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      Locoregional treatment of breast cancer during pregnancy

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          Abstract

          The management of patients with breast cancer during pregnancy is very demanding and it should be better performed in highly qualified and experienced centers. Referral to institutes and physicians trained in this special clinical scenario allows reducing the risk of both overtreating and undertreating the patients. Moreover, patients can receive appropriate information regarding safety of treatments without old-fashioned taboo. The purpose of the current paper is to discuss the main issues concerning surgical management and in general locoregional treatment of patients diagnosed with breast cancer and treated during gestation, focusing on those women who chose to continue their pregnancy. We cover the issues regarding type of breast surgery, radiation therapy, immediate reconstruction during mastectomy, and management of the axilla.

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          Use of chemotherapy during human pregnancy.

          Audrey Iacobucci, Elyce Cardonick (2004)
          When cancer is diagnosed in a pregnant woman, life-saving chemotherapy for the mother poses life-threatening concerns for the developing fetus. Depending on the type of cancer and the stage at diagnosis, chemotherapy cannot necessarily be delayed until after delivery. Women diagnosed with acute lymphoblastic leukaemia who decline both termination and chemotherapy often die with the previable fetus in utero. Safe use of chemotherapy, especially during the second and third trimester, have been reported, and pregnant women with cancer can accept therapy without definite neonatal harm. Here, we review the use of chemotherapy in pregnancy by trimester of exposure and summarise neonatal outcomes, including malformations, perinatal complications, and oldest age of neonatal follow-up. We will also discuss the modes of action of the drugs used and look at the multiagent regimens recommended for use during pregnancy.
          Article 0 comments Cited 125 times – based on 0 reviews     Review now
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            The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review of the literature.

            Zheng Chen, Will King, Robert Pearcey … (2008)
            To synthesize the direct clinical evidence relating waiting times (WTs) for radiotherapy (RT) to the outcomes of RT. We did a systematic review of the literature between 1975 and 2005 to identify clinical studies describing the relationship between WTs and outcomes of RT. Only high quality (HQ) studies that had adequately controlled for confounding factors were included in the primary analysis. WTs that had originally been reported as a categorical variable were converted to a continuous variable based on the distribution of WTs in each category. Meta-analyses were done using a fixed-effect model. The systematic review identified 44 relevant studies. Meta-analyses of 20 HQ studies of local control demonstrated a significant increase in the risk of local failure with increasing WT, RRlocal recurrence/month =1.14, 95% Confidence Intervals (CI): 1.09-1.21. For post-operative RT for breast cancer; RRlocal recurrence/month =1.11, 95%CI: 1.04-1.19. For post-operative RT for head and neck cancer, RRlocal recurrenc/month =1.28, 95%CI: 1.08-1.52. For definitive RT for head and neck cancer, RRlocal recurrence/month =1.15, 95%CI: 1.02-1.29. There was little evidence of any association between WTs and the risk of distant metastasis. Meta-analyses of the 6 HQ studies of breast cancer showed RRmetastasis/month =1.04, 95%CI: 0.98-1.09. Meta-analyses of 4 HQ studies of breast cancer showed no significant decrease in survival with increasing WT, RRdeath/month =1.06, 95%CI: 0.97-1.16, but there was a marginally significant decrease in survival in 4 HQ studies of head and neck cancer, RRdeath/month =1.16, 95%CI: 1.02-1.32. The risk of local recurrence increases with increasing WTs for RT. The increase in local recurrence rate may translate into decreased survival in some clinical situations. WTs for RT should be as short as reasonably achievable.
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              Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study.

              Frédéric Amant, Gunter von Minckwitz, Sileny Han … (2013)
              We aimed to determine the prognosis of patients with breast cancer diagnosed during pregnancy (BCP). In this cohort study, a multicentric registry of patients with BCP (from Cancer in Pregnancy, Leuven, Belgium, and GBG 29/BIG 02-03) compiled pro- and retrospectively between 2003 and 2011 was compared with patients who did not have associated pregnancies, using an age limit of 45 years. Patients with a diagnosis postpartum were excluded. The main analysis was performed using Cox proportional hazards regression of disease-free survival (DFS) and overall survival (OS) on exposure (pregnant or not), adjusting for age, stage, grade, hormone receptor status, human epidermal growth factor 2 status, histology, type of chemotherapy, use of trastuzumab, radiotherapy, and hormone therapy. The registry contained 447 women with BCP, mainly originating from Germany and Belgium, of whom 311 (69.6%) were eligible for analysis. The nonpregnant group consisted of 865 women. Median age was 33 years for the pregnant and 41 years for the nonpregnant patients. Median follow-up was 61 months. The hazard ratio of pregnancy was 1.34 (95% CI, 0.93 to 1.91; P = .14) for DFS and 1.19 (95% CI, 0.73 to 1.93; P = .51) for OS. Cox regression estimated that the 5-year DFS rate for pregnant patients would have increased from 65% to 71% if these patients had not been pregnant. Likewise, the 5-year OS rate would have increased from 78% to 81%. The results show similar OS for patients diagnosed with BCP compared with nonpregnant patients. This information is important when patients are counseled and supports the option to start treatment with continuation of pregnancy.
              Article 0 comments Cited 95 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Antonio Toesca: +390257489247 , antonio.toesca@ieo.it
                Journal
                Journal ID (nlm-ta): Gynecol Surg
                Journal ID (iso-abbrev): Gynecol Surg
                Title: Gynecological Surgery
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 1613-2076
                ISSN (Electronic): 1613-2084
                Publication date (Electronic): 30 September 2014
                Publication date PMC-release: 30 September 2014
                Publication date (Print): 2014
                Volume: 11
                Issue: 4
                Pages: 279-284
                Affiliations
                [ ]Division of Breast Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
                [ ]Department of Gynecological Oncology, European Institute of Oncology, Milan, Italy
                [ ]Department of Medicine, BrEAST Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
                [ ]Multidisciplinary Breast Center, Leuven Cancer Institute (LKI), UZ Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
                Article
                Publisher ID: 860
                DOI: 10.1007/s10397-014-0860-6
                PMC ID: 4237906
                PubMed ID: 25419205
                SO-VID: f82073d7-5549-4cca-9800-8172c83ca006
                Copyright © © The Author(s) 2014
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                Date received : 19 September 2013
                Date accepted : 17 September 2014
                Categories
                Subject: Review Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag Berlin Heidelberg 2014

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: breast cancer,pregnancy,chemotherapy,radiation therapy
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: breast cancer, pregnancy, chemotherapy, radiation therapy

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