From the Guidelines
The primary recommendation for managing a solitary fibrous tumor (SFT) in the brain during pregnancy is surgical resection after pregnancy when possible, as complete removal offers the best chance for cure, as suggested by general principles of tumor management during pregnancy 1.
Key Considerations
- If the tumor is causing significant symptoms or shows aggressive features, surgery during pregnancy may be necessary, ideally performed during the second trimester when fetal risks are lower, based on the principles outlined for other tumors during pregnancy 1.
- Preoperative embolization may be considered to reduce bleeding risk, a common consideration in neurosurgical procedures.
- Corticosteroids (dexamethasone 4-10 mg every 6 hours) can be used to reduce peritumoral edema and alleviate symptoms, as they are generally safe during pregnancy 1.
- Anticonvulsants like levetiracetam (500-1000 mg twice daily) may be needed for seizure control, as it has a favorable safety profile in pregnancy, although specific data on SFT is limited.
- Regular monitoring with MRI without contrast is preferred over CT to avoid radiation exposure, following the guidelines for diagnostic procedures during pregnancy 1.
Treatment Approach
- For large or incompletely resected tumors, postpartum adjuvant therapy may include radiation or systemic therapy, depending on the tumor's characteristics and the patient's condition, similar to approaches for other solid tumors during pregnancy 1.
- The management approach is justified by the typically slow-growing nature of most SFTs, allowing for treatment delay when possible, while acknowledging that some cases require immediate intervention based on tumor location, size, and symptom severity.
Monitoring and Follow-Up
- Close monitoring of both maternal neurological status and fetal development throughout pregnancy is essential, as with any condition that may impact pregnancy outcomes.
- Histological examination of the placenta after delivery should be considered, given the rare but potential risk of placental metastases, as recommended for other cancers during pregnancy 1.
From the Research
Management Approach for Solitary Fibrous Tumour in the Brain During Pregnancy
The management of a solitary fibrous tumour (SFT) in the brain during pregnancy requires a multidisciplinary approach, considering the rare and variable nature of these tumours. Key points to consider include:
- The exact etiology of SFTs is unknown, and they can develop in any organ due to their spindle cell origin 2.
- SFTs are usually benign, but 10-30% can exhibit aggressive and malignant features, which are not associated with their histological features 2.
- Surgical resection is the treatment of choice for SFTs, with the goal of total resection 2, 3, 4.
- Imaging findings can be used to assist in the diagnosis, but the diagnostic method is pathology 3.
- In cases of intracranial SFT, total surgical resection is the most effective treatment, with radiotherapy and chemotherapy considered if necessary 3.
Considerations for Pregnancy
While there is limited specific information on the management of SFTs in the brain during pregnancy, the following points are relevant:
- The management approach for SFTs in the brain during pregnancy would likely involve a multidisciplinary team, including neurosurgeons, radiologists, and obstetricians.
- The decision to proceed with surgical resection during pregnancy would depend on the size, location, and aggressiveness of the tumour, as well as the gestational age of the pregnancy.
- Radiotherapy and chemotherapy may be considered if necessary, but their use during pregnancy would require careful consideration of the potential risks and benefits.
Treatment Outcomes
Studies have reported excellent local control and survival outcomes for patients with SFTs treated with combined surgery and radiation therapy 5. However, the application of these findings to the management of SFTs in the brain during pregnancy is uncertain and would require individualized consideration.