NEOADJUVANT CHEMOTHERAPY IN THE TREATMENT OF LOCALLY ADVANCED CERVICAL-CARCINOMA IN PREGNANCY - A REPORT OF 2 CASES AND REVIEW OF ISSUES SPECIFIC TO THE MANAGEMENT OF CERVICAL-CARCINOMA IN PREGNANCY INCLUDING PLANNED DELAY OF THERAPY

BACKGROUND, Women diagnosed with invasive cervical carcinoma during pr egnancy are faced with difficult decisions regarding therapy and the f ate of their unborn child. A modest treatment delay for International Federation of Gynecology and Obstetrics Stage I cervical lesions is co nsidered acceptable in patients who wish to continue their pregnancy. METHODS, Two patients with locally advanced cervical carcinoma diagnos ed early in the second trimester strongly desired continuation of thei r pregnancies. They were treated with neoadjuvant chemotherapy until t he third trimester, and then underwent delivery and definitive surgica l treatment. The patients were evaluated during pregnancy for evidence of a clinical response to chemotherapy. Intraoperative findings and p athologic analysis of the surgical material provided further objective data regarding disease status. RESULTS, Both patients experienced a d ramatic reduction in tumor volume, rendering radical hysterectomy feas ible at the time of cesarean section. In addition, both patients toler ated chemotherapy well and there were no adverse fetal effects. Favora ble neonatal outcomes were achieved. One patient experienced recurrenc e within 5 months of surgery, whereas the other patient remained witho ut evidence of disease for 2 years. CONCLUSIONS. To the authors' knowl edge, these reports constitute the first description of the use of neo adjuvant chemotherapy for invasive squamous cell carcinoma of the cerv ix in pregnancy (MEDLINE 1966-1997). This therapeutic option should be considered in selected women with locally advanced cervical carcinoma who do not want termination of their pregnancy. (C) 1998 American Can cer Society.