Introduction
Methods
Search and study selection
Data extraction and analysis
Results
Study | Study type | Population size | Median age* [range] | Tumor type | WHO-grade | Known(K)/newly diagnosed (N) |
---|---|---|---|---|---|---|
Peeters et al. [2] | Multicenter case series | 52 | 26.0 [19–37] | Glioma WHO II (32), glioma WHO III (14), glioma WHO IV (6) | II–IV | K (24), N (28) |
Kasai et al. [34] | Case report | 1 | 39 | Oligodendroglioma | II | N ** |
Pallud [16] | Letter to the editor | NA | NA | NA | NA | NA |
Rønning et al. [17] | Cohort study | 65 | 31.4/25.3†† [16–40] | Astrocytoma (37), pilocytic astrocytoma (12), oligodendroglioma (11), oligoastrocytoma (5) | I–II | K (25), N (40) |
Umehara et al. [28] | Case report | 1 | 30 | Pylocytic astrocytoma | I | K |
Al-Rasheedy et al. [32] | Case report | 1 | 36 | GBM | IV | K |
Taylan et al. [10] | Case report | 1 | 21 | GBM | IV | N |
Abd-Elsayed et al. [25] | Case series | 7 | 36 [29–40] | LGG (2), HGG (2), glioma (not specified) (1), GBM (1), non-glial (1) | I–IV | N |
Daras et al. [8] | Case series | 3 | 27 [15–39] | Diffuse astrocytoma WHO II (1), well differentiated astrocytoma WHO II (1), non-glial (1) | II | K |
Flechl et al. [18] | Case report | 1 | 37 | GBM | IV | K |
Gülşen et al. [30] | Case report | 1 | 30 | Gliosarcoma | IV | N |
Yust-Katz et al. [20] | Case series | 15 | 30/28†† [24–38] | Glioma WHO II (6), glioma WHO III (6), GBM (3) | II–IV | N |
Wu et al. [23] | Case series | 2 | [25–42] | Glioma WHO III | III | N |
Zwinkels et al. [6] | Case series + Retrospective cohort | 7 | 29 [15–37] | Astrocytoma (3), oligoastrocytoma (2), ependymoma (1), pleiomorphic xanthoastrocytoma (1) | I–II | K (6), N (1) |
103 | NA | LGG (53), HGG (50) | I–III | K (28), N (75) | ||
Scarrott et al. [24] | Case report | 1 | 32 | GBM | IV | K |
Lynch et al. [7] | Retrospective case series | 10 | 33 [25–37] | Astrocytoma WHO II (3), oligodendroglioma WHO II (1), non-glial (6) | II | N |
Lew et al. [22] | Letter to the editor | 1 | 26 | GBM | IV | N |
Pallud et al. [5] | Case series | 11 | 25.5 [21.5–38.5] | WHO II gliomas | II | K |
Johnson et al. [15] | Case series | 22 | Mean 31.7/32.1†† | Astrocytoma (5), oligodendroglioma (2), ependymomas (2), mixed glioma (2), non-glial (10) | II | K (13), N (9) |
Pallud et al. [4] | Retrospective case series | 8 | 27 [18–33] | Oligodendroglioma WHO II (4), oligodendroglioma WHO III (1), astrocytoma WHO II (1), astrocytoma WHO III (1), unknown (1) | II–III | K (5), N (3) |
Blumenthal et al. [19] | Case series | 6 | 28 [24–33] | Anaplastic astrocytoma (2), anaplastic oligodendroglioma (1), oligodendroglioma (1), oligoastrocytoma (1), GBM (1) | II–IV | N |
Mackenzie et al. [27] | Case report | 1 | 48 | GBM | IV | N |
Stevenson and Thompson [29] | Literature review | NA | NA | NA | NA | NA |
Haba et al. [31] | Case report | 1 | 33 | Anaplastic astrocytoma | III | N |
Tewari et al. [11] | Case series | 8 | 24 [19–37] | GBM (4), anaplastic astrocytoma (3), non-glial (1) | III–IV | N |
Isla et al. [26] | Case series | 7 | 32 [28–38] | Ependymoma (2), low grade astrocytoma (2), non-glial (2), unknown (1) | II | N |
Nishio et al. [21] | Retrospective case series | 6 | 29 [23–35] | Malignant ependymoma (1), anaplastic astrocytoma (1), pilocytic astrocytoma (1), non-glial (3) | I–III | N |
Timing in clinical decision-making | Considerations | CEBM level of evidence |
---|---|---|
Pre-pregnancy counseling | Evidence based on observational studies | |
4 | ||
- Pregnancy does not influence overall survival in LGG [17] | 4 | |
- Pregnancy followed by birth of a healthy infant can occur three weeks after the last chemotherapy in a glioblastoma [18] | 4 | |
Expert opinions | ||
5 | ||
5 | ||
- The benefit-to-risk ratio for mother and fetus [4] | 5 | |
5 | ||
- Counsel all female patients with LGG in their reproductive years, regardless of the decision to become pregnant [17] | 5 | |
- Postpone pregnancy until chemo- or radiation therapy has finished [6] | 5 | |
- Pregnancy is not recommended in patients with HGG, untreated glioma, glioma under treatment, progressive residual tumors, clinical deterioration, uncontrolled seizures or gliomas with an unfavorable molecular profile [2] | 5 | |
- Hormonal stimulation for IVF is not recommended [6] | 5 | |
Monitoring | Expert opinions | |
5 | ||
- Apply routine follow-up MRI at 32–36 weeks of gestation, so that labor as well as tumor therapy can be scheduled [6] | 5 | |
- Gadolinium should not be administered during pregnancy unless there is an essential clinical indication [20] | 5 | |
- Contrast agents increase diagnostic yield and should therefore not be withheld [15] | 5 | |
Neuro-oncological treatment | Evidence based on observational studies | |
4 | ||
4 | ||
- Alkylator-based chemotherapy (PCV or TMZ) administered for the treatment of a glioblastoma during the first trimester can result in the birth of a healthy infant [18] | 4 | |
Expert opinions | ||
5 | ||
5 | ||
5 | ||
5 | ||
5 | ||
5 | ||
5 | ||
- Avoid chemotherapy during the first trimester, especially PCV (probarbazine, lomustine and vincristine), carmustine (Gliadel) is presumed to be relatively safe in pregnant glioma patients [19] | 5 | |
- Apply dorsal decubitus position, with trunk rotation to the left and avoid ventral decubitus position during surgery [8] | 5 | |
Medical treatment | Evidence based on observational studies | |
4 | ||
Expert opinions | ||
5 | ||
5 | ||
- Anticonvulsant treatment should be optimized before conception [19] | 5 | |
- After delivery, the anticonvulsant dosages should be re-adjusted to the original dose within two to three days [6] | 5 | |
- When prescribing anticonvulsants that interfere with vitamin K absorption, treat mother and born child with vitamin K [19] | 5 | |
5 | ||
5 | ||
- Prescribe prednisolone when lung maturation is not preferred [31] | 5 | |
- Betamethasone is preferred over dexamethasone, because of fewer side effects [10] | 5 | |
Obstetrical treatment | Evidence based on observational studies | |
4 | ||
Expert opinions | ||
5 | ||
5 | ||
5 | ||
- Apply CS in nulliparous women, because of their risk of increased intracranial pressure during delivery [21] | 5 | |
5 | ||
- Apply CS and tumor resection in two different sessions to allow for maternal-fetal bonding [27] | 5 | |
- Avoid mannitol and hypocapnia to prevent fetal dehydration and cerebral ischemia respectively [25] | 5 | |
- Epidural anesthesia can be given to shorten the second phase of delivery and decrease risk of increased intracranial pressure [27] | 5 | |
5 |