Gineco

Morice P.

FRENCH RECOMMENDATIONS ON THE MANAGEMENT OF INVASIVE CERVICAL CANCER DURING PREGNANCY.
Morice P1, Narducci F2, Mathevet P3, Marret H4, Darai E5, Querleu D6 On the behalf of the French Working Group on Gynecological Cancers in Pregnancy, SFOG7, SFCP8, and CNGOF9. Date of publication : 16 dec.2008 Running head: Cervical cancer in pregnancy

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Institut Gustave Roussy, 39 rueCamille Desmoulins, 94805 Villejuif, France Centre Oscar Lambret, 3 rue Frédéric Combemale, 59020 Lille, France Hôpital Edouard Herriot, Place d’Arsonval, 69437 Lyon, France Hôpital Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France Hôpital Tenon, 20 rue de la Chine, 75020 Paris, France Institut Claudius Regaud, 20-24 rue du Pont Saint Pierre, 31052 Toulouse, France Société Française d’OncologieGynécologique Société Française de Chirurgie Pelvienne Collège National des Gynécologues Obstétriciens Français

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Correspondence and proofs : Philippe Morice, M.D., Department of Surgery, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France. Phone: 33.1.42.11.54.41. Fax: 33.1.42.11.52.13. Email: morice@igr.fr

Key words: cervicalcancer, chemoradiation, neoadjuvant chemotherapy, pregnancy, preservation, staging procedures.

Cervical cancer in pregnancy- 16 dec.2008

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Morice P.

Abstract: Background: Cervical cancer is one of the most frequently diagnosed cancers during pregnancy but the management of such cases remains unclear. A Working Group was set up in 2007 in France to propose national recommendations forthe management of pregnant patients with invasive cervical carcinoma. Methods: The recommendations are based on this literature review conducted by the members of the Working Group. Results: Management of cervical cancer during pregnancy depends on 5 factors : stage of the disease (and the tumor size), nodal status, histologic subtype of the tumor, term of the pregnancy and on whether the patientwishes to continue her pregnancy. In patients with early stage disease diagnosed during the first 2 trimesters of pregnancy, there is an increasing tendency to preserve the pregnancy while awaiting fetal maturity in patients with absence of nodal involvement. The delivery (when the fetal maturity is attained) should be then performed using a caesarian section. Conclusions: This article proposesrecommendations for the management of pregnant patients with invasive cervical cancer. These recommendations have been validated by the 3 main scientific societies of gynecologic oncology, pelvic surgery and obstetrics and gynecology in France.

Cervical cancer in pregnancy- 16 dec.2008

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Morice P.

Cervical cancer is one of the most frequently diagnosed cancers during pregnancy alongwith breast cancer, lymphoma and melanoma (1). However, the real incidence of invasive cervical cancer remains unknown because studies of a large cohort of pregnant patients focusing on the incidence of malignancies have never been performed. The management of such patients also remains unclear because all the published series are retrospective, some of them including both invasive and preinvasivelesions whereas others mixed cases of cancer diagnosed during the pregnancy or during the post-partum period. To date, the management of pregnant patients with cervical cancer diagnosed during the first 2 trimesters of pregnancy usually signified the interruption of the pregnancy and treatment of the cervical tumor. However, recent papers indicate an increasing tendency to preserve the pregnancywhile awaiting fetal maturity before treating the cervical cancer in patients with early stage disease. This is a crucial point in patients who will be definitely deprived of future fertility after the treatment of their cervical cancer. The incidence of cervical lesions discovered in pregnant patients is unknown. In order to clarify many of the remaining unanswered questions on the incidence and...