Department of Gynecology, Charité Universitätsmedizin, Berlin, Germany.
J Perinat Med. 2011 May;39(3):279-85. doi: 10.1515/jpm.2011.015. Epub 2011 Mar 11.
Cervical cancer in second trimester of pregnancy is an oncologic challenge. Cisplatin is recommended to prevent cancer progression. This is a series correlating in vivo cisplatin concentration in the fetomaternal compartment and in breast milk with child development.
Eight consecutive patients with cervical cancer diagnosed during the second trimester underwent conization/biopsy and/or pelvic laparoscopic lymphadenectomy (LAE). Delay of pregnancy in combination with neoadjuvant monochemotherapy was performed. After 2-4 cycles of cisplatin monochemotherapy cesarean section followed by radical hysterectomy was performed above 31 weeks of gestation. Synchronous samples from maternal blood, umbilical cord blood, and amniotic fluid were taken and analyzed. A probe of breast milk was taken from three patients. Pediatric aftercare was done every three months postpartum.
Laparoscopic LAE was uncomplicated in all patients. In seven out of eight patients lymph nodes were tumor free. Nine healthy babies were delivered. Pediatric follow-up showed normal development. Cisplatin concentrations in the umbilical cord and amniotic fluid were 31-65% and 13-42% of the amount in maternal blood, respectively. In breast milk, cisplatin was detectable in 1-10% of maternal blood concentration.
Knowledge of significant lower cisplatin concentrations in fetal compartment and normal child growth provides additional security to apply cisplatin in pregnancy. Breastfeeding cannot be recommended.
妊娠中期宫颈癌是一个肿瘤学上的挑战。推荐使用顺铂来预防癌症进展。本系列研究旨在探讨胎-母体内和顺铂在母乳中的浓度与儿童发育之间的关系。
8 例连续妊娠中期宫颈癌患者接受了宫颈锥切/活检和/或盆腔腹腔镜淋巴结切除术（LAE）。结合新辅助单药化疗延迟妊娠。在接受 2-4 个周期的顺铂单药化疗后，在 31 周以上进行剖宫产术，随后行根治性子宫切除术。从母亲血液、脐带血和羊水同步采集样本进行分析。从 3 名患者中采集了母乳探针。产后每三个月进行儿科随访。
所有患者的腹腔镜 LAE 均无并发症。8 例患者中有 7 例淋巴结无肿瘤。9 名健康婴儿分娩。儿科随访显示正常发育。脐带血和顺铂在羊水的浓度分别为母体血液浓度的 31-65%和 13-42%。在母乳中，顺铂的浓度为母体血液浓度的 1-10%。
胎体和顺铂浓度显著降低以及儿童生长正常，为在妊娠中应用顺铂提供了额外的安全性。不推荐母乳喂养。
