Tratamiento del cáncer de mama diagnosticado durante el embarazo

Abstract

Breast cancer diagnosed during pregnancy is a rare entity. Nevertheless, we have data in the literature that supports safety of treatment of these patients. It has to be considered that this treatment should be as close as possible to a non-pregnant woman and that it should be performed in specialized centers that ensure multidisciplinary management of the patients in order to minimize obstetric and pediatric complications. Breast and axillary surgery can be performed at any time during pregnancy, treatment with chemotherapy based on anthracyclines and / or taxanes from the second trimester and onwards, and the use of radiotherapy and biological drugs in these patients should be avoided whenever possible. This doctoral thesis describes the treatment of 49 women diagnosed with breast cancer during their pregnancy at the Vall d'Hebrón Hospital or referred to this center for treatment. Data are reported on the characteristics of the maternal and fetal population, their prognosis, the treatment performed on the patients and the complications derived from it. In addition, specific cardiological follow-up data are reported in both mothers and fetuses and follow-up data on neuropsychological development in neonates exposed to intrauterine chemotherapy. Finally, a study of maternal angiogenic factors assessed by the sFlt-1 / PIGF ratio and the influence of these on placental development in the chemotherapy-treated population was carried out. The goal is that this ratio already used in the population of pregnant women not exposed to chemotherapy, may be informative in the future at the time of decision-making near the time of delivery also in this population. A ratio of sFlt-1 / PIGF> 38 should suggest in clinical practice to increase the obstetric follow-up of these patients due to the potential occurrence of complications related to placental insufficiency, as well as to assess, at week 34, the possibility of indicating delivery. On the other hand, a normal value in the sFlt-1 / PIGF ratio, should avoid precipitation in the decision to advance labor in this population.

Date of Award	21 Jul 2017
Original language	Spanish
Awarding Institution	Vall d'Hebron University Hospital (HUVH)
Supervisor	Javier Cortés Castán (Director) & Jordi Giralt Lopez de Sagredo (Tutor)