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Pregnancy in women with gliomas: a case-series and review of the literature

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Abstract

The occurrence of pregnancy in women with brain tumors confronts both patients and physicians with difficult decision making at each stage of pregnancy. We studied the course of events of nine pregnancies in seven women with low-grade glioma in our hospital over a 10 year period. Five patients had a surgical resection, one a biopsy and one woman was followed by wait-and-see policy before pregnancy. In two women, a therapeutic abortion was carried out in the first trimester because of signs of progression, necessitating surgical removal of the tumor. In the other five women pregnancy had an uncomplicated course. Based on a literature review, we found 28 women diagnosed with a known glioma before becoming pregnant. All pregnancies but one, were uneventful and all women had a normal delivery, including the seven cases with exposure to chemotherapy and in whom healthy babies were born. A total of 75 pregnant women were identified in whom new onset glioma developed, which was high-grade in 56 %, and becoming symptomatic in 51 % during the third trimester, usually by focal neurological deficits. We conclude that in relation to pregnancy, low-grade gliomas are more often seen in women already known with a brain tumor, while high-grade gliomas represent more frequently a new onset phenomenon. Based on these observations, guidelines are given on initiation of antitumor therapy during pregnancy, seizure management, counseling on therapeutic abortion, and on the timing and choice of obstetrical interventions.

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References

  1. Cicuttini FM, Hurley SF, Forbes A et al (1997) Association of adult glioma with medical conditions, family and reproductive history. Int J Cancer 71(2):203–207

    Article  CAS  PubMed  Google Scholar 

  2. Michaud DS, Gallo V, Schlehofer B, Tjønneland A, Olsen A, Overvad K, Dahm CC, Kaaks R, Lukanova A, Boeing H, Schütze M, Trichopoulou A, Bamia C, Kyrozis A, Sacerdote C, Agnoli C, Palli D, Tumino R, Mattiello A, Bueno-de-Mesquita HB, Ros MM, Peeters PH, van Gils CH, Lund E, Bakken K, Gram IT, Barricarte A, Navarro C, Dorronsoro M, Sánchez MJ, Rodríguez L, Duell EJ, Hallmans G, Melin BS, Manjer J, Borgquist S, Khaw KT, Wareham N, Allen NE, Tsilidis KK, Romieu I, Rinaldi S, Vineis P, Riboli E (2010) Reproductive factors and exogenous hormone use in relation to risk of glioma and meningioma in a large European cohort study. Cancer Epidemiol Biomarkers Prev 19(10):2562–2569

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Chauduri P, Wallenburg HC (1980) Brain tumors and pregnancy. Presentation of a case and a review of the literature. Eur J Obstet Gynecol Reprod Biol 11(2):109–114

    Article  Google Scholar 

  4. Haas JF, Jänisch W, Staneczek W (1986) Newly diagnosed primary intracranial neoplasms in pregnant women: a population-based assessment. J Neurol Neurosurg Psychiatry 49(8):874–880

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Goroszeniuk T, Howard RS, Wright JT (1986) The management of labour using continuous lumbar epidural analgesia in a patient with a malignant cerebral tumour. Anaesthesia 41(11):1128–1129

    Article  CAS  PubMed  Google Scholar 

  6. Roelvink NC, Kamphorst W, van Alphen HA, Rao BR (1987) Pregnancy-related primary brain and spinal tumors. Arch Neurol 44(2):209–215

    Article  CAS  PubMed  Google Scholar 

  7. Cook HE 3rd (1989) Cesarean section in a patient with brain tumor: a clinical report. Mil Med 154(6):330–331

    PubMed  Google Scholar 

  8. Warnick RE, Raisanen J, Adornato BT, Prados MD, Davis RL, Larson DA, Gutin PH (1993) Intracranial myxopapillary ependymoma: case report. J Neurooncol 15(3):251–256

    Article  CAS  PubMed  Google Scholar 

  9. Depret-Mosser S, Jomin M, Monnier JC et al (1993) Apropos of 8 cases [Article in French]. J Gynecol Obstet Biol Reprod (Paris) 22(1):71–80

    CAS  Google Scholar 

  10. Atanassoff PG, Alon E, Weiss BM, Lauper U (1994) Spinal anaesthesia for caesarean section in a patient with brain neoplasma. Can J Anaesth 41(2):163–164

    Article  CAS  PubMed  Google Scholar 

  11. Wegner-Kempf E, Sachsenheimer W (1995) Malignant glioma in pregnancy. Med Welt 46(1):48–50 (in German)

    Google Scholar 

  12. Sneed PK, Albright NW, Wara WM, Prados MD, Wilson CB (1995) Fetal dose estimates for radiotherapy of brain tumors during pregnancy. Int J Radiat Oncol Biol Phys 32(3):823–830

    Article  CAS  PubMed  Google Scholar 

  13. Opeskin K, Ruszkiewicz A, Anderson RM (1995) Sudden death due to undiagnosed medullary-pontine astrocytoma. Am J Forensic Med Pathol 16(2):168–171

    Article  CAS  PubMed  Google Scholar 

  14. Nishio S, Morioka T, Suzuki S, Takeshita I, Ikezaki K, Fukui M, Nakano H (1996) Primary brain tumours manifesting during pregnancy: presentation of six cases and a review of the literature. J Clin Neurosci 3(4):334–337

    Article  CAS  PubMed  Google Scholar 

  15. Isla A, Alvarez F, Gonzalez A, García-Grande A, Perez-Alvarez M, García-Blazquez M (1997) Brain tumour and pregnancy. Obstet Gynecol 89(1):19–23

    Article  CAS  PubMed  Google Scholar 

  16. No authors listed (1999) Astrocytoma in pregnancy. Consultant 39(12):3401

    Google Scholar 

  17. Tewari KS, Cappuccini F, Asrat T et al (2000) Obstetric emergencies precipitated by malignant brain tumours. Ann J Obstet Gynecol 182(5):1215–1221

    Article  CAS  Google Scholar 

  18. Muzumdar DP, Goel A, Pakhmode CK (2003) Oligodendroglioma causing calvarial erosion. Neurol India 51(1):129–130

    CAS  PubMed  Google Scholar 

  19. Vougioukas VI, Kyroussis G, Glasker S, Tatagiba M, Scheufler KM, Peter Vandertop W et al (2004) Neurosurgical interventions during pregnancy and the puerperium: clinical considerations and management. Acta Neurochir 146(12):1287–1292

    Article  CAS  PubMed  Google Scholar 

  20. Haba Y, Twyman N, Thomas SJ, Overton C, Dendy P, Burnet NG (2004) Radiotherapy for glioma during pregnancy: fetal dose estimates, risk assessment and clinical management. Clin Oncol (R Coll Radiol) 16(3):210–214

    Article  CAS  Google Scholar 

  21. Dahiya K, Sindhwani R, Sharma D, Sirohiwal D, Madan S (2005) Glioma in pregnancy. J Gynecol Surg 21(4):177–180

    Article  Google Scholar 

  22. McEwan A (2005) Cancer in pregnancy. Curr Obstet Gynaecol 15(6):402–408

    Article  Google Scholar 

  23. Mackenzie AP, Levine G, Garry D, Figueroa R (2005) Glioblastoma multiforme in pregnancy. J Matern Fetal Neonatal Med 17(1):81–83

    Article  PubMed  Google Scholar 

  24. Ducray F, Colin P, Cartalat-Carel S et al (2006) Management of malignant gliomas diagnosed during pregnancy. Rev Neurol (Paris) 162(3):322–329 (in French)

    Article  CAS  Google Scholar 

  25. Blumenthal DT, Parreňo MGH, Batten J, Chamberlain MC (2008) Management of malignant gliomas during pregnancy: a case series. Cancer 113(12):3349–3354

    Google Scholar 

  26. Pallud J, Duffau H, Razak RA et al (2009) Influence of pregnancy in the behaviour of diffuse gliomas: clinical cases of a French glioma study group. J Neurol 256:2014–2020

    Article  PubMed  Google Scholar 

  27. French JLH, McCullough J, Bachra P, Bedforth NM (2009) Transverses abdominis plane block for analgesia after caesarean section in a patient with an intracranial lesion. Int J Obstet Anesth 18(1):52–54

    Article  CAS  PubMed  Google Scholar 

  28. Stevens GHJ, Lupica K, Chao S, Vogelbaum MA (2009) Newly diagnosed pregnancy and glioblastoma multiforme (GBM): an ethical collision course. Neuro Oncol 11(6):936–937

    Google Scholar 

  29. Luis SA, Christie DR, Kaminski A, Kenny L, Peres MH (2009) Pregnancy and radiotherapy: management options for minimising risk, case series and comprehensive literature review. J Med Imaging Radiat Oncol 53(6):559–568

    Article  CAS  PubMed  Google Scholar 

  30. Cohen-Gadol AA, Friedman JA, Friedman JD, Tubbs SR, Munis JR, Meyer FB (2009) Neurosurgical management of intracranial lesions in the pregnant patient: a 36-year institutional experience and review of the literature. J Neurosurg 111(6):1150–1157

    Article  PubMed  Google Scholar 

  31. Johnson N, Sermer M, Lausman A, Maxwell C (2009) Obstetric outcomes of women with intracranial neoplasms. Int J Gynecol Obstet 105:56–59

    Article  Google Scholar 

  32. Lew PS, Tan WS, Tan WK, Tan HK (2010) Dilemmas in management of brain tumours in pregnancy. Ann Acad Med 39(1):9

    Google Scholar 

  33. Evans A, Dhall G, Finlay J, Wong K, McComb G (2010) Pregnancy in a patient with anaplastic oligodendroglioma taking temozolomide: a case report. Neuro Oncol 12:iv100–iv101

    Google Scholar 

  34. Lynch JC, Gouvèa F, Emmerich JC et al. (2010) Management strategy for brain tumour diagnosed during pregnancy. British J Neurosurg; Early Online 1–6

  35. Elwatidy S, Jamjoom Z, Elgamal E, Abdelwahab A (2011) Management strategies for acute brain lesions presenting during pregnancy: a case series. British J Neurosurg; Early Online 1–10

  36. Pallud J, Mandonnet E, Deroulers C et al (2010) Association des Neuro-Oncologues d’Expression Française (ANOCEF). Pregnancy increases the growth rates of World Health Organization grade II gliomas. Ann Neurol 67(3):398–404

    PubMed  Google Scholar 

  37. Frikha N, Drira M, Gargouri F, Ben Farhat L, Ouerghi S, Ben Ammar MS (2010) Convulsive crisis of a parturient taken for the account of an eclampsia: discovery of a cerebral tumour in post partum. Tunis Med 88(6):450–451 (in French)

    PubMed  Google Scholar 

  38. McGrane J, Bedford T, Kelly S (2012) Successful pregnancy and delivery after concomitant temozolomide and radiotherapy treatment of glioblastoma multiforme. Clin Oncol (R Coll Radiol) 24(4):311. doi:10.1016/j.clon.2012.01.005

    Article  CAS  Google Scholar 

  39. Stevenson CB, Thompson RC (2005) The clinical management of intracranial neoplasms in pregnancy. Clin Obstet Gynecol 38(1):24–37

    Article  Google Scholar 

  40. Terry AR, Barker FG 2nd, Leffert L, Batemann BT, Souter I, Plotkin SR (2012) Outcomes of hospitalization in pregnant women with CNS neoplasms: a population-based study. Neuro Oncol 14(6):768–776

    Article  PubMed Central  PubMed  Google Scholar 

  41. Smith KC (2010) The management of seizures in brain tumour patients. J Neurosci Nurs 42(1):28–37

    Article  PubMed  Google Scholar 

  42. Tomson T, Landmark CJ, Battino D (2013) Antiepileptic drug treatment in pregnancy: changes in drug disposition and their clinical implications. Epilepsia 54(3):405–414. doi:10.1111/epi.12109

    Article  CAS  PubMed  Google Scholar 

  43. Stupp R, Tonn JC, Brada M, Pentheroudakis G, ESMO Guidelines Working Group (2010) High-grade malignant glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v190–v193. doi:10.1093/annonc/mdq187

    Article  PubMed  Google Scholar 

  44. Soffietti R, Baumert BG, Bello L, von Deimling A, Duffau H, Frénay M, Grisold W, Grant R, Graus F, Hoang-Xuan K, Klein M, Melin B, Rees J, Siegal T, Smits A, Stupp R, Wick W, European Federation of Neurological Societies (2010) Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force. Eur J Neurol 17(9):1124–1133. doi:10.1111/j.1468-1331.2010.03151.x

    Article  CAS  PubMed  Google Scholar 

  45. Kanal E (1994) Pregnancy and the safety of magnetic resonance imaging. Magn Reson Imaging Clin N Am 2(2):309–317

    CAS  PubMed  Google Scholar 

  46. Pallud J, Taillandier L, Capelle L, Fontaine D, Peyre M, Ducray F, Duffau H, Mandonnet E (2012) Quantitative morphological MRI follow-up of low-grade glioma: a plead for systematic measurement of growth rates. Neurosurgery 71(3):729–739

    Article  PubMed  Google Scholar 

  47. Bonfield CM, Engh JA (2012) Pregnancy and brain tumors. Neurol Clin 30(3):937–946

    Article  PubMed  Google Scholar 

  48. Roth P, Junker M, Tritschler I, Mittelbron M, Dombroski Y, Breit SN, Tabatabai G, Wick W, Weller M, Wischhusen J (2012) GDF-15 contributes to proliferation and immune escape of malignant gliomas. Clin Cancer Res 16(15):3851–3859

    Article  Google Scholar 

  49. Ruddon RW, Anderson C, Meade-Cobun KS (1980) Stimulation of synthesis and secretion of chorionic gonadotropin subunits by eutopic and ectopic hormone-producing human cell lines. Cancer Res 40(12):4519–4523

    CAS  PubMed  Google Scholar 

  50. Jayasekera BAP, Bacon AD, Whitfield PC (2012) Management of glioblastoma multiforme in pregnancy. A review. J Neurosurg 116(6):1187–1194

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Medical Center Haaglanden, Lijnbaan 32, 2512 VK, The Hague, The Netherlands

    Hanneke Zwinkels, Martin J. B. Taphoorn & Charles J. Vecht

  2. PO Box 432, 2501 CK, The Hague, The Netherlands

    Hanneke Zwinkels, Joep Dörr & Fred Kloet

  3. Department of Obstetrics and Gynecology, Medical Center Haaglanden, Lijnbaan 32, 2512 VK, The Hague, The Netherlands

    Joep Dörr

  4. Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VK, The Hague, The Netherlands

    Fred Kloet

  5. Department of Neurosurgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 3-11, 2625 AD, Delft, The Netherlands

    Fred Kloet

  6. Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands

    Martin J. B. Taphoorn

  7. Service Neurologie Mazarin, CHU Pitié-Salpêtrière, 47- 83 Bld. de l’Hopital, 75651, Paris Cedex, France

    Charles J. Vecht

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  1. Hanneke Zwinkels
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Correspondence to Hanneke Zwinkels.

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Zwinkels, H., Dörr, J., Kloet, F. et al. Pregnancy in women with gliomas: a case-series and review of the literature. J Neurooncol 115, 293–301 (2013). https://doi.org/10.1007/s11060-013-1229-9

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  • DOI: https://doi.org/10.1007/s11060-013-1229-9

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