Department of Obstetrics and Gynecology, Zhongda Hospital, Southeast University, Nanjing, China.
Novant Health Maternal Fetal Medicine, Winston-Salem, North Carolina, USA.
Cancer Rep (Hoboken). 2024 Nov;7(11):e70021. doi: 10.1002/cnr2.70021.
Previous studies mainly concentrate on neoadjuvant chemotherapy (NACT) for delivery delay in FIGO Stage IB1-IIIB cervical cancer during pregnancy to prevent early preterm delivery while not affecting maternal outcome.
Here, we described two pregnant patients with FIGO Stage IIIC cervical cancer about their diagnosis, treatment, and outcome. Both patients underwent cesarean delivery, left enlarged lymph node dissection, and longitudinal monitoring by circulating tumor DNA. Our study suggested that pregnant patient was completely response to NACT, which was confirmed by ctDNA monitoring, followed by left pelvic enlarged lymph node dissection during cesarean section and adjuvant chemoradiotherapy postpartum. The infant grew normally, without any evidence of chemotherapy-related side effects after delivery.
In pregnant women with advanced cervical cancer, longitudinal ctDNA monitoring might be able to evaluate maternal response to NACT and confirm if delivery delay to optimize fetal outcome would compacting the maternal outcomes or not. Cervical cancer may not transmit across the placental barrier and so it is safe for delayed delivery until fetal maturity in utero during pregnancy.
先前的研究主要集中在妊娠期间 FIGO 分期 IB1-IIIB 宫颈癌的新辅助化疗（NACT）以延迟分娩，从而预防早产，同时不影响母婴结局。
在这里，我们描述了两名 FIGO 分期 IIIC 宫颈癌的孕妇的诊断、治疗和结局。两名患者均接受了剖宫产术、左侧肿大淋巴结清扫术，并通过循环肿瘤 DNA 进行纵向监测。我们的研究表明，孕妇对 NACT 完全有反应，这通过 ctDNA 监测得到了证实，随后在剖宫产时进行了左侧盆腔肿大淋巴结清扫术，并在产后进行辅助放化疗。婴儿生长正常，分娩后无任何化疗相关副作用的证据。
在患有晚期宫颈癌的孕妇中，纵向 ctDNA 监测可能能够评估 NACT 对母体的反应，并确认延迟分娩以优化胎儿结局是否会对母体结局产生影响。宫颈癌不会穿过胎盘屏障，因此在妊娠期间等待胎儿在宫内成熟后再延迟分娩是安全的。
