Recent Advances in Personalized Treatment of Cancer in Pregnancy

Cancer that occurs inside the pregnant or during the first postpartum year (or throughout lactation time) is considered gestational. The diagnosis of this entity is intrinsically accompanied by ethical problems when making clinical decisions about the disease and the newborn future [1,2]. Nowadays a modern medical treatment achieves treat cancer with the same prognosis than no-pregnant population and childbirth without any sequela. Spanish consensus of different specializations (Surgery, gynecology, radiology and radiotherapy and medical oncology) on the last year have published recommendations that allow harmonization of management and review the last advances in cancer in pregnancy [3].

Vulva Cancer Treatment with Cryosurgery

Vulvar cancer represents 4% to 5% of Low Genital Tract Tumors (LGTT) and 1% of all cancers in women. Treatment depends on stage, and when possible surgery is preferable. Advanced cancers require large resections (with needs grafts and-or rotating flaps), radio and/or chemotherapy, all of which can lead to high morbidity and quality of life impairment. To minimize these effects, in 1994, we developed a cryosurgery prospective protocol to manage vulvar cancer in patients with comorbid conditions.Patients and Methods: Between 1994 and 2019 we treated n=41 patients: FIGO stages I: n=2 (4.88%) II: n=9 (21.95%), III: n=28 (68.29%), IV: n=2 (4.88%). Median age 64.3 (28 to 90 years old), and 70% were 70 years old or older, 59% had severe comorbidities (diabetes, autoimmune diseases, immunosuppressive user).Cryosurgery Protocol:Firstly, tumor resection, hemostasis, and 2 rapid freezing- slow thawing cycles with Liquid Nitrogen (LN) spray. The cycles should include the logde and a 1.5 cm safety margin. After complete healing (between 45 and 95 days after cryosurgery), nodes are treated according to FIGO stages. Result:All patients after the effects of the anesthesia were able to urinate spontaneously, walk, had minimal analgesic requirements, with good postoperative. The patients remained in the hospital for one or two days, and with rare exceptions, were discharged the following day with controls twice a week at the hospital. None of the patients required flaps or grafts to repair the treated areas. After complete healing they maintained the vulvar sensitivity and considerably improved their quality of life. Some of them, who had a partner, were able to resume their sexual intercourse.Mean follow-up: 55.39 (3 months to 258 months). Five patients had local recurrences between 12 and 72 months after treatment, and were controlled with a new cryosurgery. Six patients had HPV related lesions located in other areas of the lower genital tract, which were also controlled with cryosurgery. Twenty five of them died 19 due to an unrelated cause of death, and 6 due to disease progression in the nodes without vulvar recurrence, 9 patients survived and were free of disease with a mean follow-up of 53 months. Seven patients, after a disease free follow up of 17.2 months, weren ́t able to be controlled, as they lived more than 400 km way from the hospital. Local control was achieved in all patients.Comments: Cryosurgery can be done after any previous treatment, and can be repeated to control recurrences.Conclusion: Given the simplicity of the technique, its low cost, the possibility of being used in patients with multiple co-morbidities, the absence of major complications, and the anatomical and functional results obtained, we believe that cryosurgery can be considered among the best options to control of vulvar cancer, even large or advanced cases, in elderly patients and-or with severe comorbidities.