Long-term multidisciplinary integrative therapy management resulted in favorable outcomes for ovarian cancer during pregnancy: a case report and literature review

Tianmin Xu,Zhuo Li,Yan Jia,Shaohai Cui,Manhua Cui,Zanhui Jia,Liang Wang

doi:10.1186/s13048-019-0584-3

Tianmin Xu, Zhuo Li + Show 5 more

Open Access

https://doi.org/10.1186/s13048-019-0584-3

Copy DOI

Abstract

BackgroundOvarian cancer during pregnancy is relatively rare and treatment strategies are inexperienced in surgery and chemotherapy. Multidisciplinary management of advanced epithelial ovarian cancer in pregnant patients with strong desire of fertility including sufficient mental and medical understanding, perioperative consideration, intraoperative decision, chemotherapy sensitivity and follow-up after treatment can gain successful outcomes for both maternal disease and fetus’s development.Case presentationA 34-year-old primigravidae was diagnosed with advanced epithelial ovarian tumor and then first cytoreductive surgery to resect macroscopical lesions and protect the uterus for fetus was performed following with four chemotherapy courses (docetaxel and carboplatin) before delivery and four other chemotherapy courses after delivery. Chemotherapy drugs were decided by sensitivity test and the patient’s anaphylaxis. Second surgery involved cesarean section with a healthy offspring and secondary cytoreductive surgery. Operative strategies were considered to gain a balance of disease and risk for fetus. Psychosocial support was provided during the course of diagnosis and treatment for a healthy coping situation. This patient relapsed 19 months after the last chemotherapy course and was treated by additional adjuvant therapy to a clinical remission. The 33-month baby boy has no evidence with disease until now. The follow-up of both mother and baby is still continuing.ConclusionsOvarian cancer during pregnancy has low incidence which must increase in future as women delay reproduction age. Ovarian cancer cytoreductive surgery and chemotherapy have limitation to handle conditions under a desire of fetus protection. Multidisciplinary treatment model is a therapeutic solution and a challenge for gynecological surgeons, medical oncologists, pathologists, obstetricians, neonatologists, pharmacists, anesthetist, and psychologists.

Highlights

Ovarian cancer during pregnancy is relatively rare and treatment strategies are inexperienced in surgery and chemotherapy
Ovarian cancer during pregnancy has low incidence which must increase in future as women delay reproduction age
Chemotherapy during pregnancy with docetaxel and carboplatin which was first administrated for ovarian cancer during pregnancy and a normal offspring was born in this case which showed experience of diagnosis, therapeutic timing, methods and negative effects of surgery and adjuvant therapy

Summary

Introduction

Ovarian cancer during pregnancy is relatively rare and treatment strategies are inexperienced in surgery and chemotherapy. Conclusions: Ovarian cancer during pregnancy has low incidence which must increase in future as women delay reproduction age. Ovarian cancer cytoreductive surgery and chemotherapy have limitation to handle conditions under a desire of fetus protection.

Results

Conclusion