Interactions between glioma and pregnancy: insight from a 52-case multicenter series.

OBJECTIVE The goal of this study was to provide insight into the influence of gliomas on gestational outcomes, the impact of pregnancy on gliomas, and the identification of patients at risk. METHODS In this multiinstitutional retrospective study, the authors identified 52 pregnancies in 50 women diagnosed with a glioma. RESULTS For gliomas known prior to pregnancy (n = 24), we found the following: 1) An increase in the quantified imaging growth rates occurred during pregnancy in 87% of cases. 2) Clinical deterioration occurred in 38% of cases, with seizures alone resolving after delivery in 57.2% of cases. 3) Oncological treatments were immediately performed after delivery in 25% of cases. For gliomas diagnosed during pregnancy (n = 28), we demonstrated the following: 1) The tumor was discovered during the second and third trimesters in 29% and 54% of cases, respectively, with seizures being the presenting symptom in 68% of cases. 2) The quantified imaging growth rates did not significantly decrease after delivery and before oncological treatment. 3) Clinical deterioration resolved after delivery in 21.4% of cases. 4) Oncological treatments were immediately performed after delivery in 70% of cases. Gliomas with a high grade of malignancy, negative immunoexpression of alpha-internexin, or positive immunoexpression for p53 were more likely to be associated with tumor progression during pregnancy. Deliveries were all uneventful (cesarean section in 54.5% of cases and vaginal delivery in 45.5%), and the infants were developmentally normal. CONCLUSIONS When a woman harboring a glioma envisions a pregnancy, or when a glioma is discovered in a pregnant patient, the authors suggest informing her and her partner that pregnancy may impact the evolution of the glioma clinically and radiologically. They strongly advise a multidisciplinary approach to management. ■ CLASSIFICATION OF EVIDENCE Type of question: association; study design: case series; evidence: Class IV.

[1]  E. Pantelis,et al.  Radiation dose to the fetus during CyberKnife radiosurgery for a brain tumor in pregnancy. , 2016, Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics.

[2]  E. Helseth,et al.  The effect of pregnancy on survival in a low-grade glioma cohort. , 2016, Journal of neurosurgery.

[3]  B. Devaux,et al.  Long-term results of carmustine wafer implantation for newly diagnosed glioblastomas: a controlled propensity-matched analysis of a French multicenter cohort. , 2015, Neuro-oncology.

[4]  A. Heimberger,et al.  ATPS-68COMBINATION OF TOPOISOMERASE II POISON BERUBICIN WITH STAT3 INHIBITOR WP1066BLOCKS POTENTLY TUMOR GROWTH IN GMB MODELS , 2015 .

[5]  H. Duffau,et al.  New concepts in the management of diffuse low-grade glioma: Proposal of a multistage and individualized therapeutic approach. , 2014, Neuro-oncology.

[6]  Diane D. Liu,et al.  Pregnancy and glial brain tumors. , 2014, Neuro-oncology.

[7]  I. Camacho-Arroyo,et al.  Progesterone Induces the Growth and Infiltration of Human Astrocytoma Cells Implanted in the Cerebral Cortex of the Rat , 2014, BioMed research international.

[8]  R. Guillevin,et al.  Epileptic seizures in diffuse low-grade gliomas in adults. , 2014, Brain : a journal of neurology.

[9]  M. Taphoorn,et al.  Pregnancy in women with gliomas: a case-series and review of the literature , 2013, Journal of Neuro-Oncology.

[10]  G. Barnett,et al.  A case series discussing the anaesthetic management of pregnant patients with brain tumours , 2013, F1000Research.

[11]  Winand N M Dinjens,et al.  Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  Tian-Long Wang,et al.  Glioma in the third trimester of pregnancy: Two cases and a review of the literature , 2013, Oncology letters.

[13]  M. Daras,et al.  Tumor progression and transformation of low-grade glial tumors associated with pregnancy , 2013, Journal of Neuro-Oncology.

[14]  Luc Taillandier,et al.  Quantitative morphological magnetic resonance imaging follow-up of low-grade glioma: a plea for systematic measurement of growth rates. , 2012, Neurosurgery.

[15]  P. Whitfield,et al.  Management of glioblastoma multiforme in pregnancy. , 2012, Journal of neurosurgery.

[16]  I. Souter,et al.  Outcomes of hospitalization in pregnant women with CNS neoplasms: a population-based study. , 2012, Neuro-oncology.

[17]  S. Kelly,et al.  Successful pregnancy and delivery after concomitant temozolomide and radiotherapy treatment of glioblastoma multiforme. , 2012, Clinical oncology (Royal College of Radiologists (Great Britain)).

[18]  João Cláudio Emmerich,et al.  Management strategy for brain tumour diagnosed during pregnancy , 2011, British journal of neurosurgery.

[19]  P. Fabbro-Péray,et al.  Brain tumors and hormonal factors: review of the epidemiological literature , 2011, Cancer Causes & Control.

[20]  A. Schatzkin,et al.  Reproductive factors and exogenous hormone use and risk of adult glioma in women in the NIH‐AARP Diet and Health Study , 2011, International journal of cancer.

[21]  Kristen Smith.  The Management of Seizures in Brain Tumor Patients , 2010, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[22]  H. Duffau,et al.  Pregnancy increases the growth rates of world health organization grade II gliomas , 2009, Annals of neurology.

[23]  W. Tan,et al.  Dilemmas in management of brain tumours in pregnancy. , 2010, Annals of the Academy of Medicine, Singapore.

[24]  R. Tubbs,et al.  Neurosurgical management of intracranial lesions in the pregnant patient: a 36-year institutional experience and review of the literature. , 2009, Journal of neurosurgery.

[25]  H. Duffau,et al.  Influence of pregnancy in the behavior of diffuse gliomas: clinical cases of a French glioma study group , 2009, Journal of Neurology.

[26]  M. Sermer,et al.  Obstetric outcomes of women with intracranial neoplasms , 2009, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[27]  D. Blumenthal,et al.  Management of malignant gliomas during pregnancy , 2008, Cancer.

[28]  T. Mikkelsen,et al.  Insulin-like growth factor binding protein 7 mediates glioma cell growth and migration. , 2008, Neoplasia.

[29]  T. Lange,et al.  Cell proliferation and migration in glioblastoma multiforme cell lines are influenced by insulin-like growth factor I in vitro. , 2008, Anticancer research.

[30]  D. González-Espinosa,et al.  Progesterone effects on cell growth of U373 and D54 human astrocytoma cell lines , 2007, Endocrine.

[31]  B. Scheithauer,et al.  The 2007 WHO classification of tumours of the central nervous system , 2007, Acta Neuropathologica.

[32]  Peter M Black,et al.  Survival rates and patterns of care for patients diagnosed with supratentorial low‐grade gliomas , 2006, Cancer.

[33]  P. Audra,et al.  Prise en charge des gliomes malins découverts au cours d’une grossesse , 2006 .

[34]  H. Fine,et al.  Reproductive and hormonal factors and risk of brain tumors in adult females , 2005, International journal of cancer.

[35]  R. Thompson,et al.  The clinical management of intracranial neoplasms in pregnancy. , 2005, Clinical obstetrics and gynecology.

[36]  J. Hauw,et al.  Steroid hormone receptors in human meningiomas, gliomas and brain metastases , 2004, Journal of Neuro-Oncology.

[37]  Rodríguez-Uranga Jj,et al.  Inicio de un ganglioglioma anaplásico durante un puerperio con signos de toxemia gravídica , 2003 .

[38]  R. Swensen,et al.  Brain Neoplasms in Women: A Review , 2002, Clinical obstetrics and gynecology.

[39]  P. Disaia,et al.  Obstetric emergencies precipitated by malignant brain tumors. , 2000, American journal of obstetrics and gynecology.

[40]  S. Shibata,et al.  Immunohistochemical analysis of progesterone receptor and ki‐67 labeling index in astrocytic tumors , 1997 .

[41]  A. Isla,et al.  Brain Tumor and Pregnancy , 1997, Obstetrics and gynecology.

[42]  Satoshi O. Suzuki,et al.  Primary brain tumours manifesting during pregnancy: presentation of six cases and a review of the literature , 1996, Journal of Clinical Neuroscience.

[43]  W. Kamphorst,et al.  Pregnancy-related primary brain and spinal tumors. , 1987, Archives of neurology.