Tewari K, Cappuccini F, Gambino A, Kohler M F, Pecorelli S, DiSaia P J
Department of Obstetrics and Gynecology, University of California-Irvine Medical Center, Orange 92868, USA.
Cancer. 1998 Apr 15;82(8):1529-34. doi: 10.1002/(sici)1097-0142(19980415)82:8<1529::aid-cncr15>3.0.co;2-6.
Women diagnosed with invasive cervical carcinoma during pregnancy are faced with difficult decisions regarding therapy and the fate of their unborn child. A modest treatment delay for International Federation of Gynecology and Obstetrics Stage I cervical lesions is considered acceptable in patients who wish to continue their pregnancy.
Two patients with locally advanced cervical carcinoma diagnosed early in the second trimester strongly desired continuation of their pregnancies. They were treated with neoadjuvant chemotherapy until the third trimester, and then underwent delivery and definitive surgical treatment. The patients were evaluated during pregnancy for evidence of a clinical response to chemotherapy. Intraoperative findings and pathologic analysis of the surgical material provided further objective data regarding disease status.
Both patients experienced a dramatic reduction in tumor volume, rendering radical hysterectomy feasible at the time of cesarean section. In addition, both patients tolerated chemotherapy well and there were no adverse fetal effects. Favorable neonatal outcomes were achieved. One patient experienced recurrence within 5 months of surgery, whereas the other patient remained without evidence of disease for 2 years.
To the authors' knowledge, these reports constitute the first description of the use of neoadjuvant chemotherapy for invasive squamous cell carcinoma of the cervix in pregnancy (MEDLINE 1966-1997). This therapeutic option should be considered in selected women with locally advanced cervical carcinoma who do not want termination of their pregnancy.
孕期被诊断为浸润性宫颈癌的女性面临着关于治疗及未出生胎儿命运的艰难抉择。对于希望继续妊娠的国际妇产科联盟（FIGO）I期宫颈病变患者，适度延迟治疗被认为是可以接受的。
两名在孕中期早期被诊断为局部晚期宫颈癌的患者强烈希望继续妊娠。她们接受了新辅助化疗直至孕晚期，然后进行分娩及确定性手术治疗。在孕期对患者进行评估，以寻找化疗临床反应的证据。手术材料的术中发现及病理分析提供了关于疾病状态的进一步客观数据。
两名患者的肿瘤体积均显著缩小，使得剖宫产时可行根治性子宫切除术。此外，两名患者对化疗耐受性良好，且未对胎儿产生不良影响。获得了良好的新生儿结局。一名患者在术后5个月内复发，而另一名患者在2年内未出现疾病迹象。
据作者所知，这些报告是关于孕期宫颈浸润性鳞状细胞癌使用新辅助化疗的首次描述（MEDLINE 1966 - 1997）。对于不希望终止妊娠的选定局部晚期宫颈癌女性，应考虑这种治疗选择。
