthracyclines and compared to a control group of 10 non-pregnant women matched for age, type of cancer and anthracycline treatment. Ten fetuses exposed to chemotherapy were compared to 10 control fetuses matched for gestational age and gender. Biometry, amniotic fluid index, fetal Doppler and cardiac function were assessed before and after each cycle of chemotherapy. Hundred and eight fetal ultrasounds scans were performed before and after 36 cycles of chemotherapy. Anthracycline exposure did not result in acute maternal and fetal cardiac dysfunction in this small cohort study.
Acta Obstetricia Et Gynecologica Scandinavica 08/2012; · 1.77 Impact Factor
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ABSTRACT: To assess toxicity and efficacy of weekly high-dose methotrexate-etoposide (HD MTX-ETO) in high-risk gestational trophoblastic neoplasia (GTN).
Retrospective chart review of high-risk GTN patients treated with HD MTX-ETO (methotrexate 1000 mg/m² day 1, etoposide 100 mg/m² days 1 and 2, q 1 wk).
134 cycles of HD MTX-ETO were administered to twelve patients; median number of cycles was 8 (range 2-39 cycles). Median follow up was 25.5 months (range 11-69). 7 of these patients switched due to ototoxicity from EP-EMA (etoposide 150 mg/m², cisplatin 75 mg/m² i.v. day 1; etoposide 100 mg/m², methotrexate 300 mg/m², dactinomycin 0.5 mg i.v. day 8, q 14 d) to HD MTX-ETO, after an average of 7 cycles of EP-EMA. Six achieved complete remission without disease recurrence. One patient with a placental site trophoblastic tumour died due to progressive disease. Five patients received HD MTX-ETO primarily; 1 patient with choriocarcinoma presenting with metastases to the brain and liver (WHO score 19) was switched to EP-EMA and died due to complications under EP-EMA. The other 4 achieved complete remission without disease recurrence. HD MTX-ETO was well tolerated; non-haematological toxicity was low except for alopecia and fatigue. Nine patients had grade 2-4 anaemia and received packed cells. Eight patients had grade 3-4 neutropenia and received G-CSF. Two patients developed febrile neutropenia without sepsis.
These preliminary results show a better toxicity profile with HD MTX-ETO than EP-EMA and encouraging efficacy. HD MTX-ETO might be a treatment option for some patients with high-risk GTN and needs further investigation.
Gynecologic Oncology 06/2012; 127(1):47-50. · 3.89 Impact Factor
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Journal of Surgical Oncology 06/2012; · 2.10 Impact Factor
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ABSTRACT: Evaluation of toxicity and outcome of high-risk gestational trophoblastic neoplasia when treated with EP-EMA (etoposide, 150 mg/m; cisplatin, 75 mg/m, intravenous, day 1; etoposide, 100 mg/m; methotrexate, 300 mg/m; dactinomycin, 0.5 mg, intravenous, day 8, every two weeks).
We conducted a retrospective chart review of the period 2004-2010. The first-line chemotherapy regimen for high-risk gestational tropholdastic neoplasia was EP-EMA.
Eighteen patients were treated with EP-EMA, either as first-line chemotherapy for high-risk gestational trophoblastic neoplasia (n = 6), placental site trophoblastic tumor (n = 1), or as salvage chemotherapy for gestational trophoblastic neoplasia after single-agent methotrexate (methotrexate, 1 mg/kg, on days 1, 3, 5, and 7 every two weeks) (n = 10) or high-dose methotrexate-etoposide: methotrexate, 1000 mg/m, on day 1; etoposide, 100 mg/m, on days 1 to 2, every week) (n = 1). Median number of cycles of EP-EMA was 8 (range, 3-11). Median follow-up was 19 months (range, 7-77 months). Concerning response rate, 16 patients (89%) achieved complete remission without disease recurrence.Two patients (11%) died: One patient with placental site trophoblastic tumor died of progressive disease; the second patient presented with choriocarcinoma, primarily metastasized to liver, lung, skin, kidney, and brain. She died of sepsis and endocarditis after adding intrathecal methotrexate and switching cisplatin to carboplatin in the EP-EMA regimen. Toxicity was significant. Eight treatment changes were made owing to grade 2 to grade 3 ototoxicity: 7 to high-dose methotrexate-etoposide, 1 change of cisplatin to carboplatin. Fifteen patients (83%) experienced grade 3/4 neutropenia.
International Journal of Gynecological Cancer 06/2012; 22(5):875-80. · 1.65 Impact Factor
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ABSTRACT: Cancer during pregnancy is uncommon, although not rare. As women in developed societies defer childbearing and the incidence of most malignancies rises with increasing age, the situation in which cancer complicates pregnancy is expected to become more common. Cancer staging and treatment can be performed during pregnancy and should be defined in a multidisciplinary setting. Here, we describe the potential to use chemotherapy during pregnancy.
New insights add to the practice of administering chemotherapy from 14 weeks gestational age onwards. The placental barrier function protects the fetus. The physiologic gestational changes reduce the maternal serum levels of chemotherapy, although the pharmacodynamic impact remains unknown. Comedication to chemotherapy can be administered on strict indications. Chemotherapy after 35 weeks is not recommended as an interval of at least 3 weeks is preferred between chemotherapy administration and delivery. Recent data show that the long-term outcome of children antenatally exposed to chemotherapy is comparable to children of the same age. Nevertheless, a higher rate of neurodevelopmental problems was encountered after preterm birth, also in this selected patient population.
Administration of chemotherapy during pregnancy may decrease the need for early delivery, and thus prematurity.
Current opinion in oncology 05/2012; 24(5):580-6. · 4.09 Impact Factor
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ABSTRACT: To evaluate efficacy of weekly paclitaxel/carboplatin chemotherapy in patients with locally advanced, metastatic, or recurrent vulvar squamous cell carcinoma.
A prospective, single-arm, single-center pilot study was initiated to study response rate of 9 weekly courses of paclitaxel (60 mg/m) and carboplatin (area under the curve, 2.7). We used this regimen in the neoadjuvant or metastatic setting when surgery would cause serious morbidity or was not an option owing to distant metastases. Primary outcome was response rate, measured according to Response Criteria in Solid Tumors criteria. Treatment toxicity, surgical morbidity, and type of surgery were also evaluated.
We treated 6 patients in the period between May 2009 and May 2011, of which 4 patients had a diagnosis of locally advanced disease and 2 patients had a diagnosis of recurrent disease. A median number of 7.5 cycles of paclitaxel/carboplatin weekly was administered (range, 3-9). No objective response was observed. Paclitaxel/carboplatin weekly was discontinued after a mean of 4.3 weekly cycles in 3 patients owing to local disease progression. After a median follow-up of 4.2 months (range, 1-29 months), 3 patients died owing to progressive disease and 1 patient died owing to intercurrent disease. The 2 remaining patients underwent radical vulvectomy + bilateral inguinofemoral lymphadenectomy after neoadjuvant chemotherapy. The main chemotherapy-related toxicity was anemia and could be managed conservatively with erythropoietin and intravenous iron therapy.
Weekly administration of paclitaxel-carboplatin has limited clinical benefit in the treatment of vulvar squamous cell carcinoma.
International Journal of Gynecological Cancer 04/2012; 22(5):865-8. · 1.65 Impact Factor
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ABSTRACT: The co-occurrence of cancer and pregnancy is more frequently diagnosed. The effects of cancer treatment on maternal and fetal outcomes are less well known. The cardiotoxic effects of chemotherapy are a specific concern for the mother and fetus. We wanted to review the existing literature, mainly consisting of case reports, case studies, and retrospective data.
Maternal effects Overall, the published data indicate that pregnancy is not an independent risk factor influencing cancer survival. There is no indirect evidence for an increased risk for maternal chemotherapy-related cardiotoxicity. Fetal effects During the first trimester chemotherapy needs to be avoided because of teratogenic risks. The risks of chemotherapy during the second and third trimester are more controversial. It has been associated with intrauterine growth restriction and preterm delivery in some studies, while others did not find the same effect. Cardiotoxic fetal effects have been reported despite the limited transplacental passage of chemotherapy. In most patients this was transient and long-term data are generally reassuring.
A specific strategy for monitoring fetal and maternal chemotherapy-induced cardiotoxicity is suggested. Prospective data are needed on the long-term effects of chemotherapy in both mother and child.
Prenatal Diagnosis 04/2012; 32(7):614-9. · 2.11 Impact Factor
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Frédéric Amant
Clinical advances in hematology & oncology: H&O 04/2012; 10(4):258-9.
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ABSTRACT: The objective of the study was to evaluate the response of weekly paclitaxel/carboplatin in patients with primary advanced or recurrent endometrial cancer.
Eighteen cycles of paclitaxel (60 mg/m²) and carboplatinum (area under the plasma concentration-time curve, 2.7) were administered weekly. Response rates were evaluated according to Response Criteria in Solid Tumors criteria.
Paclitaxel/carboplatin weekly was administered to 29 patients. Median age was 62 years (range, 44-80 years). Main histopathologic types were serous/clear cell (n = 16) and endometrioid (n = 9). Patients were divided into a chemonaive group (n = 16) (group 1) and a group with previous chemotherapy (n = 13) (group 2). Response rate for group 1 was as follows: partial remission, n = 8 (50%); stable disease, n = 1 (6%); and progressive disease, n = 7 (44%). Response for group 2: partial remission, n = 5 (39%), and progressive disease, n = 8 (62%). Median progression-free survival and overall survival were 9 months (range, 5-27 months) and 12 months (range, 2-27 months), respectively, for group 1 and 8 months (range, 6-10 months) and 9 months (range, 2-18 months), respectively, for group 2.Overall 411 weekly treatments were administered. Because of grade 4 bone marrow toxicity, treatments needed to be adjusted as follows: dose reduction of 50% to 75%, n = 81 (20%); dose delay, n = 66 (16%); not administered, n = 6 (1%); and changed to paclitaxel/cisplatin, n = 4 (1%). Twenty-three patients (85%) needed treatment adjustment because of toxicity. Neutropenic fever occurred in 1 patient (4%). The most common nonhematologic toxicities were grade 1 to 2 fatigue (89%) and grade 2 nausea (37%). Seven percent had grade 2 neuropathy. No grade 2 alopecia occurred.
Paclitaxel/carboplatin weekly seems effective, however, with a considerable hematologic toxicity. Larger trials are needed to confirm these data.
International Journal of Gynecological Cancer 03/2012; 22(4):617-22. · 1.65 Impact Factor
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Frédéric Amant,
Kristel Van Calsteren,
Michael J Halaska,
Mina Mhallem Gziri,
Wei Hui,
Lieven Lagae,
Michèl A Willemsen,
Livia Kapusta,
Ben Van Calster,
Heidi Wouters,
Liesbeth Heyns,
Sileny N Han,
Viktor Tomek,
Luc Mertens,
Petronella B Ottevanger
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ABSTRACT: Chemotherapy for the treatment of maternal cancers during pregnancy has become more acceptable in the past decade; however, the effect of prenatal exposure to chemotherapy on cardiac and neurodevelopmental outcomes of the offspring is still uncertain. We aimed to record the general health, cardiac function, and neurodevelopmental outcomes of children who were prenatally exposed to chemotherapy.
We did an interim analysis of a multicentre observational cohort study assessing children who were prenatally exposed to maternal cancer staging and treatment, including chemotherapy. We assessed children at birth, at age 18 months, and at age 5-6, 8-9, 11-12, 14-15, or 18 years. We did clinical neurological examinations, tests of the general level of cognitive functioning (Bayley or intelligence quotient [IQ] test), electrocardiography and echocardiography, and administered a questionnaire on general health and development. From age 5 years, we also did audiometry, the Auditory Verbal Learning Test, and subtasks of the Children's Memory Scale, and the Test of Everyday Attention for Children, and we also completed the Child Behavior Checklist. This study is registered with ClinicalTrials.gov, number NCT00330447.
236 cycles of chemotherapy were administered in 68 pregnancies. We assessed 70 children, born at a median gestational age of 35·7 weeks (range 28·3-41·0; IQR 3·3; 47 women at <37 weeks), with a median follow-up period of 22·3 months (range 16·8-211·6; IQR 54·9). Although neurocognitive outcomes were within normal ranges, cognitive development scores were lower for children who were born preterm than for those born at full term. When controlling for age, sex, and country, the score for IQ increased by an average 11·6 points (95% CI 6·0-17·1) for each additional month of gestation (p<0·0001). Our measurements of the children's behaviour, general health, hearing, and growth corresponded with those of the general population. Cardiac dimensions and functions were within normal ranges. We identified a severe neurodevelopmental delay in both members of one twin pregnancy.
Fetal exposure to chemotherapy was not associated with increased CNS, cardiac or auditory morbidity, or with impairments to general health and growth compared with the general population. However, subtle changes in cardiac and neurocognitive measurements emphasise the need for longer follow-up. Prematurity was common and was associated with impaired cognitive development. Therefore, iatrogenic preterm delivery should be avoided when possible.
Research Foundation-Flanders; Research Fund-K U Leuven; Agency for Innovation by Science and Technology; Stichting tegen Kanker; Clinical Research Fund-University Hospitals Leuven; and Belgian Cancer Plan, Ministery of Health.
The lancet oncology 03/2012; 13(3):256-64. · 14.47 Impact Factor
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ABSTRACT: Breast cancer staging and treatment are possible during pregnancy, and should be defined in a multidisciplinary setting. Tumour biology, tumour stage, and gestational stage at diagnosis determine the appropriate approach. Surgery for breast cancer is possible during all trimesters of pregnancy. Radiotherapy is possible during pregnancy but, dependent on the fetal dose received, can result in poor fetal outcomes. The decision to give radiotherapy should be made on an individual basis. Evidence increasingly supports administration of chemotherapy from 14 weeks' gestation onwards. New breast cancer treatments might be applicable to pregnant patients, but tamoxifen and trastuzumab are contraindicated during pregnancy. Cancer treatment during pregnancy will decrease the need for early delivery and thus prematurity, which is a major concern in management of breast cancer in pregnancy.
The Lancet 02/2012; 379(9815):570-9. · 38.28 Impact Factor
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Gynecologic Oncology 01/2012; 124(1):1-2. · 3.89 Impact Factor
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ABSTRACT: One in 1000 pregnancies is complicated by maternal cancer. The most frequently encountered malignancies are breast cancer, hematologic tumors, and skin cancer. Cancer management implies multidisciplinary decisions taking into account the (sub)type and stage of cancer, the gestational age at diagnosis, and patient's wish to preserve the pregnancy. Oncological treatment modalities including surgery, radiotherapy, and chemotherapy are possible during pregnancy, however, under strict conditions. Actually, pregnant patients receive the same dosages of chemotherapeutic agents as nonpregnant women, despite gestational changes in hemodynamics and drug pharmacokinetics. Data on the outcome of the children are limited. Neonatal outcome seems reassuring, albeit data on long-term outcomes are lacking. Cancer during pregnancy poses a real challenge for obstetricians, oncologists, and pediatricians to balance fetal and maternal risks and benefices. Here, we address some important clinical issues related to the management of cancer complicating pregnancy.
European journal of clinical & medical oncology 12/2011;
