Amant Frédéric, Van Calsteren Kristel, Halaska Michael J, Beijnen Jos, Lagae Lieven, Hanssens Myriam, Heyns Liesbeth, Lannoo Lore, Ottevanger Nelleke P, Vanden Bogaert Walter, Ungar Laszlo, Vergote Ignace, du Bois Andreas
Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Leuven Cancer Institute (LKI), UZ Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
Int J Gynecol Cancer. 2009 May;19 Suppl 1:S1-12. doi: 10.1111/IGC.0b013e3181a1d0ec.
Gynecologic cancer during pregnancy is a special challenge because cancer or its treatment may affect not only the pregnant women in general but directly involve the reproductive tract and fetus. Currently, there are no guidelines on how to deal with this special coincidence.
An international consensus meeting on staging and treatment of gynecological malignancies during pregnancy was organised including a systematic literature search, and interpretation followed by a physical meeting of all participants with intensive discussion. In the absence of large trials and randomized studies, recommendations were based on available literature data and personal experience thus representing a low but best achievable level of evidence.
Randomized trials and prospective studies on cancer treatment during pregnancy are lacking. Gynecological cancer during pregnancy is a demanding problem, and multidisciplinary expertise should be available. Counseling both parents on the maternal prognosis and fetal risk is needed. When there is a firm desire to continue the pregnancy, gynecological cancer can be treated in selected cases. The staging and treatment should follow the standard approach as much as possible. Guidelines for safe pelvic surgery during pregnancy are presented. Mainly in cervical and ovarian cancer, chemotherapy and an alternative surgical approach need to be considered. Administration of chemotherapy during the second or third trimester may probably not increase the incidence of congenital malformations. Until now, the long-term outcome of children in utero exposed to oncological treatment modalities is poorly documented, but preterm birth on its own is associated with cognitive impairment. Delivery should be postponed preferably until after a gestational age of 35 weeks.
Further research including international registries for gynecologic cancer in pregnancy is urgently needed. The gathering of both available literature and personal experience allowed only suggesting models for treatment of gynecologic cancer in pregnancy.
孕期妇科癌症是一项特殊挑战，因为癌症及其治疗不仅可能影响孕妇整体，还会直接累及生殖道和胎儿。目前，对于如何应对这种特殊情况尚无指导方针。
组织了一次关于孕期妇科恶性肿瘤分期与治疗的国际共识会议，包括系统的文献检索、解读，随后所有参与者进行面对面会议并展开深入讨论。由于缺乏大型试验和随机研究，建议基于现有文献数据和个人经验，因此证据水平较低，但已达到最佳可实现程度。
缺乏关于孕期癌症治疗的随机试验和前瞻性研究。孕期妇科癌症是一个棘手的问题，需要多学科专业知识。需要向父母双方咨询母亲的预后情况和胎儿风险。当有强烈意愿继续妊娠时，部分病例中的妇科癌症可以得到治疗。分期和治疗应尽可能遵循标准方法。给出了孕期安全盆腔手术的指南。主要针对宫颈癌和卵巢癌，需要考虑化疗及替代手术方法。在孕中期或孕晚期进行化疗可能不会增加先天性畸形的发生率。目前，子宫内接受肿瘤治疗方式的儿童的长期结局记录不足，但早产本身与认知障碍有关。分娩最好推迟至孕35周后。
迫切需要开展进一步研究，包括建立国际孕期妇科癌症登记处。收集现有文献和个人经验仅能为孕期妇科癌症的治疗提供建议模型。
