A comprehensive review of childbearing after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Our plain-English summary of A comprehensive review of childbearing after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, by D. Papageorgiou, D.K. Manatakis, K. Papakonstantinou, et al (Archives of Gynecology and Obstetrics, 2020).

The study

• Authors: D. Papageorgiou, D.K. Manatakis, K. Papakonstantinou, I.D. Kyriazanos
• Journal: Archives of Gynecology and Obstetrics
• Published: 2020;302(4):793-799
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Our aim is to present a review on childbearing following CRS and HIPEC for peritoneal malignancy.

Methods: A review of the English literature, up to December 2019, was conducted, using PubMed/MEDLINE, EmBase and Google Scholar bibliographic databases, following the MOOSE guidelines. The terms "Cytoreductive Surgery", "Hyperthermic Intraperitoneal Chemotherapy", "Peritoneal Carcinomatosis", "Pregnancy", "Fertility Preservation", "Conception" were used. All study designs were eligible for inclusion in the final analysis.

Results: In total, 7 studies (5 case reports and 2 case series) were included in the final analysis, reporting on 14 successful pregnancies after CRS and HIPEC. The mean age of patients at the time of CRS/HIPEC was 28.8 ± 5.9 years (range 18-36), while the mean interval between CRS/HIPEC and pregnancy was 29.6 ± 20.3 months (range 9-80 months). Nine patients were treated for pseudomyxoma peritonei, four for primary peritoneal mesothelioma and one for endocrine carcinoma. Mean Peritoneal Carcinomatosis Index was 9.8 ± 7.8 (range 1-26). All patients underwent fertility-sparing CRS (preservation of at least one ovary and the uterus). In 12 cases, conception was spontaneous, whereas two pregnancies were achieved through in-vitro fertilization. One patient developed gestational hypertension, while two labors were preterm. Mean disease-free survival was 64.1 months (range 24-106 months).

Conclusion: A successful pregnancy is feasible in selected patients, after CRS and HIPEC. Assisted reproduction techniques (IVF using frozen oocytes or frozen embryos, ovarian tissue cryopreservation, preoperative treatment with GnRH analogs) should be discussed pre-operatively with the patient, without, however, compromising overall survival or risking locoregional recurrence.

In plain English

This was a review of published reports of women who became pregnant after cytoreductive surgery (CRS, an operation removing visible tumor inside the abdomen) followed by heated chemotherapy delivered into the abdomen (HIPEC). The authors searched the English-language literature up to December 2019 and found seven studies, five case reports and two case series, describing 14 pregnancies. Nine women had been treated for pseudomyxoma peritonei, four for peritoneal mesothelioma and one for endocrine carcinoma. Cisplatin was used in all the mesothelioma cases. Mean age at treatment was 28.8 years, and pregnancy followed 9 to 80 months later. Twelve women conceived without assistance and two through in-vitro fertilization. One woman developed high blood pressure in pregnancy and two births were preterm. One baby had a congenital diaphragmatic hernia and one premature baby had a Streptococcus bovis infection. Mean disease-free survival was 64.1 months. The authors concluded that pregnancy is feasible in selected patients after CRS and HIPEC, and said their review is limited by its small sample size.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Literature review of published case reports and case series, following the MOOSE guidelines
• Who was studied: 14 pregnancies in women previously treated with CRS and HIPEC, reported in 7 published studies (5 case reports, 2 case series) from the USA, France, Brazil and Spain, published 2006 to 2019. Mean age at treatment was 28.8 plus or minus 5.9 years (stated range 18 to 36).
• Exposure: Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy. Cisplatin was used in all mesothelioma cases. In eight pseudomyxoma peritonei cases, mitomycin-C, oxaliplatin, or mitomycin-C plus cisplatin was used. The article does not address asbestos exposure.
• Main results:
  • Treatment indications among the 14 women: 9 pseudomyxoma peritonei, 4 peritoneal mesothelioma, 1 endocrine carcinoma
  • According to the results text, all but one patient had fertility-sparing surgery that preserved at least one ovary and the uterus
  • Mean Peritoneal Carcinomatosis Index score was 9.8 plus or minus 7.8 (range 1 to 26)
  • Time from CRS/HIPEC to pregnancy ranged from 9 to 80 months, with a mean of 29.5 plus or minus 20.3 months
  • Of the 14 pregnancies, 12 were conceived spontaneously and 2 through in-vitro fertilization
  • Eight pregnancies were uneventful and one woman developed gestational arterial hypertension (data missing for 3). Two births were preterm, by 1 month and 2 months.
  • There were 3 caesarean sections and 6 vaginal deliveries (data missing for 5)
  • One full-term newborn had congenital diaphragmatic hernia. One preterm newborn was admitted to intensive care 5 hours after delivery with Streptococcus bovis infection.
  • Mean maternal disease-free survival was 64.1 months (range 24 to 106 months)
• The authors' conclusion: The authors concluded that a successful pregnancy is feasible in selected patients after CRS and HIPEC. They also wrote that assisted reproduction or protective procedures should be offered, without risking recurrence or compromising overall survival.
• Limitations the authors state:
  • Small sample size
  • The evidence consists of case reports and small case series, which the authors describe as low quality

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Carcinoma, Disease-Free Survival, Overall Survival.

Related studies

• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma — Y. Huang, N.A. Alzahrani, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)

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