Stage I squamous cell cervical carcinoma in pregnancy: planned delay in therapy awaiting fetal maturity

It is not known whether intentional delay to allow fetal maturity in patients with Stage I cervical carcinoma diagnosed during pregnancy will affect the survival of these patients. The purpose of this study is to report our experience with invasive squamous cervical carcinoma after planned delay in therapy for fetal indications, to assess maternal morbidity due to treatment delay, and to report maternal and fetal survival.

Between 1989 and 1994, eight pregnant women with Stage I squamous cervical carcinoma, who declined immediate therapy in order to improve fetal outcome, were prospectively followed until the late third trimester. Serial MRIs were used to follow the lesion in two patients.

Stage IB cervical cancer was diagnosed in seven pregnant women. All lesions were less than 2.5 cm. The mean diagnosis-to-treatment interval was 109 days (range, 21-201; median, 112). One woman conceived in the cycle after diagnosis and had a diagnosis-to-treatment interval of 282 days. All were delivered by cesarean section-radical hysterectomy late in the third trimester. There was no clinical progression of disease detected during any of the pregnancies. Serial MRI examination confirmed stable disease in one patient and suggested an increase in tumor volume in one patient that was not pathologically confirmed. All are alive and disease free after a mean follow-up of 37 months (range, 13-68; median, 33). Neonatal morbidity was encountered in one infant (spontaneous pneumothorax).

With a median follow-up of 33 months, patient-requested delays in therapy between 3 and 40 weeks (mean, 19) did not affect progression.