The complexity of management of pregnancy-associated malignant soft tissue and bone tumors.
OBJECTIVE
The incidence of musculoskeletal tumors during pregnancy is very low. The aim of this study was to summarize our experience in treating a large cohort of pregnant patients diagnosed with these rare tumors.


METHODS
Women diagnosed with musculoskeletal tumors during pregnancy or immediately after delivery were identified retrospectively in our database between 1996 and 2006. Relevant maternal and neonatal data were collected.


RESULTS
Twenty patients, 8 with bone sarcomas (BS) and 12 with soft tissue sarcomas (STS) were identified. Two women were treated by wide excision of mass during pregnancy. In all other cases oncological treatment was delayed until delivery or termination of pregnancy. Vaginal delivery was possible in 9 patients, cesarean section was performed in 7, spontaneous abortion occurred in 1, and 3 underwent termination of pregnancy. Three newborns were premature, but normal growth and development were observed. Different techniques of fertility preservation were used in our patients. Five patients with BS and 5 patients with STS received preoperative chemotherapy, with different grades of toxicity. The degree of tumor necrosis tended to correlate with dose-intensity of chemotherapy. Seven patients with BS received adjuvant chemotherapy. Two patients with STS received adjuvant chemotherapy, two - radiotherapy, and four - both modalities. Median disease-free survival was 15.1 months, median overall survival - 25.4 months.


CONCLUSIONS
Musculoskeletal tumors diagnosed during pregnancy, or after delivery, do not appear to have a significant impact on the prognosis. A multidisciplinary team should tailor the oncological approach individually.
Molho
Rinat Bernstein
RB
Unit of Bone and Soft Tissue Oncology, Division of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Kollender
Yehuda
Y
Issakov
Josephine
J
Bickels
Jacob
J
Flusser
Gideon
G
Azem
Fuad
F
Alon
Adele
A
Inbar
Moshe J
MJ
Meller
Isaac
I
Merimsky
Ofer
O
D000028:Abortion, Induced; D000328:Adult; D001859:Bone Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D036861:Delivery, Obstetric; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000401:mortality / Q000628:therapy*; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D013534:Survival