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1. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC)

Author

Loibl, S., Azim, H.A., Jr, Bachelot, T., Berveiller, P., Bosch, A., Cardonick, E., Denkert, C., Halaska, M.J., Hoeltzenbein, M., Johansson, A.L.V., Maggen, C., Markert, U.R., Peccatori, F., Poortmans, P., Saloustros, E., Saura, C., Schmid, P., Stamatakis, E., van den Heuvel-Eibrink, M., van Gerwen, M., Vandecaveye, V., Pentheroudakis, G., Curigliano, G., and Amant, F.

Published
2023
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4. Cognitive and Behavioral Development of 9-Year-Old Children after Maternal Cancer during Pregnancy: A Prospective Multicenter Cohort Study

Author

Van Assche, I, Huis In 'T Veld, E, Van Calsteren, K, Van Gerwen, M, Blommaert, J, Cardonick, E, Halaska, M, Fruscio, R, Fumagalli, M, Lemiere, J, Van Dijk-Lokkart, E, Fontana, C, Van Tinteren, H, De Ridder, J, Van Grotel, M, Van Den Heuvel-Eibrink, M, Lagae, L, Amant, F, Van Assche I. A., Huis In 'T Veld E. A., Van Calsteren K., Van Gerwen M., Blommaert J., Cardonick E., Halaska M. J., Fruscio R., Fumagalli M., Lemiere J., Van Dijk-Lokkart E. M., Fontana C., Van Tinteren H., De Ridder J., Van Grotel M., Van Den Heuvel-Eibrink M. M., Lagae L., Amant F., Van Assche, I, Huis In 'T Veld, E, Van Calsteren, K, Van Gerwen, M, Blommaert, J, Cardonick, E, Halaska, M, Fruscio, R, Fumagalli, M, Lemiere, J, Van Dijk-Lokkart, E, Fontana, C, Van Tinteren, H, De Ridder, J, Van Grotel, M, Van Den Heuvel-Eibrink, M, Lagae, L, Amant, F, Van Assche I. A., Huis In 'T Veld E. A., Van Calsteren K., Van Gerwen M., Blommaert J., Cardonick E., Halaska M. J., Fruscio R., Fumagalli M., Lemiere J., Van Dijk-Lokkart E. M., Fontana C., Van Tinteren H., De Ridder J., Van Grotel M., Van Den Heuvel-Eibrink M. M., Lagae L., and Amant F.

Abstract

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.This multicenter cohort study reports on the long-term effects of prenatal exposure to maternal cancer and its treatment on cognitive and behavioral outcomes in 9-year-old children. In total, 151 children (mean age, 9.3 years; range, 7.8-10.6 years) were assessed using a neurocognitive test battery and parent-report behavioral questionnaires. During pregnancy, 109 children (72.2%) were exposed to chemotherapy (only or in combination with other treatment modalities), 18 (11.9%) to surgery only, 16 (10.6%) to radiotherapy, one to trastuzumab, and 16 (10.6%) were not exposed to oncologic treatment. Mean cognitive and behavioral outcomes were within normal ranges. Gestational age at birth showed a positive association with Full Scale Intelligence Quotient (FSIQ), with the average FSIQ score increasing by 1.6 points for each week increase in gestational age (95% CI, 0.7 to 2.5; P <.001). No difference in FSIQ was found between treatment types (F[4,140] = 0.45, P =.776). In children prenatally exposed to chemotherapy, no associations were found between FSIQ and chemotherapeutic agent, exposure level, or timing during pregnancy. These results indicate a reassuring follow-up during the critical maturational period of late childhood, when complex functions develop and rely on the integrity of early brain development. However, associations were observed with preterm birth, maternal death, and maternal education.

Published
2023

6. A natural language processing approach to uncover patterns among online ratings of otolaryngologists.

Author

Vasan, V, Cheng, Christopher P., Lerner, David K., Vujovic, D, van Gerwen, M, and Iloreta, A M

Subjects
SENTIMENT analysis, CONFIDENCE, NATURAL language processing, INTERNET, PHYSICIAN-patient relations, MULTIPLE regression analysis, HUMAN comfort, MACHINE learning, PATIENT satisfaction, PATIENTS' attitudes, DESCRIPTIVE statistics, PROFESSIONAL competence, PHYSICIAN practice patterns, DEMOGRAPHY, WORLD Wide Web
Abstract

Background: Patients increasingly use physician rating websites to evaluate and choose potential healthcare providers. A sentiment analysis and machine learning approach can uniquely analyse written prose to quantitatively describe patients' perspectives from interactions with their physicians. Methods: Online written reviews and star scores were analysed from Healthgrades.com using a natural language processing sentiment analysis package. Demographics of otolaryngologists were compared and a multivariable regression for individual words was performed. Results: This study analysed 18 546 online reviews of 1240 otolaryngologists across the USA. Younger otolaryngologists (aged less than 40 years) had higher sentiment and star scores compared with older otolaryngologists (p < 0.001). Male otolaryngologists had higher sentiment and star scores compared with female otolaryngologists (p < 0.001). 'Confident', 'kind', 'recommend' and 'comfortable' were words associated with positive reviews (p < 0.001). Conclusion: Positive bedside manner was strongly reflected in better reviews, and younger age and male gender of the otolaryngologist were associated with better sentiment and star scores. [ABSTRACT FROM AUTHOR]

Published
2023
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7. Association of Chemotherapy Timing in Pregnancy With Congenital Malformation

Author

van Gerwen, M, Maggen, C, Cardonick, E, Verwaaijen, E, van den Heuvel-Eibrink, M, Shmakov, R, Boere, I, Gziri, M, Ottevanger, P, Lok, C, Halaska, M, Shao, L, Struys, I, van Dijk-Lokkart, E, van Calsteren, K, Fruscio, R, Zola, P, Scarfone, G, Amant, F, van Gerwen M., Maggen C., Cardonick E., Verwaaijen E. J., van den Heuvel-Eibrink M., Shmakov R. G., Boere I., Gziri M. M., Ottevanger P. B., Lok C. A. R., Halaska M., Shao L. T., Struys I., van Dijk-Lokkart E. M., van Calsteren K., Fruscio R., Zola P., Scarfone G., Amant F., van Gerwen, M, Maggen, C, Cardonick, E, Verwaaijen, E, van den Heuvel-Eibrink, M, Shmakov, R, Boere, I, Gziri, M, Ottevanger, P, Lok, C, Halaska, M, Shao, L, Struys, I, van Dijk-Lokkart, E, van Calsteren, K, Fruscio, R, Zola, P, Scarfone, G, Amant, F, van Gerwen M., Maggen C., Cardonick E., Verwaaijen E. J., van den Heuvel-Eibrink M., Shmakov R. G., Boere I., Gziri M. M., Ottevanger P. B., Lok C. A. R., Halaska M., Shao L. T., Struys I., van Dijk-Lokkart E. M., van Calsteren K., Fruscio R., Zola P., Scarfone G., and Amant F.

Abstract

Chemotherapy puts a developing fetus at risk of teratogenic effects. The standard recommendation is that chemotherapy be administered after organogenesis is complete, however, the exact gestational age that chemotherapy can be administered safely and avoid causing congenital malformations remains unknown. The goal of this study was to assess the teratogenic role of prenatal chemotherapy by gestational age, to evaluate for the presence of major and minor congenital malformations during pregnancy or at birth.This was a multicenter study that evaluated all pregnant women who received chemotherapy in the International Network on Cancer, Infertility and Pregnancy (INCIP) database between 1977 and 2019.A total of 755 pregnant women treated with chemotherapy between 1977 and 2019 were included in analysis. The median age at cancer diagnosis was 33 (14-48) years. The major congenital malformation rate was 3.6% (95% confidence interval [CI], 2.4%-5.2%), and the minor congenital malformation rate was 1.9% (95% CI, 1.0%-3.1%) among offspring. Chemotherapy exposure before 12 weeks' gestational age was associated with a high rate of major congenital malformations, at 21.7%(95% CI, 7.5%-43.7%; odds ratio, 9.24 [95% CI, 3.13-27.30]). When chemotherapy was initiated after 12 weeks' gestation, the frequency of major congenital malformations decreased to 3.0% (95% CI, 1.9%-4.6%), which was comparable to the anticipated rates in the general population. Minor malformations were similar when exposure occurred before or after 12 weeks' gestation (4.3% [95% CI, 0.1%-21.9%] vs 1.8% [95% CI, 1.0-3.0]; odds ratio, 3.13 [95% CI, 0.39-25.28]). Of 29 women who received chemotherapy before 12 weeks' gestation, 17 (58.6%) were not aware of their pregnancy, and 6 (20.7%) had a miscarriage (3 women [10.3%]) or elected to terminate their pregnancy (3 women [10.3%]).Overall, this study found that chemotherapy was associated with an increased risk of major congenital malformations only when it adminis

Published
2021

8. Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

Author

Vandenbroucke, T, Verheecke, M, van Gerwen, M, Van Calsteren, K, Halaska, M, Fumagalli, M, Fruscio, R, Gandhi, A, Veening, M, Lagae, L, Ottevanger, P, Voigt, J, de Haan, J, Gziri, M, Maggen, C, Mertens, L, Naulaers, G, Claes, L, Amant, F, Blommaert, J, Dekrem, J, Goffin, F, Rigo, V, Fontana, C, Mosca, F, Passera, S, Picciolini, O, Scarfone, G, Peccatori, F, Boffi, M, Delle Marchette, M, Nacinovich, R, Lok, C, Wolters, V, Boere, I, Witteveen, E, Schroder, C, de Groot, C, van Grotel, M, van den Heuvel-Eibrink, M, Babkova, A, Drochytek, V, Vandenbroucke T., Verheecke M., van Gerwen M., Van Calsteren K., Halaska M. J., Fumagalli M., Fruscio R., Gandhi A., Veening M., Lagae L., Ottevanger P. B., Voigt J. -U., de Haan J., Gziri M. M., Maggen C., Mertens L., Naulaers G., Claes L., Amant F., Blommaert J., Dekrem J., Goffin F., Rigo V., Fontana C., Mosca F., Passera S., Picciolini O., Scarfone G., Peccatori F. A., Boffi M. L., Delle Marchette M., Nacinovich R., Lok C., Wolters V., Boere I., Witteveen E., Schroder C., de Groot C., van Grotel M., van den Heuvel-Eibrink M., Babkova A., Drochytek V., Vandenbroucke, T, Verheecke, M, van Gerwen, M, Van Calsteren, K, Halaska, M, Fumagalli, M, Fruscio, R, Gandhi, A, Veening, M, Lagae, L, Ottevanger, P, Voigt, J, de Haan, J, Gziri, M, Maggen, C, Mertens, L, Naulaers, G, Claes, L, Amant, F, Blommaert, J, Dekrem, J, Goffin, F, Rigo, V, Fontana, C, Mosca, F, Passera, S, Picciolini, O, Scarfone, G, Peccatori, F, Boffi, M, Delle Marchette, M, Nacinovich, R, Lok, C, Wolters, V, Boere, I, Witteveen, E, Schroder, C, de Groot, C, van Grotel, M, van den Heuvel-Eibrink, M, Babkova, A, Drochytek, V, Vandenbroucke T., Verheecke M., van Gerwen M., Van Calsteren K., Halaska M. J., Fumagalli M., Fruscio R., Gandhi A., Veening M., Lagae L., Ottevanger P. B., Voigt J. -U., de Haan J., Gziri M. M., Maggen C., Mertens L., Naulaers G., Claes L., Amant F., Blommaert J., Dekrem J., Goffin F., Rigo V., Fontana C., Mosca F., Passera S., Picciolini O., Scarfone G., Peccatori F. A., Boffi M. L., Delle Marchette M., Nacinovich R., Lok C., Wolters V., Boere I., Witteveen E., Schroder C., de Groot C., van Grotel M., van den Heuvel-Eibrink M., Babkova A., and Drochytek V.

Abstract

Background: Data on the long-term effects of prenatal exposure to maternal cancer and its treatment on child development are scarce. Methods: In a multicenter cohort study, the neurologic and cardiac outcomes of 6-year-old children born to women diagnosed with cancer during pregnancy were compared with the outcome of children born after an uncomplicated pregnancy. Assessment included clinical evaluation, comprehensive neuropsychological testing, electrocardiography and echocardiography. Results: In total, 132 study children and 132 controls were included. In the study group, 97 children (73.5%) were prenatally exposed to chemotherapy (alone or in combination with other treatments), 14 (10.6%) to radiotherapy (alone or in combination), 1 (0.8%) to trastuzumab, 12 (9.1%) to surgery alone and 16 (12.1%) to no treatment. Although within normal ranges, statistically significant differences were found in mean verbal IQ and visuospatial long-term memory, with lower scores in the study versus control group (98.1, 95% confidence interval [CI]: 94.5–101.8, versus 104.4, 95% CI: 100.4–108.4, P = 0.001, Q < 0.001 [Q refers to the false discovery rate adjusted P value], and 3.9, 95% CI: 3.6–4.3, versus 4.5, 95% CI: 4.1–4.9, P = 0.005, Q = 0.045, respectively). A significant difference in diastolic blood pressure was found, with higher values in chemotherapy-exposed (61.1, 95% CI: 59.0 to 63.2) versus control children (56.0, 95% CI 54.1 to 57.8) (P < 0.001, Q < 0.001) and in a subgroup of 59 anthracycline-exposed (61.8, 95% CI: 59.3 to 64.4) versus control children (55.9, 95% CI: 53.6 to 58.1) (P < 0.001, Q = 0.02). Conclusions: Children prenatally exposed to maternal cancer and its treatment are at risk for lower verbal IQ and visuospatial long-term memory scores and for higher diastolic blood pressure, but other cognitive functions and cardiac outcomes were normal at the age of 6 years. Clinical trial registration: The study is registered at ClinicalTrials.gov, NCT00330447.

Published
2020

9. Patient-reported outcomes following total thyroidectomy and lobectomy in thyroid cancer survivors: An analysis of the profiles registry data

Author

van Gerwen, M., Cooke, P.V., Alpert, N., Mols, F., Genden, E., Schwartz, R.M., van Gerwen, M., Cooke, P.V., Alpert, N., Mols, F., Genden, E., and Schwartz, R.M.

Abstract

Purpose Patient-reported outcomes are important in the surgical decision-making process for low-risk, differentiated thyroid cancer. Current study aimed to assess patient-reported outcomes in thyroid cancer survivors comparing total thyroidectomy (TT) and lobectomy (LT) using the Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship (PROFILES) registry. Methods European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) scales, illness perception questions, Beliefs about Medicines Questionnaire (BMQ) scales and questions about thyroid surgery–related medication use were compared between thyroid cancer patients who underwent TT versus LT using descriptive analyses. Results In total, 58 thyroid cancer patients who underwent TT or LT were included in this study. None of the EORTC QLQ-C30 scales or questions regarding illness perception were significantly different between the surgical groups. Patients in the TT group had significantly higher belief in the necessity of their medication (21.0 vs 15.4; p = 0.003) and greater concerns about taking their medicines (14.7 vs 11.1; p = 0.008) versus patients in the LT group. Conclusion Concerns about post-surgical medication use specifically in the TT group may indicate that clinicians should consider LT in patients with low-risk, differentiated thyroid cancer when LT and TT are viable surgical options. Clinicians should be aware of the impact of post-surgical medication use in particular following TT and use this knowledge to align goals of treatment with the extent of surgery, allowing for a better-informed decision-making process.

Published
2022

10. Long-term neurodevelopmental outcome after prenatal exposure to maternal hematological malignancies with or without cytotoxic treatment

Author

van Gerwen, M, Huis In 't Veld, E, van Grotel, M, van den Heuvel-Eibrink, M, Van Calsteren, K, Maggen, C, Drochytek, V, Scarfone, G, Fontana, C, Fruscio, R, Cardonick, E, van Dijk-Lokkart, E, Amant, F, van Gerwen, Mathilde, Huis In 't Veld, Evangeline, van Grotel, Martine, van den Heuvel-Eibrink, Marry M, Van Calsteren, Kristel, Maggen, Charlotte, Drochytek, Vit, Scarfone, Giovanna, Fontana, Camilla, Fruscio, Robert, Cardonick, Elyce, van Dijk-Lokkart, Elisabeth M, Amant, Frédéric, van Gerwen, M, Huis In 't Veld, E, van Grotel, M, van den Heuvel-Eibrink, M, Van Calsteren, K, Maggen, C, Drochytek, V, Scarfone, G, Fontana, C, Fruscio, R, Cardonick, E, van Dijk-Lokkart, E, Amant, F, van Gerwen, Mathilde, Huis In 't Veld, Evangeline, van Grotel, Martine, van den Heuvel-Eibrink, Marry M, Van Calsteren, Kristel, Maggen, Charlotte, Drochytek, Vit, Scarfone, Giovanna, Fontana, Camilla, Fruscio, Robert, Cardonick, Elyce, van Dijk-Lokkart, Elisabeth M, and Amant, Frédéric

Abstract

Data on the long-term neurodevelopmental outcomes of children exposed to hematological maternal cancer with or without treatment during pregnancy are lacking. A total of 57 children, of whom 33 males and 24 females, prenatally exposed to hematological malignancies and its treatment, were invited for neuropsychological and physical examinations at 18months, 36months, 6, 9, 12, 15 and 18years of age. Oncological, obstetrical, neonatal and follow-up data of these children were collected. Parents were asked to complete questionnaires on their child's general health, school performances, social situation, behavioral development, executive functioning, and if their child receives supportive care. Non-Hodgkin lymphoma was diagnosed in 35.1%, Hodgkin lymphoma in 28.1%, acute myeloid leukemia in 15.8%, chronic myeloid leukemia in 12.3%, and acute lymphoblastic leukemia in 8.8%. Cognitive development at a median age of 10.7years was within the normal range. In subgroup analyses of children in early childhood, the gestational age at birth was correlated with the cognitive outcome at a median age of 1.7years. Scores for language development, intelligence, attention, memory and behavior, as well as clinical neurological and general pediatric examinations were within normal ranges. In subgroup analyses, the need for supportive care in the child was associated with the loss of the mother. Prenatal exposure to hematological maternal malignancies with or without treatment did not affect the neurodevelopment of the child in the long term. Yet, caution is indicated and surveillance of the emotional development of the child is needed, especially when the mother is deceased to cancer.

Published
2021

11. Long-term neurodevelopmental outcome of children after in utero exposure to chemotherapy

Author

Korakiti, A.-M. Zografos, E. van Gerwen, M. Amant, F. Dimopoulos, M.-A. Zagouri, F.

Abstract

Pregnancy-related cancer management represents a real challenge for both the patients and the physicians. The long-term neurodevelopmental outcome of children in utero exposed to chemotherapeutic agents has only recently been addressed. This review aims to systematically integrate and highlight all existing data from the literature regarding the effect of prenatal exposure to chemotherapy on fetal brain growth and child development. All eligible studies are based on validated neurodevelopmental testing scales (e.g., Bayley Scales of Infant Development, Wechsler Preschool and Primary Scale of Intelligence) and/or well-defined questionnaires. Our systematic review including 17 studies demonstrates that no major consequences on the neurodevelopment of children after in utero exposure to anti-cancer drugs have been reported; nevertheless, longer and more thorough follow-up with large-scale multicenter prospective studies is certainly required in order to draw firm conclusions. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Published
2020

12. Gastric cancer during pregnancy: A report on 13 cases and review of the literature with focus on chemotherapy during pregnancy

Author

Maggen, C, Lok, C, Cardonick, E, Van Gerwen, M, Ottevanger, N, Boere, I, Koskas, M, Halaska, M, Fruscio, R, Mhallem, M, Witteveen, P, Van Calsteren, K, Amant, F, Maggen, Charlotte, Lok, Christianne, Cardonick, Elyce, Van Gerwen, Mathilde, Ottevanger, Nelleke, Boere, Ingrid, Koskas, Martin, Halaska, Michael J, Fruscio, Robert, Mhallem, Mina, Witteveen, Petronella, Van Calsteren, Kristel, Amant, Frédéric, Maggen, C, Lok, C, Cardonick, E, Van Gerwen, M, Ottevanger, N, Boere, I, Koskas, M, Halaska, M, Fruscio, R, Mhallem, M, Witteveen, P, Van Calsteren, K, Amant, F, Maggen, Charlotte, Lok, Christianne, Cardonick, Elyce, Van Gerwen, Mathilde, Ottevanger, Nelleke, Boere, Ingrid, Koskas, Martin, Halaska, Michael J, Fruscio, Robert, Mhallem, Mina, Witteveen, Petronella, Van Calsteren, Kristel, and Amant, Frédéric

Abstract

Introduction: Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. Material and methods: Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. Results: In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6-30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. Conclusions: The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account.

Published
2020

17. Gynecologic cancers in pregnancy: Guidelines based on a third international consensus meeting

Author

Amant, F. Berveiller, P. Boere, I.A. Cardonick, E. Fruscio, R. Fumagalli, M. Halaska, M.J. Hasenburg, A. Johansson, A.L.V. Lambertini, M. Lok, C.A.R. Maggen, C. Morice, P. Peccatori, F. Poortmans, P. Van Calsteren, K. Vandenbroucke, T. Van Gerwen, M. Van Den Heuvel-Eibrink, M. Zagouri, F. Zapardiel, I.

Abstract

We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged. © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Published
2019

18. Gastric cancer during pregnancy: A report on 13 cases and review of the literature with focus on chemotherapy during pregnancy

Author

Maggen, C. (Charlotte), Lok, C.A. (Christianne), Cardonick, E. (Elyce), van Gerwen, M. (Mathilde), Ottevanger, P.B. (Petronella), Boere, I.A. (Ingrid), Koskas, M. (Martin), Halaska, M.J. (Michael), Fruscio, R. (Robert), Gziri, M.M. (Mina Mhallem), Witteveen, P.O. (Petronella O.), Calsteren, K. (Kristel) van, Amant, F. (Frédéric), Maggen, C. (Charlotte), Lok, C.A. (Christianne), Cardonick, E. (Elyce), van Gerwen, M. (Mathilde), Ottevanger, P.B. (Petronella), Boere, I.A. (Ingrid), Koskas, M. (Martin), Halaska, M.J. (Michael), Fruscio, R. (Robert), Gziri, M.M. (Mina Mhallem), Witteveen, P.O. (Petronella O.), Calsteren, K. (Kristel) van, and Amant, F. (Frédéric)

Abstract

Introduction: Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. Material and methods: Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. Results: In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6-30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, 8 out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of 6 women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and 1 of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. Conclusions: The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account.

Published
2019
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19. Gynecologic cancers in pregnancy: Guidelines based on a third international consensus meeting

Author

Amant, F, Berveiller, P, Boere, I, Cardonick, E, Fruscio, R, Fumagalli, M, Halaska, M, Hasenburg, A, Johansson, A, Lambertini, M, Lok, C, Maggen, C, Morice, P, Peccatori, F, Poortmans, P, Van Calsteren, K, Vandenbroucke, T, van Gerwen, M, van den Heuvel-Eibrink, M, Zagouri, F, Zapardiel, I, Amant, Frédéric, Berveiller, Paul, Boere, Ingrid, Cardonick, Elyce, Fruscio, Robert, Fumagalli, Monica, Halaska, Michael J, Hasenburg, Annette, Johansson, Anna L V, Lambertini, Matteo, Lok, Christianne, Maggen, Charlotte, Morice, Philippe, Peccatori, Fedro, Poortmans, Philip, Van Calsteren, Kristel, Vandenbroucke, Tineke, van Gerwen, Mathilde, van den Heuvel-Eibrink, Marry, Zagouri, Flora, Zapardiel, Ignacio, Amant, F, Berveiller, P, Boere, I, Cardonick, E, Fruscio, R, Fumagalli, M, Halaska, M, Hasenburg, A, Johansson, A, Lambertini, M, Lok, C, Maggen, C, Morice, P, Peccatori, F, Poortmans, P, Van Calsteren, K, Vandenbroucke, T, van Gerwen, M, van den Heuvel-Eibrink, M, Zagouri, F, Zapardiel, I, Amant, Frédéric, Berveiller, Paul, Boere, Ingrid, Cardonick, Elyce, Fruscio, Robert, Fumagalli, Monica, Halaska, Michael J, Hasenburg, Annette, Johansson, Anna L V, Lambertini, Matteo, Lok, Christianne, Maggen, Charlotte, Morice, Philippe, Peccatori, Fedro, Poortmans, Philip, Van Calsteren, Kristel, Vandenbroucke, Tineke, van Gerwen, Mathilde, van den Heuvel-Eibrink, Marry, Zagouri, Flora, and Zapardiel, Ignacio

Abstract

We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.c

Published
2019

20. An Updated Review of the Evidence of Human Exposure to Glyphosate

Author

Luoping Zhang, Rachel M. Shaffer, Iemaan Rana, van Gerwen M, Emanuela Taioli, Lianne Sheppard, and Christina Gillezeau

Subjects
Global and Planetary Change, chemistry.chemical_compound, chemistry, Epidemiology, Human exposure, Health, Toxicology and Mutagenesis, Glyphosate, Public Health, Environmental and Occupational Health, Physiology, Biology, Pollution
Published
2019

28. Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

Author

Vandenbroucke, T., primary, Verheecke, M., additional, van Gerwen, M., additional, Van Calsteren, K., additional, Halaska, M., additional, Fumagalli, M., additional, Fruscio, R., additional, Veening, M., additional, Lagae, L., additional, Ottevanger, P., additional, Voigt, J.-U., additional, de Haan, J., additional, Gziri, M., additional, Gandhi, A., additional, Maggen, C., additional, Mertens, L., additional, Naulaers, G., additional, Claes, L., additional, and Amant, F., additional

Published
2019
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33. Are physical measures good indicators of clinical image quality at low dose levels? A pilot study

Author

Lança, Luís, Andersen, E. N., Carvalho, G., van Gerwen, M., Jorge, José, Kleiker, M., Markali, B., Nightingale, P., and Hogg, Peter

Subjects
genetic structures, Clinical image quality, Dosimetry, Low dose levels, Radiology
Abstract

Background - For dose reduction actions, the principle of “image quality as good as possible” to “image quality as good as needed” requires to know whether the physical measures and visual image quality relate. Visual evaluation and objective physical measures of image quality can appear to be different. If there is no noticeable effect on the visual image quality with a low dose but there is a objective physical measure impact, then the overall dose may be reduced without compromising the diagnostic image quality. Low dose imaging can be used for certain types of observations, e.g. thoracic scoliosis, control after metal implantation for osteosynthesis, reviewing pneumonia and tuberculosis. Aim of the study - To determine whether physical measures of noise predict visual (clinical) image quality at low dose levels.

Published
2016

34. Hoe werkt werk in de toekomst?

Author

Nauta, A., van Gerwen, M., and Arbeids- en Organisatie Psychologie (Psychologie, FMG)

Abstract

Hoe ziet werken in de sociale sector er over pakweg dertien jaar uit? Een analyse aan de hand van Lynda Grattons vijf krachten die de toekomst bepalen.

Published
2015

38. Cognitive and Behavioral Development of 9-Year-Old Children After Maternal Cancer During Pregnancy: A Prospective Multicenter Cohort Study

Author

Indra A. Van Assche, Evangeline A. Huis in 't Veld, Kristel Van Calsteren, Mathilde van Gerwen, Jeroen Blommaert, Elyce Cardonick, Michael J. Halaska, Robert Fruscio, Monica Fumagalli, Jurgen Lemiere, Elisabeth M. van Dijk-Lokkart, Camilla Fontana, Harm van Tinteren, Jessie De Ridder, Martine van Grotel, Marry M. van den Heuvel-Eibrink, Lieven Lagae, Frédéric Amant, Obstetrics and Gynaecology, CCA - Cancer Treatment and Quality of Life, CCA - Cancer biology and immunology, Amsterdam Reproduction & Development (AR&D), Van Assche, I, Huis In 'T Veld, E, Van Calsteren, K, Van Gerwen, M, Blommaert, J, Cardonick, E, Halaska, M, Fruscio, R, Fumagalli, M, Lemiere, J, Van Dijk-Lokkart, E, Fontana, C, Van Tinteren, H, De Ridder, J, Van Grotel, M, Van Den Heuvel-Eibrink, M, Lagae, L, and Amant, F

Subjects
Cancer Research, Oncology, Cancer in pregnancy
Abstract

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.This multicenter cohort study reports on the long-term effects of prenatal exposure to maternal cancer and its treatment on cognitive and behavioral outcomes in 9-year-old children. In total, 151 children (mean age, 9.3 years; range, 7.8-10.6 years) were assessed using a neurocognitive test battery and parent-report behavioral questionnaires. During pregnancy, 109 children (72.2%) were exposed to chemotherapy (only or in combination with other treatment modalities), 18 (11.9%) to surgery only, 16 (10.6%) to radiotherapy, one to trastuzumab, and 16 (10.6%) were not exposed to oncologic treatment. Mean cognitive and behavioral outcomes were within normal ranges. Gestational age at birth showed a positive association with Full Scale Intelligence Quotient (FSIQ), with the average FSIQ score increasing by 1.6 points for each week increase in gestational age (95% CI, 0.7 to 2.5; P < .001). No difference in FSIQ was found between treatment types (F[4,140] = 0.45, P = .776). In children prenatally exposed to chemotherapy, no associations were found between FSIQ and chemotherapeutic agent, exposure level, or timing during pregnancy. These results indicate a reassuring follow-up during the critical maturational period of late childhood, when complex functions develop and rely on the integrity of early brain development. However, associations were observed with preterm birth, maternal death, and maternal education. ispartof: JOURNAL OF CLINICAL ONCOLOGY vol:41 issue:8 pages:1527-+ ispartof: location:United States status: published

Published
2023

39. Long-term neurodevelopmental outcome after prenatal exposure to maternal hematological malignancies with or without cytotoxic treatment

Author

Elyce Cardonick, Martine van Grotel, Elisabeth M. van Dijk-Lokkart, Evangeline Huis in ‘t Veld, Mathilde van Gerwen, Robert Fruscio, Camilla Fontana, Charlotte Maggen, Frédéric Amant, Marry M. van den Heuvel-Eibrink, Vit Drochytek, Giovanna Scarfone, Kristel Van Calsteren, Obstetrics, van Gerwen, M, Huis In 't Veld, E, van Grotel, M, van den Heuvel-Eibrink, M, Van Calsteren, K, Maggen, C, Drochytek, V, Scarfone, G, Fontana, C, Fruscio, R, Cardonick, E, van Dijk-Lokkart, E, Amant, F, Obstetrics and Gynaecology, CCA - Cancer Treatment and Quality of Life, Amsterdam Reproduction & Development (AR&D), Obstetrics and gynaecology, and CCA - Cancer Treatment and quality of life

Subjects
Male, Pediatrics, 0302 clinical medicine, hemic and lymphatic diseases, Developmental and Educational Psychology, Cognitive development, Early childhood, Child, Child development, 05 social sciences, Neuropsychology, Myeloid leukemia, Gestational age, cancer in pregnancy, intelligence, follow-up studies, 3. Good health, Neuropsychology and Physiological Psychology, Prenatal Exposure Delayed Effects, prenatal exposure delayed effect, Female, pregnancy, Psychology, Life Sciences & Biomedicine, 050104 developmental & child psychology, medicine.medical_specialty, Child, preschool, Clinical Neurology, follow-up studie, Mothers, Antineoplastic Agents, hematologic malignancie, Hematologic Neoplasms/complications, 03 medical and health sciences, prenatal exposure delayed effects, medicine, Humans, 0501 psychology and cognitive sciences, Pregnancy, Science & Technology, Infant, Newborn, Infant, Cancer, hematologic malignancies, medicine.disease, Lymphoma, Pediatrics, Perinatology and Child Health, Neurosciences & Neurology, 030217 neurology & neurosurgery
Abstract

Data on the long-term neurodevelopmental outcomes of children exposed to hematological maternal cancer with or without treatment during pregnancy are lacking. A total of 57 children, of whom 33 males and 24 females, prenatally exposed to hematological malignancies and its treatment, were invited for neuropsychological and physical examinations at 18 months, 36 months, 6, 9, 12, 15 and 18 years of age. Oncological, obstetrical, neonatal and follow-up data of these children were collected. Parents were asked to complete questionnaires on their child's general health, school performances, social situation, behavioral development, executive functioning, and if their child receives supportive care. Non-Hodgkin lymphoma was diagnosed in 35.1%, Hodgkin lymphoma in 28.1%, acute myeloid leukemia in 15.8%, chronic myeloid leukemia in 12.3%, and acute lymphoblastic leukemia in 8.8%. Cognitive development at a median age of 10.7 years was within the normal range. In subgroup analyses of children in early childhood, the gestational age at birth was correlated with the cognitive outcome at a median age of 1.7 years. Scores for language development, intelligence, attention, memory and behavior, as well as clinical neurological and general pediatric examinations were within normal ranges. In subgroup analyses, the need for supportive care in the child was associated with the loss of the mother. Prenatal exposure to hematological maternal malignancies with or without treatment did not affect the neurodevelopment of the child in the long term. Yet, caution is indicated and surveillance of the emotional development of the child is needed, especially when the mother is deceased to cancer. ispartof: CHILD NEUROPSYCHOLOGY vol:27 issue:6 pages:822-833 ispartof: location:England status: published

Published
2021

40. Association of Chemotherapy Timing in Pregnancy With Congenital Malformation

Author

van Gerwen, Mathilde, Maggen, Charlotte, Cardonick, Elyce, Verwaaijen, Emma J., van den Heuvel-eibrink, Marry, Shmakov, Roman G., Boere, Ingrid, Gziri, Mina M., Ottevanger, Petronella B., Lok, Christianne A. R., Halaska, Michael, Shao, Long Ting, Struys, Ilana, van Dijk-Lokkart, Elisabeth M., Van Calsteren, Kristel, Fruscio, Robert, Zola, Paolo, Scarfone, Giovanna, Amant, Frederic, on Cancer, Infertility and Pregnancy, International Network, Tummers, Philippe, Medical Oncology, UCL - SSS/IREC - Institut de recherche expérimentale et clinique, UCL - (SLuc) Service d'obstétrique, van Gerwen, M, Maggen, C, Cardonick, E, Verwaaijen, E, van den Heuvel-Eibrink, M, Shmakov, R, Boere, I, Gziri, M, Ottevanger, P, Lok, C, Halaska, M, Shao, L, Struys, I, van Dijk-Lokkart, E, Van Calsteren, K, Fruscio, R, Zola, P, Scarfone, G, Amant, F, Obstetrics and Gynaecology, CCA - Cancer Treatment and Quality of Life, ARD - Amsterdam Reproduction and Development, Obstetrics, Medical psychology, and Amsterdam Reproduction & Development (AR&D)

Subjects
Time Factors, Abnormalities, Drug-Induced/etiology, Miscarriage, Cohort Studies, Fetal Development, Pregnancy, Neoplasms, Medicine and Health Sciences, Odds Ratio, First, Original Investigation, Abnormalities, Drug-Induced, Adolescent, Adult, Antineoplastic Agents, Female, Gestational Age, Humans, Middle Aged, Pregnancy Trimester, First, Pregnant Women, Young Adult, Drug Administration Schedule, education.field_of_study, Obstetrics, Fetal Development/drug effects, Gestational age, Obstetrics and Gynecology, General Medicine, Chemotherapy regimen, Women's cancers Radboud Institute for Health Sciences [Radboudumc 17], Online Only, Oncology, embryonic structures, Gestation, Pregnancy Trimester, Abnormalities, Life Sciences & Biomedicine, Cohort study, medicine.medical_specialty, congenital malformation, Population, Medicine, General & Internal, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Chemotherapy, education, Science & Technology, business.industry, Research, Antineoplastic Agents/adverse effects, Odds ratio, medicine.disease, Neoplasms/drug therapy, Drug-Induced, business
Abstract

Key Points Question Is gestational age at initiation of chemotherapy during pregnancy associated with risk of congenital malformations? Findings In this cohort study including 755 pregnant women with cancer, the risk of major congenital malformations was elevated when first chemotherapy exposure was prior to 12 weeks of gestation, whereas the occurrence of major congenital malformations was similar to expected rates in the general population when chemotherapy was initiated after 12 weeks of gestation. Meaning The findings of this study could allow clinicians to better tailor chemotherapy during pregnancy and to inform patients on fetal risks of malformations., This cohort study assesses the association of gestational age at initiation of chemotherapy among pregnant women with cancer with congenital malformation rates among their offspring., Importance Chemotherapy during the first trimester of pregnancy should be avoided owing to the risk of congenital malformations. However, the precise gestational age at which chemotherapy can be initiated safely remains unclear. Objective To assess congenital malformation rates associated with gestational age at initiation of chemotherapy among pregnant women with cancer. Design, Setting, and Participants This multicenter cohort study evaluated all pregnant women who received chemotherapy between 1977 and 2019 registered in the International Network on Cancer, Infertility and Pregnancy (INCIP) database. Data were analyzed from February 15 to June 2, 2020. Exposures Cancer treatment with chemotherapy during pregnancy. Main Outcomes and Measures Analysis was focused on major and minor structural malformations in offspring, defined by EUROCAT, detected during pregnancy or at birth. Results A total of 755 women in the INCIP database who underwent cancer treatment with chemotherapy during pregnancy were included in analysis. The median (range) age at cancer diagnosis was 33 (14-48) years. Among offspring, the major congenital malformation rate was 3.6% (95% CI, 2.4%-5.2%), and the minor congenital malformation rate was 1.9% (95% CI, 1.0%-3.1%). Chemotherapy exposure prior to 12 weeks gestational age was associated with a high rate of major congenital malformations, at 21.7% (95% CI, 7.5%-43.7%; odds ratio, 9.24 [95% CI, 3.13-27.30]). When chemotherapy was initiated after gestational age 12 weeks, the frequency of major congenital malformations was 3.0% (95% CI, 1.9%-4.6%), which was similar to the expected rates in the general population. Minor malformations were comparable when exposure occurred before or after gestational age 12 weeks (4.3% [95% CI, 0.1%-21.9%] vs 1.8% [95% CI, 1.0-3.0]; odds ratio, 3.13 [95% CI, 0.39-25.28]). Of 29 women who received chemotherapy prior to 12 weeks gestation, 17 (58.6%) were not aware of pregnancy, and 6 (20.7%) experienced a miscarriage (3 women [10.3%]) or decided to terminate their pregnancy (3 women [10.3%]). Conclusions and Relevance This cohort study found that chemotherapy was associated with an increased risk of major congenital malformations only in the first 12 weeks of pregnancy. The risk of congenital malformations when chemotherapy was administered during the first trimester and the high number of incidental pregnancies during cancer treatment in the INCIP registry underscore the importance of contraceptive advice and pregnancy testing at the start of chemotherapeutic treatment in young women with cancer.

Published
2021

41. Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy

Author

Fedro A. Peccatori, Anna Babkova, Monica Fumagalli, Amarendra Gandhi, Michael J. Halaska, Charlotte Maggen, Ingrid A. Boere, Sofia Passera, Christianne A. R. Lok, Giovanna Scarfone, Magali Verheecke, Laurence Claes, Vít Drochýtek, Mathilde van Gerwen, Vincent Rigo, Martine van Grotel, Jorine de Haan, Martina Delle Marchette, Marry M. van den Heuvel-Eibrink, Gunnar Naulaers, Robert Fruscio, Tineke Vandenbroucke, Maria Lucia Boffi, Lieven Lagae, Mina Mhallem Gziri, Fabio Mosca, Margreet A. Veening, Jens-Uwe Voigt, Jana Dekrem, Luc Mertens, Kristel Van Calsteren, Christianne J.M. de Groot, Frédéric Amant, Vera E. R. A. Wolters, Els Witteveen, Odoardo Picciolini, Camilla Fontana, Jeroen Blommaert, Petronella B. Ottevanger, Renata Nacinovich, Frédéric Goffin, Carolina P. Schröder, Obstetrics and Gynaecology, CCA - Cancer Treatment and Quality of Life, ARD - Amsterdam Reproduction and Development, Obstetrics, Vandenbroucke, T, Verheecke, M, van Gerwen, M, Van Calsteren, K, Halaska, M, Fumagalli, M, Fruscio, R, Gandhi, A, Veening, M, Lagae, L, Ottevanger, P, Voigt, J, de Haan, J, Gziri, M, Maggen, C, Mertens, L, Naulaers, G, Claes, L, Amant, F, Blommaert, J, Dekrem, J, Goffin, F, Rigo, V, Fontana, C, Mosca, F, Passera, S, Picciolini, O, Scarfone, G, Peccatori, F, Boffi, M, Delle Marchette, M, Nacinovich, R, Lok, C, Wolters, V, Boere, I, Witteveen, E, Schroder, C, de Groot, C, van Grotel, M, van den Heuvel-Eibrink, M, Babkova, A, Drochytek, V, Obstetrics and gynaecology, Pediatric surgery, CCA - Cancer Treatment and quality of life, Amsterdam Reproduction & Development (AR&D), Erasmus MC other, Medical Oncology, and Pathology

Subjects
0301 basic medicine, Male, Pediatrics, Cancer Research, Memory/drug effects, Intelligence, Pregnancy Complications, Neoplastic/drug therapy, 0302 clinical medicine, Diastole, Pregnancy, Antineoplastic agents, Medicine, Childbirth, Fertility preservation, Prospective Studies, Child, Child development, Original Research, media_common, Cervical cancer, 0303 health sciences, Prenatal exposure delayed effect, Intelligence quotient, Obstetrics, High risk, Hematology, Prenatal exposure delayed effects, Chemotherapy regimen, Women's cancers Radboud Institute for Health Sciences [Radboudumc 17], 3. Good health, Antineoplastic agent, Oncology, 030220 oncology & carcinogenesis, Female, Pregnancy Complications, Neoplastic, Cohort study, Adult, medicine.medical_specialty, Child, preschool, media_common.quotation_subject, Fertility, Follow-up studies, 03 medical and health sciences, Intelligence/drug effects, Breast cancer, SDG 3 - Good Health and Well-being, Memory, media_common.cataloged_instance, Humans, European union, Child Development/drug effects, 030304 developmental biology, Diastole/drug effects, Follow-up studie, business.industry, Cancer, Infant, Antineoplastic Agents/adverse effects, medicine.disease, Clinical trial, 030104 developmental biology, business
Abstract

Background Data on the long-term effects of prenatal exposure to maternal cancer and its treatment on child development are scarce. Methods In a multicenter cohort study, the neurologic and cardiac outcomes of 6-year-old children born to women diagnosed with cancer during pregnancy were compared with the outcome of children born after an uncomplicated pregnancy. Assessment included clinical evaluation, comprehensive neuropsychological testing, electrocardiography and echocardiography. Results In total, 132 study children and 132 controls were included. In the study group, 97 children (73.5%) were prenatally exposed to chemotherapy (alone or in combination with other treatments), 14 (10.6%) to radiotherapy (alone or in combination), 1 (0.8%) to trastuzumab, 12 (9.1%) to surgery alone and 16 (12.1%) to no treatment. Although within normal ranges, statistically significant differences were found in mean verbal IQ and visuospatial long-term memory, with lower scores in the study versus control group (98.1, 95% confidence interval [CI]: 94.5–101.8, versus 104.4, 95% CI: 100.4–108.4, P = 0.001, Q, Highlights • Cancer treatment including chemotherapy is possible during pregnancy. • Children are at risk for lower verbal IQ and visuospatial long-term memory scores. • Other cognitive functions and cardiac outcomes were normal at the age of 6 years. • We documented ototoxicity in three children exposed to cisplatin. • Follow-up until adulthood is recommended.

Published
2020

42. Gastric cancer during pregnancy: A report on 13 cases and review of the literature with focus on chemotherapy during pregnancy

Author

Charlotte Maggen, Elyce Cardonick, Michael J. Halaska, Mathilde van Gerwen, Martin Koskas, Petronella B. Ottevanger, Robert Fruscio, Christianne A.R. Lok, Ingrid A. Boere, Kristel Van Calsteren, Frédéric Amant, Petronella O. Witteveen, Mina Mhallem Gziri, Maggen, C, Lok, C, Cardonick, E, Van Gerwen, M, Ottevanger, N, Boere, I, Koskas, M, Halaska, M, Fruscio, R, Mhallem, M, Witteveen, P, Van Calsteren, K, Amant, F, Obstetrics, Obstetrics and Gynaecology, CCA - Cancer Treatment and Quality of Life, Medical Oncology, UCL - SSS/IREC/SLUC - Pôle St.-Luc, and UCL - (SLuc) Service d'obstétrique

Subjects
medicine.medical_treatment, chemotherapy, Pregnancy Complications, Neoplastic/drug therapy, 0302 clinical medicine, Pre-Eclampsia, Antineoplastic Combined Chemotherapy Protocols, Obstetrics and Gynaecology, Original Research Article, 030212 general & internal medicine, Maternal-Fetal Exchange, obstetric outcome, Fetal Growth Retardation/chemically induced, Fetal Growth Retardation, 030219 obstetrics & reproductive medicine, Obstetrics, Obstetrics and Gynecology, Gestational age, General Medicine, Women's cancers Radboud Institute for Health Sciences [Radboudumc 17], 3. Good health, Oncology, Prenatal Exposure Delayed Effects, Premature Birth, Female, pregnancy, Pregnancy Complications, Neoplastic, Adult, Infertility, medicine.medical_specialty, Pre-Eclampsia/chemically induced, Antineoplastic Agents, Preeclampsia, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Stomach Neoplasms, medicine, Humans, Brain abscess, Pregnancy, Fetus, Chemotherapy, pregnancy outcome, business.industry, gastric cancer, Antineoplastic Combined Chemotherapy Protocols/adverse effects, Infant, Newborn, Cancer, Antineoplastic Agents/adverse effects, medicine.disease, maternal outcome, Stomach Neoplasms/drug therapy, business, Gastric cancer
Abstract

INTRODUCTION: Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. MATERIAL AND METHODS: Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. RESULTS: In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6-30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. CONCLUSIONS: The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account. ispartof: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA vol:99 issue:1 pages:79-88 ispartof: location:United States status: published

Published
2020

43. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting

Author

Paul Berveiller, K. Van Calsteren, Ingrid A. Boere, Tineke Vandenbroucke, Michael J. Halaska, Charlotte Maggen, Matteo Lambertini, P. Poortmans, Robert Fruscio, Christianne A.R. Lok, Monica Fumagalli, M. van Gerwen, Frédéric Amant, M.M. van den Heuvel-Eibrink, Annette Hasenburg, Elyce Cardonick, Ignacio Zapardiel, A.L.V. Johansson, P. Morice, Flora Zagouri, Fedro A. Peccatori, Medical Oncology, Amant, F, Berveiller, P, Boere, I, Cardonick, E, Fruscio, R, Fumagalli, M, Halaska, M, Hasenburg, A, Johansson, A, Lambertini, M, Lok, C, Maggen, C, Morice, P, Peccatori, F, Poortmans, P, Van Calsteren, K, Vandenbroucke, T, van Gerwen, M, van den Heuvel-Eibrink, M, Zagouri, F, Zapardiel, I, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Gamètes, implantation, gestation (GIG), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, University Hospital Kralovské Vinohrady, University Medical Center [Mainz], Karolinska Institutet [Stockholm], Ospedale Policlinico San Martino [Genoa], Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek Hospital, Département de chirurgie gynécologique [Gustave Roussy], Institut Gustave Roussy (IGR), European Institute of Oncology [Milan] (ESMO), Université Paris sciences et lettres (PSL), University Hospitals Leuven [Leuven], VU University Medical Center [Amsterdam], Princess Máxima Center for Pediatric Oncology [Utrecht, Netherlands], University of Athens Medical School [Athens], Hospital Universitario La Paz, Obstetrics, and Faculty of Economic and Social Sciences and Solvay Business School

Subjects
0301 basic medicine, medicine.medical_specialty, Cognitive, Genital Neoplasms, Female, International Cooperation, [SDV.CAN]Life Sciences [q-bio]/Cancer, Cancer, Chemotherapy, Cognitive, Gynecologic, Offspring, Pregnancy, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, Genital Neoplasms, Female/therapy, Gynecologic, Offspring, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Pregnancy, Health care, medicine, Prenatal Exposure Delayed Effects/etiology, Humans, Chemotherapy, Radiation treatment planning, Intensive care medicine, Societies, Medical, Cancer, Pregnancy Complications, Neoplastic/therapy, Vaginal delivery, business.industry, Hematology, medicine.disease, Prognosis, 3. Good health, Cancer registry, Long-term care, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Prenatal Exposure Delayed Effects, Practice Guidelines as Topic, Female, Practice Guidelines as Topic/standards, business, Breast feeding, Pregnancy Complications, Neoplastic
Abstract

We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged. ispartof: ANNALS OF ONCOLOGY vol:30 issue:10 pages:1601-1612 ispartof: location:England status: published

Published
2019

44. The Association between Metals and Thyroid Cancer in Puerto Rico-A National Health and Nutrition Examination Survey Analysis and Ecological Study.

Author

Shaked Y, Yang J, Monaghan M, and van Gerwen M

Abstract

Thyroid cancer rates have risen globally over the past four decades, with Puerto Rico experiencing a particularly pronounced increase. This may be linked to higher metal exposure, as some metals are endocrine disruptors and carcinogens. Currently, certain regions of Puerto Rico have Superfund programs because of high concentrations of metals in the soil. Therefore, we investigated the association between thyroid cancer incidence and three metals (lead, cadmium, and mercury) with known endocrine-disrupting properties and increased levels in soil samples in Puerto Rico. We used the National Health and Nutrition Examination Survey (NHANES) data for heavy metal levels and the thyroglobulin antibody (TgAb) as a thyroid cancer marker. Additionally, we performed an ecological study using data from the Environmental Protection Agency (EPA) report on Metals from Natural and Anthropogenic Sources in Puerto Rico Soils and data from the Puerto Rico Central Cancer Registry on age-adjusted thyroid cancer incidence rates from 2015 to 2019. Through NHANES analysis, we found a significant negative association between mercury and TgAb. Through our ecological study, we observed higher thyroid cancer incidence rates and increased metal levels in the soil in the northern parts of Puerto Rico. Our heterogenous results necessitate further research on this topic.

Published
2024
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45. Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer: Systematic review and meta-analysis.

Author

van Gerwen M, Chung T, Monaghan M, Vermeulen R, Petrick L, and Leung AM

Subjects
Humans, Environmental Exposure adverse effects, Caprylates toxicity, Incidence, Alkanesulfonic Acids toxicity, Environmental Pollutants toxicity, Risk Factors, Risk Assessment, Thyroid Neoplasms chemically induced, Thyroid Neoplasms epidemiology, Fluorocarbons toxicity
Abstract

Per- and polyfluoroalkyl substances (PFAS) exposure is a potential risk factor for thyroid cancer and may be a contributor to the increasing thyroid cancer incidence rates. A systematic review and meta-analysis was performed to summarize all human studies to date investigating the association between PFAS exposure and thyroid cancer. A search of the National Library of Medicine and National Institutes of Health PubMed and Scopus databases was done to identify relevant articles published in English through January 2024. Studies reporting the association between PFAS exposure and thyroid cancer using odds ratios (OR) were included in the meta-analysis with summary estimate calculated using a random effects model (n=5). Perfluorooctanoic acid (PFOA) was the most investigated PFAS. Results of the included studies varied, ranging from significant positive to significant negative associations with thyroid cancer incidence for different PFAS. Meta-analyses of PFOA, Perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), perfluorohexanesulfonic acid (PFHxS) were not significant. This comprehensive review of the current literature highlights the limited knowledge and inconsistent results of this association. Large longitudinal cohort studies with varying time between sample collection and thyroid cancer diagnosis are needed to better understand the role of PFAS exposure on thyroid carcinogenesis., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Maaike van Gerwen reports financial support was provided by National Institutes of Health. Lauren Petrick reports financial support was provided by National Institutes of Health. Angela Leung reports a relationship with United States Environmental Protection Agency that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2024
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46. Investigating potential disparities by exploring time to surgical thyroid cancer treatment.

Author

Vujovic D, Rodriguez N, Alsen M, Genden E, and van Gerwen M

Subjects
Humans, Male, Female, Middle Aged, Retrospective Studies, United States, Aged, Adult, Insurance, Health statistics & numerical data, Social Class, Medicare, Thyroidectomy statistics & numerical data, Medicaid, Socioeconomic Factors, Time Factors, Income, Thyroid Neoplasms surgery, Healthcare Disparities statistics & numerical data, Time-to-Treatment statistics & numerical data
Abstract

(1) Delays in initial treatment have been a frequently used metric for assessing disparities in medicine; however, there has been sparse literature on treatment delays in thyroid cancer. We therefore aimed to assess disparities by investigating the association between race/ethnicity, insurance type, and socioeconomic status and time to surgical treatment of thyroid cancer. (2) A retrospective chart review was conducted to collect demographic and clinical data from 443 surgical thyroid cancer patients at Mount Sinai Hospital in 2018-2019. We investigated the time between thyroid cancer diagnosis and surgery by race/ethnicity, insurance, and income groups. (3) Univariate analysis showed that race/ethnicity, insurance type, and SES alone were not statistically significant predictors of earlier time to treatment (p = 0.766, 0.339, 0.435, respectively). On multivariable linear regression, time between diagnosis and surgical treatment was not significantly different for racial minorities compared to non-Hispanic White patients, patients with Medicare/Medicaid compared to private insurance, and patients with lowest income quartile (<$54,585) compared to those with the highest (≥$116,560). (4) Present study showed no significant delays in treatment for different racial/ethnic, insurance, and income groups., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Published
2024
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47. A Review of the Association between Exposure to Flame Retardants and Thyroid Function.

Author

Yeshoua B, Romero Castillo H, Monaghan M, and van Gerwen M

Abstract

Flame retardants have been shown to cause widespread physiological effects, in particular on endocrine organs such as the thyroid. This review aims to provide an overview of the literature on the association between flame retardants and thyroid function within humans. A search in the National Library of Medicine and National Institutes of Health PubMed database through January 2024 yielded 61 studies that met the inclusion criteria. The most frequently analyzed flame retardants across all thyroid hormones were polybrominated diphenyl ethers (PBDEs), in particular BDE-47 and BDE-99. Ten studies demonstrated exclusively positive associations between flame retardants and thyroid stimulating hormone (TSH). Six studies demonstrated exclusively negative associations between flame retardants and TSH. Twelve studies demonstrated exclusively positive associations for total triiodothyronine (tT3) and total thyroxine (tT4). Five and eight studies demonstrated exclusively negative associations between flame retardants and these same thyroid hormones, respectively. The effect of flame retardants on thyroid hormones is heterogeneous; however, the long-term impact warrants further investigation. Vulnerable populations, including indigenous people, individuals working at e-waste sites, firefighters, and individuals within certain age groups, such as children and elderly, are especially critical to be informed of risk of exposure.

Published
2024
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48. Thyroid abnormalities identified on CT screening for lung cancer.

Author

van Gerwen M, Ma T, Yip R, Choi C, Paksashvili N, Yankelevitz D, and Henschke C

Subjects
Humans, Male, Female, Middle Aged, Retrospective Studies, Aged, Incidental Findings, Thyroid Nodule diagnostic imaging, Early Detection of Cancer methods, Lung Neoplasms diagnostic imaging, Lung Neoplasms epidemiology, Tomography, X-Ray Computed methods
Abstract

Purpose: Because incidental thyroid nodules (ITNs) are common extrapulmonary findings in low-dose computed tomography (LDCT) scans for lung cancer screening, we aimed to investigate the frequency of ITNs on LDCT scans separately on baseline and annual repeat scans, the frequency of malignancy among the ITNs, and any association with demographic, clinical, CT characteristics., Methods: Retrospective case series of all 2309 participants having baseline and annual repeat screening in an Early Lung and Cardiac Action Program (MS-ELCAP) LDCT lung screening program from January 2010 to December 2016 was performed. Frequency of ITNs in baseline and annual repeat rounds were determined. Multivariable regression analysis was performed to identify significant predictors., Results: Dominant ITNs were seen in 2.5 % of 2309 participants on baseline and in 0.15 % of participants among 4792 annual repeat LDCTs. The low incidence of new ITNs suggests slow growth as it would take approximately an average of 16.8 years for a new ITN to be detected on annual rounds of screening. Newly detected ITNs on annual repeat LDCT were all smaller than 15 mm. Regression analysis showed that the increasing of age, coronary artery calcifications score and breast density grade were significant predictors for females having an ITN. No significant predictors were found for ITNs in males., Conclusion: ITNs are detected at LDCT however, no malignancy was found. Certain predictors for ITNs in females have been identified including breast density, which may point towards a common causal pathway., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Yankelevitz is a named inventor on a number of patents and patent applications related to the evaluation of chest diseases including measurements of chest nodules. Dr. Yankelevitz has received financial compensation for the licensing of these patents. In addition, he is a consultant and co-owner of Accumetra, a private company developing tools to improve the quality of CT imaging. He is on the advisory board and owns equity in HeartLung, a company that develops software related to CT scans of the chest. He is on the medical advisory board of Median Technology that is developing technology related to analyzing pulmonary nodules and is on the medical advisory board of Carestream, a company that develops radiography equipment and has consulted for Genentech, AstraZeneca and Pfizer. Dr. Claudia Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on CT scans of the chest which are owned by Cornell Research Foundation (CRF). Since 2009, Dr. Henschke does not accept any financial benefit from these patents including royalties and any other proceeds related to the patents or patent applications owned by CRF. Dr. Henschke is the President and serve on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the Foundation. The Foundation is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients include, I-ELCAP, among others. The funding comes from a variety of sources including philanthropic donations, grants and contracts with agencies (federal and non-federal), imaging and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. Dr. Claudia Henschke is on the advisory board of LungLife AI without compensation. All other authors have no competing interests to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Published
2024
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49. Anxiety and Depression as Potential Predictors for Shorter Time to Undergo Initial Surgical Treatment for Papillary Thyroid Cancer.

Author

Vujovic D, Alsen M, Vasan V, Genden E, and van Gerwen M

Abstract

(1) Background: A pre-existing psychiatric condition may impact decision making by patients and/or physicians following a thyroid cancer diagnosis, such as potentially electing surgery over active surveillance, thus shortening the time to cancer removal. This is the first study to investigate the association between pre-existing anxiety and/or depression and time to receive surgical treatment for thyroid cancer. (2) Methods: Retrospective data were collected from 652 surgical thyroid cancer patients at our institution from 2018 to 2020. We investigated the time between thyroid cancer diagnosis and surgery, comparing patients with pre-existing anxiety and/or depression to those without. (3) Results: Patients with anxiety, depression, and both anxiety and depression had a significantly shorter time between diagnosis and surgery (51.6, 57, and 57.4 days, respectively) compared to patients without (111.9 days) ( p = 0.002, p = 0.004, p = 0.003, respectively). (4) Conclusions: Although little is known about the impact of pre-existing psychiatric conditions in the decision-making process for thyroid cancer surgery, this present study showed that anxiety and/or depression may lead to more immediate surgical interventions. Thus, psychiatric history may be an important factor for physicians to consider when counseling patients with thyroid cancer.

Published
2024
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50. Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer risk.

Author

van Gerwen M, Colicino E, Guan H, Dolios G, Nadkarni GN, Vermeulen RCH, Wolff MS, Arora M, Genden EM, and Petrick LM

Subjects
Humans, Prospective Studies, Thyroid Cancer, Papillary, Case-Control Studies, Environmental Pollutants, Fluorocarbons, Thyroid Neoplasms epidemiology, Thyroid Neoplasms etiology
Abstract

Background: Although per- and polyfluoroalkyl substances (PFAS) exposure is a potential contributor to the increasing thyroid cancer trend, limited studies have investigated the association between PFAS exposure and thyroid cancer in human populations. We therefore investigated associations between plasma PFAS levels and thyroid cancer diagnosis using a nested case-control study of patients with thyroid cancer with plasma samples collected at/before cancer diagnosis., Methods: 88 patients with thyroid cancer using diagnosis codes and 88 healthy (non-cancer) controls pair-matched on sex, age (±5 years), race/ethnicity, body mass index, smoking status, and year of sample collection were identified in the BioMe population (a medical record-linked biobank at the Icahn School of Medicine at Mount Sinai in New York); 74 patients had papillary thyroid cancer. Eight plasma PFAS were measured using untargeted analysis with liquid chromatography-high resolution mass spectrometry and suspect screening. Associations between individual PFAS levels and thyroid cancer were evaluated using unconditional logistic regression models to estimate adjusted odds ratios (OR adj ) and 95% confidence intervals (CI)., Findings: There was a 56% increased rate of thyroid cancer diagnosis per doubling of linear perfluorooctanesulfonic acid (n-PFOS) intensity (OR adj , 1.56, 95% CI: 1.17-2.15, P = 0.004); results were similar when including patients with papillary thyroid cancer only (OR adj , 1.56, 95% CI: 1.13-2.21, P = 0.009). This positive association remained in subset analysis investigating exposure timing including 31 thyroid cancer cases diagnosed ≥1 year after plasma sample collection (OR adj , 2.67, 95% CI: 1.59-4.88, P < 0.001)., Interpretation: This study reports associations between exposure to PFAS and increased rate of (papillary) thyroid cancer. Thyroid cancer risk from PFAS exposure is a global concern given the prevalence of PFAS exposure. Individual PFAS studied here are a small proportion of the total number of PFAS supporting additional large-scale prospective studies investigating thyroid cancer risk associated with exposure to PFAS chemicals., Funding: National Institutes of Health grants and The Andrea and Charles Bronfman Philanthropies., Competing Interests: Declaration of interests Manish Arora is co-founder of Linus Biotechnology and is owner of a license agreement with NIES (Japan). He also received honoraria and travel compensation for lectures for the Bio-Echo and Brin foundations. Dr. Arora has 22 patents at various stages., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2023
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