Abstract
Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.
Highlights
Breast cancer is the most common malignancy occurring in the course of gestation, with approximately 1,400 new diagnoses every year in Europe [1, 2]
21 (70.0%) PrBC were treated with adjuvant CT during gestation (including taxanes in 7 (33.3%) cases)
The clinical management of this condition, especially in the first three months of gestation, is fairly challenging with limited therapeutic options [40]. In this context, when the tumor is small, a conservative surgical approach could be employed as in the non-pregnant setting, considering the possible complications after mastectomy, which could be worrisome during pregnancy [41]
Summary
Breast cancer is the most common malignancy occurring in the course of gestation, with approximately 1,400 new diagnoses every year in Europe [1, 2]. Delayed diagnosis is responsible for the worse outcome of PrBC compared to pregnancy-unrelated breast cancer, but stage-normalized survival is not different from that of age-matched non-pregnant controls [7,8,9,10,11,12]. Surgery is feasible and relatively safe at any stage of gestation, even if it might slightly increase the risk of pregnancy loss in the first trimester (1.0-2.0%) and might lead to premature birth in 1.5-2.0% of cases when performed in the second/third trimester [17, 26,27,28]. Mastectomy is often proposed during the first trimester of pregnancy, regardless of the tumor stage, to reduce the risks of a delayed RT [14, 25, 26, 29,30,31]. The choice of the optimal surgical approach during the first trimester of pregnancy remains a matter of controversy
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