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Cancers
Special Issues
Fertility and Pregnancy in Cancer Patients: Illusion or Reality
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Fertility and Pregnancy in Cancer Patients: Illusion or Reality

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (20 May 2023) | Viewed by 7759

Special Issue Editors

Dr. Giacomo Corrado

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Guest Editor
Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: gynecologic oncology; electrochemotherapy; oncofertility
Special Issues, Collections and Topics in MDPI journals
Dr. Inge T. A. Peters

E-Mail Website
Guest Editor
Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: gynecologic oncology; oncofertility
Dr. Ida Paris

E-Mail Website
Guest Editor
Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: breast cancer; precision medicine; targeted therapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

New advances in the field of medicine have significantly increased cancer survival rates. Cancer survivors generally wish to resume their normal life even if they experience late side effects as a consequence of the disease itself and/or the treatments they have been exposed to. One of the most distressing consequences of these anticancer treatments is the loss of reproductive potential and thus infertility. Unfortunately, even today only a small percentage of cancer patients receive counselling on fertility preservation options prior to the start of their potential gonadotoxic anticancer treatment. It therefore remains of utmost importance to create awareness on this topic. Especially since the majority of the available preservation techniques are no longer considered experimental, fertility preservation counselling should be incorporated into routine cancer care.

The aim of this Special Issue is to disseminate knowledge of medical specialists and healthcare providers working in related disciplines about the latest insights and new frontiers in the field of fertility preservation and pregnancy in patients diagnosed with oncological and onco-hematological diseases.

Dr. Giacomo Corrado
Dr. Inge T. A. Peters
Dr. Ida Paris
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cancer
  • survival
  • fertility
  • pregnancy

Published Papers (6 papers)

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Research

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16 pages, 1992 KiB  
Article
Obstetric Results after Fertility-Sparing Management of Non-Epithelial Ovarian Cancer
by Szymon Piątek, Iwona Szymusik, Piotr Sobiczewski, Wojciech Michalski, Magdalena Kowalska, Mariusz Ołtarzewski and Mariusz Bidziński
Cancers 2023, 15(16), 4170; https://doi.org/10.3390/cancers15164170 - 18 Aug 2023
Viewed by 870
Abstract
Purpose: To assess the recurrence and birth rates among patients with non-epithelial ovarian cancer. Methods: The study included 146 patients with germ cell (GCT, n = 84) and sex cord-stromal tumors (SCST, n = 62), who underwent fertility-sparing surgery. Adjuvant chemotherapy was administered [...] Read more.
Purpose: To assess the recurrence and birth rates among patients with non-epithelial ovarian cancer. Methods: The study included 146 patients with germ cell (GCT, n = 84) and sex cord-stromal tumors (SCST, n = 62), who underwent fertility-sparing surgery. Adjuvant chemotherapy was administered to 86 (58.9%) patients. Most cases (133 out of 146) were staged FIGO I. Results: The 5- and 10-year disease-free survival rates were 91% and 83%, respectively. The recurrence risk was not associated with tumor histology, stage or age. Twenty-four months after the treatment, the rate of recurrence was higher than the rate of childbearing. The childbearing rates kept rising after the treatment and exceeded the rate of recurrence after 2 years. The cumulative incidence rates of birth 36, 60 and 120 months after treatment were 13.24%, 20.75%, and 42.37%, respectively. Chemotherapy was not related to childbearing. The patients’ age was related to the chance of childbearing. Conclusions: The prognoses of GCT and SCST are similar. Close follow-ups along with contraception should be offered to women during the first two years after treatment due to the increased risk of recurrence. After this period, relapses are rare and women can safely become pregnant. Full article
(This article belongs to the Special Issue Fertility and Pregnancy in Cancer Patients: Illusion or Reality)
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13 pages, 303 KiB  
Article
The Safe Use of 125I-Seeds as a Localization Technique in Breast Cancer during Pregnancy
by Eva Heeling, Jeroen B. van de Kamer, Michelle Methorst, Annemarie Bruining, Mette van de Meent, Marie-Jeanne T. F. D. Vrancken Peeters, Christianne A. R. Lok and Iris M. C. van der Ploeg
Cancers 2023, 15(12), 3229; https://doi.org/10.3390/cancers15123229 - 17 Jun 2023
Viewed by 1179
Abstract
Introduction: Some aspects of the treatment protocol for breast cancer during pregnancy (PrBC) have not been thoroughly studied. This study provides clarity regarding the safety of the use of 125I-seeds as a localization technique for breast-conserving surgery in patients with PrBC. Methods: [...] Read more.
Introduction: Some aspects of the treatment protocol for breast cancer during pregnancy (PrBC) have not been thoroughly studied. This study provides clarity regarding the safety of the use of 125I-seeds as a localization technique for breast-conserving surgery in patients with PrBC. Methods: To calculate the exposure to the fetus of one 125I-seed implanted in a breast tumor, we developed a model accounting for the decaying 125I-source, time to surgery, and the declining distance between the 125I-seed and the fetus. The primary outcome was the maximum cumulative fetal dose of radiation at consecutive gestational ages (GA). Results: The cumulative fetal dose remains below 1 mSv if a single 125I-seed is implanted at a GA of 26 weeks. After a GA of 26 weeks, the fetal dose can be at a maximum of 11.6 mSv. If surgery takes place within two weeks of implantation from a GA of 26 weeks, and one week above a GA of 32 weeks, the dose remains below 1 mSv. Conclusion: The use of 125I-seeds is safe in PrBC. The maximum fetal exposure remains well below the threshold of 100 mSv, and therefore, does not lead to an increased risk of fetal tissue damage. Still, we propose keeping the fetal dose as low as possible, preferably below 1 mSv. Full article
(This article belongs to the Special Issue Fertility and Pregnancy in Cancer Patients: Illusion or Reality)
10 pages, 663 KiB  
Article
Fertility-Sparing Treatment and Assisted Reproductive Technology in Patients with Endometrial Carcinoma and Endometrial Hyperplasia: Pregnancy Outcomes after Embryo Transfer
by Hilary Friedlander, Jennifer K. Blakemore, David H. McCulloh and M. Elizabeth Fino
Cancers 2023, 15(7), 2123; https://doi.org/10.3390/cancers15072123 - 02 Apr 2023
Cited by 1 | Viewed by 1501
Abstract
The goal of fertility-sparing treatment (FST) for patients desiring future fertility with EMCA, and its precursor EH, is to clear the affected tissue and revert to normal endometrial function. Approximately 15% of patients treated with FST will have a live birth without the [...] Read more.
The goal of fertility-sparing treatment (FST) for patients desiring future fertility with EMCA, and its precursor EH, is to clear the affected tissue and revert to normal endometrial function. Approximately 15% of patients treated with FST will have a live birth without the need for assisted reproductive technology (ART). Despite this low number, little information exists on the pregnancy outcomes of patients who utilize ART. The purpose of this study was to evaluate pregnancy outcomes following embryo transfer in patients with EMCA or EH who elected for FST. This retrospective cohort study at a large urban university-affiliated fertility center included all patients who underwent embryo transfer after fertility-sparing treatment for EMCA or EH between January 2003 and December 2018. Primary outcomes included embryo transfer results and a live birth rate (defined as the number of live births per number of transfers). There were 14 patients, three with EMCA and 11 with EH, who met the criteria for inclusion with a combined total of 40 embryo transfers. An analysis of observed outcomes by sub-group, compared to the expected outcomes at our center (patients without EMCA/EH matched for age, embryo transfer type and number, and utilization of PGT-A) showed that patients with EMCA/EH after FST had a significantly lower live birth rate than expected (Z = −5.04, df = 39, p < 0.01). A sub-group analysis of the 14 euploid embryo transfers resulted in a live birth rate of 21.4% compared to an expected rate of 62.8% (Z = −3.32, df = 13, p < 0.001). Among patients with EMCA/EH who required assisted reproductive technology, live birth rates were lower than expected following embryo transfer when compared to patients without EMCA/EH at our center. Further evaluation of the impact of the diagnosis, treatment, and repeated cavity instrumentation for FST is necessary to create an individualized and optimized approach for this unique patient population. Full article
(This article belongs to the Special Issue Fertility and Pregnancy in Cancer Patients: Illusion or Reality)
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13 pages, 1134 KiB  
Article
Oocyte Quality Assessment in Breast Cancer: Implications for Fertility Preservation
by Cristina Fabiani, Antonella Guarino, Caterina Meneghini, Emanuele Licata, Gemma Paciotti, Donatella Miriello, Michele Carlo Schiavi, Vincenzo Spina, Roberta Corno, Mariagrazia Gallo and Rocco Rago
Cancers 2022, 14(22), 5718; https://doi.org/10.3390/cancers14225718 - 21 Nov 2022
Cited by 5 | Viewed by 1553
Abstract
Background: The aim of this study was to evaluate the effects of breast cancer on the ovarian response and on oocyte quality following controlled ovarian hyperstimulation (COH). Methods: This retrospective case-control study evaluated the effects of breast cancer on the ovarian response and [...] Read more.
Background: The aim of this study was to evaluate the effects of breast cancer on the ovarian response and on oocyte quality following controlled ovarian hyperstimulation (COH). Methods: This retrospective case-control study evaluated the effects of breast cancer on the ovarian response and on the oocyte quality. Oncological patients with breast cancer undergoing controlled ovarian stimulation cycles for fertility preservation, and age- and date-matched controls undergoing COH for in vitro fertilization (IVF) for male or tubal factor infertility were included in the study. Two hundred and ninety-four women were enrolled: 105 affected by breast cancer and 189 healthy women in the control group. Both groups were comparable in terms of age, BMI, and AMH value. Maximal estradiol levels on the triggering day, duration of stimulation, total amount of gonadotropins administered, number of oocytes retrieved, rate of metaphase 2 oocyte production, and numbers of immature and dysmorphic oocytes were analyzed. Results: Considering factors influencing the oocyte quality, such as age, BMI, AMH, duration of stimulation, E2 level on the triggering day, total FSH cumulative dose, stage, histotype, BRCA status, and hormone receptors, the univariate and multivariate analyses identified breast cancer as a risk factor for the presence of dysmorphic oocytes. Conclusions: The diagnosis of breast cancer does not seem to be associated with the impairment of the ovarian reserve, but is linked to a worsening oocyte quality. Full article
(This article belongs to the Special Issue Fertility and Pregnancy in Cancer Patients: Illusion or Reality)
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Review

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12 pages, 7319 KiB  
Review
Reproductive Results in Cancer Survivors after Fertility Sparing Management: The Need for the Standardization of Definitions
by Szymon Piątek, Iwona Szymusik and Mariusz Bidziński
Cancers 2023, 15(14), 3569; https://doi.org/10.3390/cancers15143569 - 11 Jul 2023
Cited by 3 | Viewed by 1017
Abstract
In fertility-sparing management (FSM), two different issues can be distinguished: the risk of recurrence/death and the chance of childbearing. Survival is the principal outcome in oncology, and definitions of overall survival and progression-free survival are therefore well defined and widely accepted. The introduction [...] Read more.
In fertility-sparing management (FSM), two different issues can be distinguished: the risk of recurrence/death and the chance of childbearing. Survival is the principal outcome in oncology, and definitions of overall survival and progression-free survival are therefore well defined and widely accepted. The introduction of FSM to clinical practice was determined by the desire of young cancer patients to still have children. Initially, in small groups of patients, any pregnancy and/or childbirth were considered successes. Nowadays, FSM occupies an important place in cancer treatment, with thousands of young women treated successfully. However, in contrast to survival, no definition has been established for evaluating the reproductive outcomes of FSM. This review article evaluates the current pregnancy and birth rates of cancer patients. Differences between fertility-sparing and conservative treatment are analyzed, and improper and confusing interchangeable applications of these terms are pointed out. Additionally, various reasons for choosing FSM as a treatment method—which are not directly related to fertility preservation (treatment mismatch)—are presented. Uniform definitions of reproduction after FSM should be established to enable the comparison of results and facilitate the counseling of patients regarding the chances of reproduction. Full article
(This article belongs to the Special Issue Fertility and Pregnancy in Cancer Patients: Illusion or Reality)
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Other

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39 pages, 587 KiB  
Systematic Review
Patient-Reported Outcomes (PROs) and Patient Experiences in Fertility Preservation: A Systematic Review of the Literature on Adolescents and Young Adults (AYAs) with Cancer
by Nicole F. Klijn, Moniek M. ter Kuile and Elisabeth E. L. O. Lashley
Cancers 2023, 15(24), 5828; https://doi.org/10.3390/cancers15245828 - 13 Dec 2023
Viewed by 830
Abstract
With better survival rates for patients diagnosed with cancer, more attention has been focused on future risks, like fertility decline due to gonadotoxic treatment. In this regard, the emphasis during counselling regarding possible preservation options is often on the treatment itself, meaning that [...] Read more.
With better survival rates for patients diagnosed with cancer, more attention has been focused on future risks, like fertility decline due to gonadotoxic treatment. In this regard, the emphasis during counselling regarding possible preservation options is often on the treatment itself, meaning that the medical and emotional needs of patients regarding counselling, treatment, and future fertility are often overlooked. This review focuses on patient-reported outcomes (PROs) and patient experiences regarding fertility preservation (FP)—among adolescents and young adults (AYAs) with cancer. A systematic review of the literature, with a systematic search of online databases, was performed, resulting in 61 selected articles. A quality assessment was performed by a mixed methods appraisal tool (MMAT). Based on this search, three important topics emerged: initiating discussion about the risk of fertility decline, acknowledging the importance of future fertility, and recognizing the need for more verbal and written patient-specific information. In addition, patients value follow-up care and the opportunity to rediscuss FP and their concerns about future fertility and use of stored material. A clear FP healthcare pathway can prevent delays in receiving a referral to a fertility specialist to discuss FP options and initiating FP treatment. This patient-centered approach will optimize FP experiences and help to establish a process to achieve long-term follow up after FP treatment. Full article
(This article belongs to the Special Issue Fertility and Pregnancy in Cancer Patients: Illusion or Reality)
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