BACKGROUND Diagnosis of a glioma during pregnancy has ethical and medical dilemmas; treatment of the mother may harm the unborn child, but a too conservative approach towards tumor treatment can compromise the survival of the mother. In patients with a suspected high-grade glioma, postponing tumor treatment is undesirable. We collected published cases to describe the given treatments during pregnancy and the outcomes for mother and child. METHODS From Pubmed, Embase and Web of Science, 122 cases were extracted from 65 reports published between 1999 and 2020. We added 7 cases from our center. Cases came from: North-America (54/129), Europe (47/129), Asia (13/129), Middle-East (3/129) and one from Oceania and Africa each; 10 cases were from an unspecified country. The data were analysed with descriptive statistics. RESULTS The median age of the pregnant women was 30 (range 17–48) years; at the time of publication 42% of mothers had deceased. Most frequent symptoms at presentation were high intracranial pressure (35%), seizures (30%) or focal deficits (19%). Patients were diagnosed in each phase of the pregnancy - 30% in the first, 35% in the second and 35% in the last trimester. Twenty-two women decided to terminate the pregnancy (North America 9; Europe 9; international unspecified, Africa, Asia and Middle-East each one case). In sixty-seven percent of women, tumors were operated while pregnant, 70% of those were planned surgery, while in 30% surgery was in performed in an emergency setting. Most women received a resection. In 6 patients tumor surgery was combined with a caesarian section. Histological diagnosis of the tumor was available in 112 patients: anaplastic oligodendroglioma (n=10), anaplastic astrocytoma (n=30), glioblastoma (n=66) or high-grade glioma NOS (n=6). In 10 patients there was a suspected high grade glioma based on MRI imaging. Only 20 patients were treated after surgery whilst still pregnant with either radiotherapy (15/20, 75%), chemotherapy (2/20, 10%) or a combination of radiotherapy and chemotherapy (3/20, 15%) Other patients received additional treatment after delivery (109/129; 84%). Delivery method was a caesarian section in 60% and vaginal delivery in 21%- in 19% delivery method was not described. In 63% of cesarean sections were brought forward either because of rapid maternal deterioration or to enable maternal treatment after delivery. In 92% a healthy child was born, 7% had a intrauterine fetal death and 1% the child was stillborn. None of the patients who experienced intrauterine fetal death had received radio- or chemotherapy during pregnancy. CONCLUSIONS The majority of pregnant women continue their pregnancy when facing a diagnosis of a high grade glioma. Tumor surgery seemed safe during pregnancy. No adverse events were reported in the limited patients who received radiotherapy (n=15) during pregnancy. For chemotherapy we could not draw any conclusions.

中文翻译：

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P14.51 疑似高级别胶质瘤患者能否在妊娠期间安全接受肿瘤治疗？

背景在怀孕期间诊断胶质瘤存在伦理和医学困境。母亲的治疗可能会伤害未出生的孩子，但对肿瘤治疗过于保守的方法可能会危及母亲的生存。对于疑似高级别胶质瘤的患者，推迟肿瘤治疗是不可取的。我们收集了已发表的病例来描述怀孕期间给予的治疗以及母婴的结局。方法来自 Pubmed、Embase 和 Web of Science，从 1999 年至 2020 年间发表的 65 篇报告中提取 122 例。我们从我们中心添加了 7 例。病例来自：北美（54/129）、欧洲（47/129）、亚洲（13/129）、中东（3/129），大洋洲和非洲各1例；10个病例来自一个未指明的国家。用描述性统计分析数据。结果孕妇的中位年龄为30（范围17-48）岁；在出版时，42% 的母亲已经去世。就诊时最常见的症状是高颅内压 (35%)、癫痫发作 (30%) 或局灶性缺陷 (19%)。患者在妊娠的每个阶段都被诊断出来——第一阶段占 30%，第二阶段占 35%，最后三个月占 35%。22 名妇女决定终止妊娠（北美 9 名；欧洲 9 名；国际未指明，非洲、亚洲和中东各 1 例）。在 67% 的女性中，肿瘤在怀孕期间进行了手术，其中 70% 是计划手术，而 30% 的手术是在紧急情况下进行的。大多数女性接受了切除术。在 6 名患者中，肿瘤手术与剖腹产相结合。112 名患者可获得肿瘤的组织学诊断：间变性少突胶质细胞瘤 (n=10)、间变性星形细胞瘤 (n=30)、胶质母细胞瘤 (n=66) 或高级别胶质瘤 NOS (n=6)。在 10 名患者中，基于 MRI 成像怀疑为高级别胶质瘤。只有 20 名患者在手术后接受了治疗，同时仍在怀孕期间接受放疗（15/20, 75%）、化疗（2/20, 10%）或放化疗联合治疗（3/20, 15%） 其他患者接受了额外的治疗产后治疗 (109/129; 84%)。60% 的分娩方法是剖腹产，21% 的分娩方式是阴道分娩，19% 的分娩方式没有描述。在 63% 的剖宫产中，要么是因为产妇病情迅速恶化，要么是为了在分娩后进行产妇治疗。92% 的孩子出生时健康，7% 的胎儿宫内死亡，1% 的孩子死产。没有经历过宫内胎儿死亡的患者在怀孕期间接受过放疗或化疗。结论 大多数孕妇在被诊断为高级别胶质瘤时会继续妊娠。肿瘤手术在怀孕期间似乎是安全的。在怀孕期间接受放射治疗的有限患者（n = 15）中未报告任何不良事件。对于化疗，我们无法得出任何结论。