Molho Rinat Bernstein, Kollender Yehuda, Issakov Josephine, Bickels Jacob, Flusser Gideon, Azem Fuad, Alon Adele, Inbar Moshe J, Meller Isaac, Merimsky Ofer
Unit of Bone and Soft Tissue Oncology, Division of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Gynecol Obstet Invest. 2008;65(2):89-95. doi: 10.1159/000108402. Epub 2007 Sep 18.
The incidence of musculoskeletal tumors during pregnancy is very low. The aim of this study was to summarize our experience in treating a large cohort of pregnant patients diagnosed with these rare tumors.
Women diagnosed with musculoskeletal tumors during pregnancy or immediately after delivery were identified retrospectively in our database between 1996 and 2006. Relevant maternal and neonatal data were collected.
Twenty patients, 8 with bone sarcomas (BS) and 12 with soft tissue sarcomas (STS) were identified. Two women were treated by wide excision of mass during pregnancy. In all other cases oncological treatment was delayed until delivery or termination of pregnancy. Vaginal delivery was possible in 9 patients, cesarean section was performed in 7, spontaneous abortion occurred in 1, and 3 underwent termination of pregnancy. Three newborns were premature, but normal growth and development were observed. Different techniques of fertility preservation were used in our patients. Five patients with BS and 5 patients with STS received preoperative chemotherapy, with different grades of toxicity. The degree of tumor necrosis tended to correlate with dose-intensity of chemotherapy. Seven patients with BS received adjuvant chemotherapy. Two patients with STS received adjuvant chemotherapy, two - radiotherapy, and four - both modalities. Median disease-free survival was 15.1 months, median overall survival - 25.4 months.
Musculoskeletal tumors diagnosed during pregnancy, or after delivery, do not appear to have a significant impact on the prognosis. A multidisciplinary team should tailor the oncological approach individually.
孕期肌肉骨骼肿瘤的发病率非常低。本研究的目的是总结我们治疗大量被诊断患有这些罕见肿瘤的孕妇的经验。
回顾性分析1996年至2006年期间我们数据库中在孕期或产后立即被诊断患有肌肉骨骼肿瘤的女性。收集相关的孕产妇和新生儿数据。
共确定了20例患者，其中8例为骨肉瘤（BS），12例为软组织肉瘤（STS）。两名女性在孕期接受了肿块广泛切除术。在所有其他病例中，肿瘤治疗被推迟至分娩或终止妊娠。9例患者经阴道分娩，7例行剖宫产，1例自然流产，3例终止妊娠。3例新生儿早产，但生长发育正常。我们的患者采用了不同的生育力保存技术。5例骨肉瘤患者和5例软组织肉瘤患者接受了术前化疗，出现了不同程度的毒性反应。肿瘤坏死程度倾向于与化疗的剂量强度相关。7例骨肉瘤患者接受了辅助化疗。2例软组织肉瘤患者接受了辅助化疗，2例接受了放疗，4例接受了两种治疗方式。无病生存期的中位数为15.1个月，总生存期的中位数为25.4个月。
孕期或产后诊断的肌肉骨骼肿瘤似乎对预后没有显著影响。多学科团队应根据个体情况制定肿瘤治疗方案。
