妇科癌症保留生育能力的医疗管理选择。

IF 4.7 2区 医学 Q2 ONCOLOGY
Current Treatment Options in Oncology Pub Date : 2025-03-01 Epub Date: 2025-02-19 DOI:10.1007/s11864-025-01299-4
Ana Kouri, Janelle P Darby
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引用次数: 0

摘要

意见声明:由于新辅助治疗、延迟生育和辅助生殖技术的使用增加,对妇科癌症的医疗管理越来越多。化疗虽然广泛用于大多数妇科癌症,但缺乏其相关的性腺毒性和潜在不良妊娠结局的长期数据。免疫治疗和其他靶向治疗已经在其他肿瘤类型中显示出有希望的反应,正在越来越多地研究妇科恶性肿瘤。这些疗法可能为提高治疗效果提供机会,以尽量减少可能对生育产生重大负面影响的毒性、侵入性或外科治疗方法。鉴于其中一些疗法并不代表标准的护理,目前仅存在于实验环境中,详细的咨询和谨慎选择患者进行生育保留治疗仍然至关重要。对于早期、低风险的子宫内膜癌患者,在确定明确的治疗目标的同时,尝试保守治疗是合理的。为了优化这些患者的妊娠目标,生育专家的早期介入是必要的。强调生活方式的改变,特别是减肥也应该与这些患者讨论。对于低风险小肿瘤的宫颈癌患者,新辅助化疗后保留生育能力的手术显示出有希望的结果,表明这可能是一种安全的治疗选择。任何原发肿瘤或侵袭性组织学的晚期患者,如卵巢癌,都不适合优先考虑保留生育能力的治疗方案。正在进行的和未来的研究将有助于更好地确定合适的患者,并最大限度地提高早期妇科癌症的医疗管理选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Fertility Sparing Medical Management Options in Gynecologic Cancers.

Opinion statement: There is an increasing use of medical management for gynecologic cancers given the rise in neoadjuvant therapies, delayed childbearing, and use of assisted reproductive technology. Chemotherapy, albeit broadly used in most gynecologic cancers, lacks long term data with respect to its associated gonadotoxicity and potential adverse pregnancy outcomes. Immunotherapy and other targeted therapies that have demonstrated promising responses in other tumor types are increasingly being studied in gynecologic malignancies. These therapies may offer opportunities for enhanced treatment response in an effort to minimize more toxic, invasive, or surgical management approaches that could have significant negative implications on fertility. Given that some of these therapies do not represent the standard of care and currently only exist in the experimental setting, detailed counseling and careful selection of patients for fertility sparing treatment remains critical. It is reasonable for patients with early stage, low-risk endometrial cancers to attempt conservative management while establishing clear treatment objectives. Early involvement of fertility specialists is necessary in order to optimize these patients' pregnancy goals. An emphasis on lifestyle changes and in particular weight loss should also be discussed with these patients. Neoadjuvant chemotherapy followed by fertility sparing surgery in cervix cancer patients with low-risk, small tumors shows promising results that suggest this can be a safe treatment option. Patients with advanced stage disease of any primary tumor or aggressive histology such as in many cases of ovarian cancer are not appropriate candidates for prioritization of fertility sparing treatment options. Ongoing and future studies will help to better identify appropriate patients and maximize medical management options in early-stage gynecologic cancers.

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来源期刊
CiteScore
7.10
自引率
0.00%
发文量
113
审稿时长
>12 weeks
期刊介绍: This journal aims to review the most important, recently published treatment option advances in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to facilitate worldwide approaches to cancer treatment. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as endocrine tumors, lymphomas, neuro-oncology, and cancers of the breast, head and neck, lung, skin, gastrointestinal tract, and genitourinary region. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. We also provide commentaries from well-known oncologists, and an international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research.
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