title: Delivery delay with neoadjuvant chemotherapy for cervical cancer patients during pregnancy: a series of nine cases and literature review.
abstract: OBJECTIVE
  Treatment of locally invasive cervical cancer diagnosed during pregnancy in women who desire to retain their pregnancy is a major challenge to physicians. Neoadjuvant chemotherapy followed by radical hysterectomy has been reported to be an attractive option to delay delivery until fetal viability has been reached.
  
  
  METHODS
  Between 1994 and 2009 9 patients were treated at San Gerardo Hospital (Monza, Italy) for cervical cancer during pregnancy.
  
  
  RESULTS
  FIGO stage was IB1 in four patients and IB2 in five. Tumor diameter ranged between 20 and 70 mm. After neoadjuvant platinum-based chemotherapy partial response was achieved in 5 patients, while 4 had a stable disease. One patient received a second-line chemotherapy during pregnancy due to progressive disease, achieving a partial response. Median duration of therapy delay until cesarean section was 16 weeks. Between 30 and 36 weeks of gestation all patients underwent cesarean section. Piver II radical hysterectomy with pelvic lymphadenectomy was performed. Two children had mild perinatal morbidities and were discharged in good conditions after 14 and 40 days. Three patients received adjuvant therapy for pathological risk factors. Four patients relapsed (44%) and two of them (23%) died because of tumor progression.
  
  
  CONCLUSIONS
  During pregnancy, the oncological outcome of cervical cancer patients is similar to non-pregnant ones. Chemotherapy does not seem to affect fetal health and development, even if longer follow-up is required. Therefore, neoadjuvant chemotherapy for the treatment of locally invasive cervical cancer during pregnancy seems to be a reasonable option for delay definitive treatment until fetal viability is obtained.
authors.affiliation: Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy. robilandia@gmail.com
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
authors.forename: Annalisa
authors.initials: A
authors.lastname: Villa
authors.forename: Stefania
authors.initials: S
authors.lastname: Chiari
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vergani
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ceppi
authors.forename: Federica
authors.initials: F
authors.lastname: Dell'Orto
authors.forename: Tiziana
authors.initials: T
authors.lastname: Dell'Anna
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiappa
authors.forename: Cristina Maria
authors.initials: CM
authors.lastname: Bonazzi
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
authors.forename: Costantino
authors.initials: C
authors.lastname: Mangioni
authors.forename: Anna
authors.initials: A
authors.lastname: Locatelli
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery