孕期妇科癌症：第二届国际共识会议指南

Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting.

作者信息

Amant Frédéric, Halaska Michael J, Fumagalli Monica, Dahl Steffensen Karina, Lok Christianne, Van Calsteren Kristel, Han Sileny N, Mir Olivier, Fruscio Robert, Uzan Cathérine, Maxwell Cynthia, Dekrem Jana, Strauven Goedele, Mhallem Gziri Mina, Kesic Vesna, Berveiller Paul, van den Heuvel Frank, Ottevanger Petronella B, Vergote Ignace, Lishner Michael, Morice Philippe, Nulman Irena

机构信息

*Department of Oncology, Katholieke Universiteit Leuven and Gynecologic Oncology, University Hospitals Leuven, Belgium; †Gynecologic Oncology, 2nd Medical Faculty, Charles University, Prague, Czech Republic; ‡Neonatal Intensive Care, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; §Radiotherapy and Clinical Oncology, Vejle Hospital, Vejle, Denmark; ∥Gynecological Oncology, Center for Gynecological Oncology Amsterdam, Amsterdam, The Netherlands; ¶Obstetrics, University Hospitals Leuven, Katholieke Universiteit Leuven, Belgium; #Medical Oncology, Cochin Teaching Hospital, Paris Descartes University, Paris, France; **Obstetrics and Gynecology, Ospedale San Gerardo, Monza, Italy; ††Gynecologic Surgery, Institute de Cancérologie Gustave Roussy, Villejuif, France; ‡‡Maternal Fetal Medicine Unit, Mt Sinai Hospital, Toronto, Ontario, Canada; §§Obstetrics and Gynecology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; ∥∥Department of Gynecology and Obstetrics, Hôpital Trousseau, Assistance-Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France; ¶¶Radiation Oncology, University Hospitals Leuven, Katholieke Universiteit Leuven, Belgium; ##Medical Oncology, Radboudziekenhuis, Nijmegen, The Netherlands; ***Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; and †††Clinical Pharmacology and Toxicology, Motherisk Program, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

出版信息

Int J Gynecol Cancer. 2014 Mar;24(3):394-403. doi: 10.1097/IGC.0000000000000062.

DOI:10.1097/IGC.0000000000000062

PMID:24445819

Abstract

OBJECTIVES

This study aimed to provide timely and effective guidance for pregnant women and health care providers to optimize maternal treatment and fetal protection and to promote effective management of the mother, fetus, and neonate when administering potentially teratogenic medications. New insights and more experience were gained since the first consensus meeting 5 years ago.

METHODS

Members of the European Society of Gynecological Oncology task force "Cancer in Pregnancy" in concert with other international experts reviewed the existing literature on their respective areas of expertise. The summaries were subsequently merged into a complete article that served as a basis for discussion during the consensus meeting. All participants approved the final article.

RESULTS

In the experts' view, cancer can be successfully treated during pregnancy in collaboration with a multidisciplinary team, optimizing maternal treatment while considering fetal safety. To maximize the maternal outcome, cancer treatment should follow a standard treatment protocol as for nonpregnant patients. Iatrogenic prematurity should be avoided. Individualization of treatment and effective psychologic support is imperative to provide throughout the pregnancy period. Diagnostic procedures, including staging examinations and imaging, such as magnetic resonance imaging and sonography, are preferable. Pelvic surgery, either open or laparoscopic, as part of a treatment protocol, may reveal beneficial outcomes and is preferably performed by experts. Most standard regimens of chemotherapy can be administered from 14 weeks gestational age onward. Apart from cervical and vulvar cancer, as well as important vulvar scarring, the mode of delivery is determined by the obstetrician. Term delivery is aimed for. Breast-feeding should be considered based on individual drug safety and neonatologist-breast-feeding expert's consult.

CONCLUSIONS

Despite limited evidence-based information, cancer treatment during pregnancy can succeed. State-of-the-art treatment should be provided for this vulnerable population to preserve maternal and fetal prognosis.

SUPPLEMENTARY INFORMATION

Supplementary data on teratogenic effects, ionizing examinations, sentinel lymph node biopsy, tumor markers during pregnancy, as well as additional references and tables are available at the extended online version of this consensus article, go to http://links.lww.com/IGC/A197.

摘要

目的

本研究旨在为孕妇及医疗保健人员提供及时有效的指导，以便在使用潜在致畸药物时优化母体治疗和胎儿保护，并促进对母亲、胎儿及新生儿的有效管理。自5年前首次共识会议以来，已获得了新的见解和更多经验。

方法

欧洲妇科肿瘤学会“妊娠合并癌症”特别工作组的成员与其他国际专家共同回顾了各自专业领域的现有文献。随后将这些总结合并成一篇完整的文章，作为共识会议讨论的基础。所有参与者均批准了最终文章。

结果

专家们认为，通过多学科团队协作，在孕期可以成功治疗癌症，在考虑胎儿安全的同时优化母体治疗。为使母体获得最佳结局，癌症治疗应遵循与非孕期患者相同的标准治疗方案。应避免医源性早产。在整个孕期必须进行个体化治疗并提供有效的心理支持。诊断程序，包括分期检查和影像学检查，如磁共振成像和超声检查，更为可取。作为治疗方案一部分的盆腔手术，无论是开腹手术还是腹腔镜手术，可能会带来有益的结果，且最好由专家进行。大多数标准化化疗方案可在孕14周及以后使用。除宫颈癌、外阴癌以及严重的外阴瘢痕外，分娩方式由产科医生决定。目标是足月分娩。应根据个体药物安全性并咨询新生儿科医生及母乳喂养专家的意见来考虑母乳喂养。