Defining the management of bone and soft tissue sarcoma diagnosed during pregnancy using 38-year data collected in a single centre

Background

Diagnosis of a bone or soft tissue sarcomas is uncommon, and the odds of being present during pregnancy are rare. Hence, the management of sarcoma during pregnancy is more complicated, and to date, no single guideline suits all.

Method

Patients diagnosed with either bone or soft-tissue sarcomas or metastatic sarcoma progression during pregnancy were identified retrospectively between 1983 and 2021 from our orthopaedic oncology database. Demographic and relevant information regarding their management was collected, including maternal and neonatal outcomes, metastatic progression, and survival rates.

Results

A sum of 30 patients diagnosed with sarcoma during pregnancy were included; 16 (53.33%) with bone sarcoma and nine (30%) with soft-tissue sarcoma. Five (16.67%) had metastatic progression of their bone or soft-tissue sarcoma during pregnancy. The median age at diagnosis is 31 years old, youngest at 18 and eldest at 38 years old. Detailed discussions between the sarcoma multidisciplinary team (MDT) and obstetric teams took place throughout each patient's pregnancy follow-up. Seven underwent termination of pregnancy, and six underwent surgical treatment during pregnancy with no maternal or neonatal complications reported. Eight were induced early and four underwent early caesarean section to allow for staging and definitive management without any neonatal complications. Maternal one-year and five-year survival rates for bone sarcomas were 100% and 73.68%, respectively, and 100% and 70%, respectively, for soft-tissue sarcomas. One survived more than five years in the metastatic progression group but succumbed at 7th year due to cerebral metastasis.

Conclusion

The management of bone and soft-tissue sarcomas during pregnancy by sarcoma MDT with collective knowledge and expertise led to good neonatal or maternal outcomes comparable to maternal survival rates of the non-pregnant population. The treatment plan should be based on individual expectations from the patient depending on the gestational period of the pregnancy, the type of pathology, and the location of the sarcoma.