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Abstract：
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
摘要：
我们旨在提供全面的方案，并促进对患有妇科癌症的孕妇的有效管理。自2014年之前的指南发布以来，已经获得了新的见解和更多的经验。国际癌症网络成员，不孕症和妊娠（INCIP）与其他国际专家合作，回顾了他们各自专业领域的现有文献。摘要随后被合并成一份手稿，作为共识会议讨论的基础。如果通过多学科医疗保健提供者团队的合作来实现管理，则可以在怀孕期间治疗妇科癌症。这允许进一步优化产妇治疗，同时考虑胎儿发育，并为婴儿提供心理支持和长期随访。非电离成像程序是首选的诊断程序，但是，如果治疗计划不可或缺，则可以允许使用有限的电离成像方法。与其他癌症相比，妇科癌症的标准手术通常需要根据癌症类型和胎龄进行调整。大多数标准化疗方案可以在胎龄14周后施用，但不建议超过35周。大多数宫颈癌和外阴癌都推荐剖腹产，而大多数卵巢癌允许阴道分娩。母乳喂养应避免持续化疗，内分泌或靶向治疗。需要更多的研究关注妇科癌症治疗的长期毒性作用，以充分了解其对胎儿的影响。特别是,在某些妇科恶性肿瘤中成为标准治疗的靶向治疗的数据仍然有限.此外，有必要进行更多旨在确定产前癌症治疗后患者确切预后的研究.参与现有登记册(www.cancerinpregnancy.org）并鼓励与多学科护理提供者团队一起创建国家肿瘤委员会（补充方框S1，可在《肿瘤学年鉴》在线获得）。
