Pub Date : 2025-11-07DOI: 10.1016/j.gore.2025.101988
Délya Valcourt-Gendron , Basile Tessier-Cloutier , Xing Zeng , Reitan Ribeiro , Shuk On Annie Leung , Victoria Mandilaras , Lili Fu , Tuyet Nhung Ton Ton Nu , Lara Richer , Lucy Gilbert , Laurence Bernard
Background
Low-grade endometrial stromal sarcoma (LG-ESS) is the most common type of endometrial stromal malignancy, yet treatment options are limited, particularly in advanced or recurrent cases that are resistant to hormonal therapy.
Case Presentation
We describe a 48-year-old patient with recurrent stage IVB LG-ESS who was treated with a combination of doxorubicin and trabectedin, followed by trabectedin maintenance; a protocol extrapolated from leiomyosarcoma treatment. Following failure to hormonal therapy, this regimen demonstrated disease stabilization, particularly in pelvic metastases.
Conclusion
Our results highlight the potential role of this chemotherapy combination in hormonal therapy-resistant LG-ESS, a malignancy with limited systemic therapeutic options. This is the first reported case of LG-ESS achieving prolonged stable disease with doxorubicin-trabectedin therapy and trabectedin maintenance. Given the manageable toxicity profile and encouraging tumor control, further studies should explore its potential role in LG-ESS management.
{"title":"Use of doxorubicin and trabectedin in low-grade endometrial stromal sarcoma: A case report","authors":"Délya Valcourt-Gendron , Basile Tessier-Cloutier , Xing Zeng , Reitan Ribeiro , Shuk On Annie Leung , Victoria Mandilaras , Lili Fu , Tuyet Nhung Ton Ton Nu , Lara Richer , Lucy Gilbert , Laurence Bernard","doi":"10.1016/j.gore.2025.101988","DOIUrl":"10.1016/j.gore.2025.101988","url":null,"abstract":"<div><h3>Background</h3><div>Low-grade endometrial stromal sarcoma (LG-ESS) is the most common type of endometrial stromal malignancy, yet treatment options are limited, particularly in advanced or recurrent cases that are resistant to hormonal therapy.</div></div><div><h3>Case Presentation</h3><div>We describe a 48-year-old patient with recurrent stage IVB LG-ESS who was treated with a combination of doxorubicin and trabectedin, followed by trabectedin maintenance; a protocol extrapolated from leiomyosarcoma treatment. Following failure to hormonal therapy, this regimen demonstrated disease stabilization, particularly in pelvic metastases.</div></div><div><h3>Conclusion</h3><div>Our results highlight the potential role of this chemotherapy combination in hormonal therapy-resistant LG-ESS, a malignancy with limited systemic therapeutic options. This is the first reported case of LG-ESS achieving prolonged stable disease with doxorubicin-trabectedin therapy and trabectedin maintenance. Given the manageable toxicity profile and encouraging tumor control, further studies should explore its potential role in LG-ESS management.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101988"},"PeriodicalIF":1.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Low-grade endometrial stroma sarcoma is a very rare mesenchymal neoplasm, that is usually found inside the uterine corpus. It is very uncommon that LG-ESS arises from extrauterine foci.
Case presentation
We report the case of a 31-year-old patient diagnosed with extrauterine LG-ESS arising from deep infiltrating endometriosis. Primary symptoms, diagnostic workflow, operating method, and the outcome will be described, as well as a short review of the current literature about the optimal treatment for young LG-ESS patients within the reproductive window.
Conclusions
Long-term surveillance is imperative for patients with LG-ESS given the potential for late recurrences. Although extrauterine LG-ESS represents an exceedingly rare gynecologic malignancy, establishing standardized treatment approaches is critical to optimize therapeutic efficacy and improve patient outcomes.
{"title":"Low-grade endometrial stromal sarcoma arising from extrauterine deep infiltrating endometriosis: a rare, but important differential diagnosis and short review of the literature","authors":"Lina Judit Schiestl , Simin Schadmand-Fischer , Evangelos Tagkalos , Udo Raab , Pia-Elisabeth Baqué , Nadja Hamscho , Friedrich Kommoss , Dennis Jung , Valerie Linz , Marcus Schmidt , Annette Hasenburg , Roxana Schwab","doi":"10.1016/j.gore.2025.101985","DOIUrl":"10.1016/j.gore.2025.101985","url":null,"abstract":"<div><h3>Background</h3><div>Low-grade endometrial stroma sarcoma is a very rare mesenchymal neoplasm, that is usually found inside the uterine corpus. It is very uncommon that LG-ESS arises from extrauterine foci.</div></div><div><h3>Case presentation</h3><div>We report the case of a 31-year-old patient diagnosed with extrauterine LG-ESS arising from deep infiltrating endometriosis. Primary symptoms, diagnostic workflow, operating method, and the outcome will be described, as well as a short review of the current literature about the optimal treatment for young LG-ESS patients within the reproductive window.</div></div><div><h3>Conclusions</h3><div>Long-term surveillance is imperative for patients with LG-ESS given the potential for late recurrences. Although extrauterine LG-ESS represents an exceedingly rare gynecologic malignancy, establishing standardized treatment approaches is critical to optimize therapeutic efficacy and improve patient outcomes.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101985"},"PeriodicalIF":1.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.gore.2025.101984
Amaya Martinez Mesa , Alexandra Diggs , Leslie H. Clark
Background
Polycythemia is a rare paraneoplastic phenomenon associated with benign and malignant tumors, including uterine leiomyomas. Few cases of secondary erythrocytosis due to erythropoietin (EPO)-producing fibroids have been reported. Tumor resection is the mainstay of treatment for paraneoplastic polycythemia.
Case
We describe a 44-year-old woman who presented with a large uterine mass and elevated hemoglobin and hematocrit. Evaluation included elevated serum EPO level. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy for bulky adenopathy. Final histopathology confirmed a benign leiomyoma. Following surgery, HGB level normalized.
Conclusion
Although uncommon, EPO-secreting uterine fibroids should be considered in the differential for erythrocytosis, particularly when other causes are not evident.
{"title":"Erythropoietin-Secreting uterine leiomyoma presenting with secondary erythrocytosis: A case report","authors":"Amaya Martinez Mesa , Alexandra Diggs , Leslie H. Clark","doi":"10.1016/j.gore.2025.101984","DOIUrl":"10.1016/j.gore.2025.101984","url":null,"abstract":"<div><h3>Background</h3><div>Polycythemia is a rare paraneoplastic phenomenon associated with benign and malignant tumors, including uterine leiomyomas. Few cases of secondary erythrocytosis due to erythropoietin (EPO)-producing fibroids have been reported. Tumor resection is the mainstay of treatment for paraneoplastic polycythemia.</div></div><div><h3>Case</h3><div>We describe a 44-year-old woman who presented with a large uterine mass and elevated hemoglobin and hematocrit. Evaluation included elevated serum EPO level. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy for bulky adenopathy. Final histopathology confirmed a benign leiomyoma. Following surgery, HGB level normalized.</div></div><div><h3>Conclusion</h3><div>Although uncommon, EPO-secreting uterine fibroids should be considered in the differential for erythrocytosis, particularly when other causes are not evident.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101984"},"PeriodicalIF":1.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.gore.2025.101983
Michelle Greenman , Yasmin Abozenah , Yifang Eva Pan , Elena S. Ratner , Gary Altwerger
BackgroundHyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective adjuvant therapy to cytoreductive surgery in recurrent epithelial ovarian cancer. However, platinum hypersensitivity poses a significant barrier in the platinum-sensitive setting. While intravenous desensitization protocols for platinum hypersensitive patients are standard of care, strategies for safe delivery of platinum agents during HIPEC remain unclear.
Case PresentationWe report a 45-year-old woman with high-grade serous carcinoma of the fallopian tube who initially underwent primary cytoreduction followed by adjuvant carboplatin-paclitaxel chemotherapy and PARP inhibitor maintenance. She subsequently developed platinum-sensitive recurrence and was retreated with carboplatin-paclitaxel but experienced a severe hypersensitivity reaction at the 12th total cycle, requiring epinephrine. Given her platinum-sensitive disease and isolated recurrence, she was considered for secondary cytoreductive surgery with HIPEC. A multidisciplinary team created a modified cisplatin desensitization strategy derived from our previous established institution four step carboplatin desensitization regimen, with pre-medications and a stepwise intraperitoneal perfusion protocol with escalating cisplatin concentrations over 90 min for delivery during HIPEC. The patient tolerated the procedure well and recovered uneventfully. She was discharged on postoperative day six.
Conclusion
This case, to our knowledge, is the first reported in gynecologic oncology to demonstrate the feasibility of safely delivering HIPEC with cisplatin in a patient with prior carboplatin hypersensitivity. As HIPEC adoption expands in platinum-sensitive recurrent ovarian cancer, platinum hypersensitivity will become an increasing challenge. This report underscores the need for further study of intraperitoneal desensitization strategies and cross-reactivity risks, offering a potential for extending HIPEC to patients with platinum hypersensitivity.
{"title":"HIPEC with cisplatin desensitization at the time of secondary debulking in a patient with a prior carboplatin hypersensitivity reaction","authors":"Michelle Greenman , Yasmin Abozenah , Yifang Eva Pan , Elena S. Ratner , Gary Altwerger","doi":"10.1016/j.gore.2025.101983","DOIUrl":"10.1016/j.gore.2025.101983","url":null,"abstract":"<div><div>BackgroundHyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective adjuvant therapy to cytoreductive surgery in recurrent epithelial ovarian cancer. However, platinum hypersensitivity poses a significant barrier in the platinum-sensitive setting. While intravenous desensitization protocols for platinum hypersensitive patients are standard of care, strategies for safe delivery of platinum agents during HIPEC remain unclear.</div><div>Case PresentationWe report a 45-year-old woman with high-grade serous carcinoma of the fallopian tube who initially underwent primary cytoreduction followed by adjuvant carboplatin-paclitaxel chemotherapy and PARP inhibitor maintenance. She subsequently developed platinum-sensitive recurrence and was retreated with carboplatin-paclitaxel but experienced a severe hypersensitivity reaction at the 12th total cycle, requiring epinephrine. Given her platinum-sensitive disease and isolated recurrence, she was considered for secondary cytoreductive surgery with HIPEC. A multidisciplinary team created a modified cisplatin desensitization strategy derived from our previous established institution four step carboplatin desensitization regimen, with pre-medications and a stepwise intraperitoneal perfusion protocol with escalating cisplatin concentrations over 90 min for delivery during HIPEC. The patient tolerated the procedure well and recovered uneventfully. She was discharged on postoperative day six.</div></div><div><h3>Conclusion</h3><div>This case, to our knowledge, is the first reported in gynecologic oncology to demonstrate the feasibility of safely delivering HIPEC with cisplatin in a patient with prior carboplatin hypersensitivity. As HIPEC adoption expands in platinum-sensitive recurrent ovarian cancer, platinum hypersensitivity will become an increasing challenge. This report underscores the need for further study of intraperitoneal desensitization strategies and cross-reactivity risks, offering a potential for extending HIPEC to patients with platinum hypersensitivity.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101983"},"PeriodicalIF":1.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.gore.2025.101982
Kayla Paulosky , Pegah Blustein , Amanda Fader , Matthew Jacob Lankiewicz , Samuel M. Law , Emily MacArthur
Acquired aplastic anemia may rarely present as a paraneoplastic syndrome primarily associated with thymomas and lymphoma. We describe the first case, to our knowledge, of paraneoplastic aplastic anemia secondary to high-grade serous primary peritoneal carcinoma (PPC). A 63-year-old female with a pathogenic germline BRCA1 mutation was found to have pancytopenia at the time of PPC diagnosis. She received granulocyte colony-stimulating factor (GCSF), thrombopoietin (TPO) mimetic, and immunosuppressive therapy with prednisone prior to primary cytoreductive surgery to no apparent gross residual disease. Stage IIIC2 PPC was confirmed on pathology. Her post-operative course was complicated by a large bowel anastomotic leak and sepsis in the setting of neutropenia. Persistent pancytopenia led to the diagnosis of severe aplastic anemia on serial bone marrow biopsies. She was treated with anti-thymocyte globulin (ATG) and cyclosporine and subsequently received adjuvant chemotherapy with weekly cisplatin and subsequent addition of weekly paclitaxel, resulting in reduction in her serum Cancer Antigen-125 (CA-125) and no radiographic evidence of disease. Despite initial response, her clinical deterioration and her decision to forego further cancer- or aplastic anemia-directed therapy resulted in transition to home hospice care, and she was discharged 119 days after admission. This case report highlights the importance of multi-disciplinary collaboration to manage the medical complexities of paraneoplastic aplastic anemia secondary to a gynecologic malignancy.
{"title":"Severe, refractory paraneoplastic aplastic anemia secondary to primary peritoneal carcinoma: a case report","authors":"Kayla Paulosky , Pegah Blustein , Amanda Fader , Matthew Jacob Lankiewicz , Samuel M. Law , Emily MacArthur","doi":"10.1016/j.gore.2025.101982","DOIUrl":"10.1016/j.gore.2025.101982","url":null,"abstract":"<div><div>Acquired aplastic anemia may rarely present as a paraneoplastic syndrome primarily associated with thymomas and lymphoma. We describe the first case, to our knowledge, of paraneoplastic aplastic anemia secondary to high-grade serous primary peritoneal carcinoma (PPC). A 63-year-old female with a pathogenic germline BRCA1 mutation was found to have pancytopenia at the time of PPC diagnosis. She received granulocyte colony-stimulating factor (GCSF), thrombopoietin (TPO) mimetic, and immunosuppressive therapy with prednisone prior to primary cytoreductive surgery to no apparent gross residual disease. Stage IIIC2 PPC was confirmed on pathology. Her post-operative course was complicated by a large bowel anastomotic leak and sepsis in the setting of neutropenia. Persistent pancytopenia led to the diagnosis of severe aplastic anemia on serial bone marrow biopsies. She was treated with anti-thymocyte globulin (ATG) and cyclosporine and subsequently received adjuvant chemotherapy with weekly cisplatin and subsequent addition of weekly paclitaxel, resulting in reduction in her serum Cancer Antigen-125 (CA-125) and no radiographic evidence of disease. Despite initial response, her clinical deterioration and her decision to forego further cancer- or aplastic anemia-directed therapy resulted in transition to home hospice care, and she was discharged 119 days after admission. This case report highlights the importance of multi-disciplinary collaboration to manage the medical complexities of paraneoplastic aplastic anemia secondary to a gynecologic malignancy.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101982"},"PeriodicalIF":1.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1016/j.gore.2025.101977
Naba Ali , Katherine D. Sykes Martin , Rachel Tobillo , Karthik Meiyappan , Ashley McCook-Veal , Jeffrey Switchenko , Sean Dresser , Sarah Dilley , Kristen D. Starbuck , Namita Khanna , Joseph Shelton , Ashish Patel , Tony Eng , Beryl Manning-Geist , Jill S. Remick
Purpose/Objectives
The standard treatment for locally advanced cervical cancer (LACC) is concurrent chemoradiation and brachytherapy (CRT-B). Fistula formation is a serious complication of pelvic radiation; however, risk factors and outcomes are not well described. We sought to identify the incidence, risk factors and prognosis of radiation-induced fistula in women who underwent CRT-B for LACC.
Materials/Methods
Patients with FIGO IB2-IV cervical cancer treated with CRT-B at a single institution from 2013 to 2022 were reviewed. Patient and treatment characteristics were analyzed. The primary endpoint was fistula incidence. Logistic regression model was performed to assess factors associated with fistula. Fistula-free survival and overall survival were estimated using the Kaplan-Meier method.
Results
Thirteen (9 %) of 150 reviewed patients developed fistula with median follow up of 20 months (CI: 22.8–35.4). Fistula symptoms resolved in 8/13 patients (62 %). Two-year overall survival and fistula-free survival was 72.0 % (CI: 62.6–79.5) and 91.6 % (CI: 84.9–95.4), respectively. On univariate analysis, higher BMI was associated with decreased fistula risk (OR 0.90, CI: 0.82–1.00; p = 0.048). Current smoking (OR 8.37, CI: 2.58–27.22; p < 0.001), lack of MRI guidance (OR 4.77, CI: 1.42–15.97; p = 0.011) and disease extension into bladder (OR 3.99, CI: 1.27–12.53; p = 0.018), were associated with increased fistula risk. On multivariable analysis, only current smoking (OR 5.14, CI: 1.43–18.48; p = 0.012) was associated with increased fistula risk.
Conclusions
Patients treated with CRT-B for LACC have a 9% risk of fistula formation. MRI guidance may be useful in brachytherapy planning to reduce the risk of toxicity.
目的/目的局部晚期宫颈癌（LACC）的标准治疗是同步放化疗和近距离放疗（CRT-B）。瘘管形成是骨盆放射治疗的严重并发症；然而，风险因素和结果并没有很好地描述。我们试图确定因LACC而接受CRT-B治疗的女性放射诱发瘘的发生率、危险因素和预后。材料/方法回顾2013年至2022年在单一机构接受CRT-B治疗的FIGO IB2-IV宫颈癌患者。分析患者及治疗特点。主要终点为瘘管发生率。采用Logistic回归模型评估瘘相关因素。采用Kaplan-Meier法估计无瘘生存期和总生存期。结果150例患者中有13例（9%）出现瘘管，中位随访20个月（CI: 22.8-35.4）。8/13例（62%）患者的瘘管症状得到缓解。两年总生存率和无瘘生存率分别为72.0% （CI: 62.6-79.5）和91.6% （CI: 84.9-95.4）。在单因素分析中，较高的BMI与瘘风险降低相关（OR 0.90, CI: 0.82-1.00; p = 0.048）。当前吸烟（OR 8.37, CI: 2.58-27.22; p < 0.001）、缺乏MRI指导（OR 4.77, CI: 1.42-15.97; p = 0.011）和疾病扩展至膀胱（OR 3.99, CI: 1.27-12.53; p = 0.018）与瘘管风险增加相关。在多变量分析中，只有当前吸烟（OR 5.14, CI: 1.43-18.48; p = 0.012）与瘘风险增加相关。结论接受CRT-B治疗的LACC患者有9%的瘘管形成风险。MRI指导可能有助于近距离治疗计划，以减少毒性风险。
{"title":"Risk factors and clinical outcomes of radiation-induced fistula after chemoradiation and image-guided brachytherapy for locally advanced cervical cancer","authors":"Naba Ali , Katherine D. Sykes Martin , Rachel Tobillo , Karthik Meiyappan , Ashley McCook-Veal , Jeffrey Switchenko , Sean Dresser , Sarah Dilley , Kristen D. Starbuck , Namita Khanna , Joseph Shelton , Ashish Patel , Tony Eng , Beryl Manning-Geist , Jill S. Remick","doi":"10.1016/j.gore.2025.101977","DOIUrl":"10.1016/j.gore.2025.101977","url":null,"abstract":"<div><h3>Purpose/Objectives</h3><div>The standard treatment for locally advanced cervical cancer (LACC) is concurrent chemoradiation and brachytherapy (CRT-B). Fistula formation is a serious complication of pelvic radiation; however, risk factors and outcomes are not well described. We sought to identify the incidence, risk factors and prognosis of radiation-induced fistula in women who underwent CRT-B for LACC.</div></div><div><h3>Materials/Methods</h3><div>Patients with FIGO IB2-IV cervical cancer treated with CRT-B at a single institution from 2013 to 2022 were reviewed. Patient and treatment characteristics were analyzed. The primary endpoint was fistula incidence. Logistic regression model was performed to assess factors associated with fistula. Fistula-free survival and overall survival were estimated using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>Thirteen (9 %) of 150 reviewed patients developed fistula with median follow up of 20 months (CI: 22.8–35.4). Fistula symptoms resolved in 8/13 patients (62 %). Two-year overall survival and fistula-free survival was 72.0 % (CI: 62.6–79.5) and 91.6 % (CI: 84.9–95.4), respectively. On univariate analysis, higher BMI was associated with decreased fistula risk (OR 0.90, CI: 0.82–1.00; p = 0.048). Current smoking (OR 8.37, CI: 2.58–27.22; p < 0.001), lack of MRI guidance (OR 4.77, CI: 1.42–15.97; p = 0.011) and disease extension into bladder (OR 3.99, CI: 1.27–12.53; p = 0.018), were associated with increased fistula risk. On multivariable analysis, only current smoking (OR 5.14, CI: 1.43–18.48; p = 0.012) was associated with increased fistula risk.</div></div><div><h3>Conclusions</h3><div>Patients treated with CRT-B for LACC have a 9% risk of fistula formation. MRI guidance may be useful in brachytherapy planning to reduce the risk of toxicity.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101977"},"PeriodicalIF":1.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145463532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1016/j.gore.2025.101981
Khrystyna Levytska , SeungYong Han , Allison E. Axtell , Malaika W. Amneus , Brandon Ing , Scott E. Lentz
Objective
Describe surgical outcomes of patients undergoing HIPEC with cisplatin (C) alone or cisplatin/paclitaxel (CP), compared to interval debulking surgery (IDS) without HIPEC, and stratify disease-free survival (DFS) by treatment and homologous recombination (HR) status.
Methods
Retrospective chart review of patients with advanced ovarian cancer undergoing IDS with and without HIPEC between 2018–2024. DFS was compared using a log rank test. Cox proportional hazards model was used to test association between treatment group and recurrence.
Results
74 patients were included: 20 in no HIPEC, 28 in HIPEC-C, and 26 in HIPEC-CP groups. Duration of surgery was shortest in no HIPEC group (159 ± 64 min vs HIPEC-C 377 ± 54 min vs HIPEC-CP 400 ± 48 min, p < 0.0001). Post-operatively, there was no difference in days to return of bowel function (p = 0.17) or Grade II-IV complications (p = 0.39). HIPEC-C group had longest time to discharge (4.5 ± 1.2 post-operative days vs no HIPEC 3.8 ± 1.9 vs HIPEC-CP 3.6 ± 0.9, p = 0.002). Twenty-nine (39.2 %) patients were HR deficient (HRD). Median DFS did not differ between treatment groups (no HIPEC 17.0 months vs HIPEC-C 13.87 months vs HIPEC-CP 19.25 months, p = 0.853). Median DFS was higher in HRD vs HRP (HR proficient) patients (40.5 months vs 11.4 months, HR 0.32 (95 % CI: 0.19–0.57, p = 0.0001).
Conclusions
Addition of paclitaxel to cisplatin at the time of IDS with HIPEC had no effect on peri-operative morbidity. No differences in DFS were seen between treatment groups. HRD group had a significantly longer DFS, when compared to HRP. Tumor genetics and HR status likely drive response to treatment in advanced ovarian cancer.
目的描述HIPEC患者单用顺铂(C)或顺铂/紫杉醇（CP）的手术结果，与不使用HIPEC的间隔减压手术（IDS）进行比较，并通过治疗和同源重组（HR）状态对无病生存（DFS）进行分层。方法回顾性分析2018-2024年晚期卵巢癌合并和不合并HIPEC的IDS患者。DFS采用对数秩检验进行比较。采用Cox比例风险模型检验治疗组与复发率的相关性。结果74例患者：无HIPEC组20例，HIPEC- c组28例，HIPEC- cp组26例。无HIPEC组手术时间最短（159±64 min vs . HIPEC- c 377±54 min vs . HIPEC- cp 400±48 min, p < 0.0001）。术后肠功能恢复天数（p = 0.17）和II-IV级并发症（p = 0.39）无差异。HIPEC- c组出院时间最长（术后4.5±1.2天vs未HIPEC组3.8±1.9天vs HIPEC- cp组3.6±0.9天，p = 0.002）。29例（39.2%）患者为HR缺陷（HRD）。治疗组间的中位DFS无差异（无HIPEC 17.0个月vs HIPEC- c 13.87个月vs HIPEC- cp 19.25个月，p = 0.853）。HRD患者的中位DFS高于HRP （HR精通）患者(40.5个月vs 11.4个月，HR 0.32 （95% CI: 0.19-0.57, p = 0.0001）。结论在IDS合并HIPEC时顺铂加用紫杉醇对围手术期发病率无影响。治疗组间DFS无差异。与HRP相比，HRD组的DFS明显更长。肿瘤遗传学和HR状态可能驱动对晚期卵巢癌治疗的反应。
{"title":"Homologous recombination status drives disease-free survival in patients with advanced ovarian cancer undergoing hyperthermic intraperitoneal chemotherapy at the time of interval debulking surgery","authors":"Khrystyna Levytska , SeungYong Han , Allison E. Axtell , Malaika W. Amneus , Brandon Ing , Scott E. Lentz","doi":"10.1016/j.gore.2025.101981","DOIUrl":"10.1016/j.gore.2025.101981","url":null,"abstract":"<div><h3>Objective</h3><div>Describe surgical outcomes of patients undergoing HIPEC with cisplatin (C) alone or cisplatin/paclitaxel (CP), compared to interval debulking surgery (IDS) without HIPEC, and stratify disease-free survival (DFS) by treatment and homologous recombination (HR) status.</div></div><div><h3>Methods</h3><div>Retrospective chart review of patients with advanced ovarian cancer undergoing IDS with and without HIPEC between 2018–2024. DFS was compared using a log rank test. Cox proportional hazards model was used to test association between treatment group and recurrence.</div></div><div><h3>Results</h3><div>74 patients were included: 20 in no HIPEC, 28 in HIPEC-C, and 26 in HIPEC-CP groups. Duration of surgery was shortest in no HIPEC group (159 ± 64 min <em>vs</em> HIPEC-C 377 ± 54 min <em>vs</em> HIPEC-CP 400 ± 48 min, p < 0.0001). Post-operatively, there was no difference in days to return of bowel function (p = 0.17) or Grade II-IV complications (p = 0.39). HIPEC-C group had longest time to discharge (4.5 ± 1.2 post-operative days <em>vs</em> no HIPEC 3.8 ± 1.9 <em>vs</em> HIPEC-CP 3.6 ± 0.9, p = 0.002). Twenty-nine (39.2 %) patients were HR deficient (HRD). Median DFS did not differ between treatment groups (no HIPEC 17.0 months <em>vs</em> HIPEC-C 13.87 months <em>vs</em> HIPEC-CP 19.25 months, p = 0.853). Median DFS was higher in HRD <em>vs</em> HRP (HR proficient) patients (40.5 months <em>vs</em> 11.4 months, HR 0.32 (95 % CI: 0.19–0.57, p = 0.0001).</div></div><div><h3>Conclusions</h3><div>Addition of paclitaxel to cisplatin at the time of IDS with HIPEC had no effect on <em>peri</em>-operative morbidity. No differences in DFS were seen between treatment groups. HRD group had a significantly longer DFS, when compared to HRP. Tumor genetics and HR status likely drive response to treatment in advanced ovarian cancer.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101981"},"PeriodicalIF":1.3,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Malignant peritoneal mesothelioma (MPM) as a secondary malignancy following radiotherapy is extremely rare. We report a case of MPM that developed as a secondary malignancy after initial concurrent chemoradiotherapy (CCRT) for cervical cancer.
Case Presentation.
A 52-year-old woman with no history of asbestos exposure underwent definitive CCRT for stage IIB cervical cancer, as classified by the International Federation of Gynecology and Obstetrics (FIGO) staging system. Over 10 years after initial treatment, she developed ascites. Diagnostic laparoscopy led to a pathological diagnosis of peritoneal mesothelioma. Given the absence of asbestos exposure and her medical history, the tumor was considered a radiation-induced secondary cancer. The patient received two lines of chemotherapy, but her performance status progressively declined, and she was transitioned to best supportive care. She died 1 year and 8 months after the MPM diagnosis.
Discussion
This case highlights the importance of long-term surveillance following radiotherapy for cervical cancer. Including this case, only four reports exist of MPM developing as a secondary malignancy following pelvic radiotherapy for cervical cancer. In all cases, patients presented with abdominal symptoms and ascites. The case findings underscore the need for clinicians to consider secondary malignancies such as MPM when ascites is detected during follow-up and to pursue a thorough diagnostic workup.
{"title":"Malignant peritoneal mesothelioma as a secondary cancer following radiotherapy for cervical cancer: a case report and literature review","authors":"Miki Otsubo , Masahiro Aichi , Yukiko Kawashima , Shoji Yamanaka , Yuichi Imai , Etsuko Miyagi , Taichi Mizushima","doi":"10.1016/j.gore.2025.101979","DOIUrl":"10.1016/j.gore.2025.101979","url":null,"abstract":"<div><h3>Background</h3><div>Malignant peritoneal mesothelioma (MPM) as a secondary malignancy following radiotherapy is extremely rare. We report a case of MPM that developed as a secondary malignancy after initial concurrent chemoradiotherapy (CCRT) for cervical cancer.</div><div>Case Presentation.</div><div>A 52-year-old woman with no history of asbestos exposure underwent definitive CCRT for stage IIB cervical cancer, as classified by the International Federation of Gynecology and Obstetrics (FIGO) staging system. Over 10 years after initial treatment, she developed ascites. Diagnostic laparoscopy led to a pathological diagnosis of peritoneal mesothelioma. Given the absence of asbestos exposure and her medical history, the tumor was considered a radiation-induced secondary cancer. The patient received two lines of chemotherapy, but her performance status progressively declined, and she was transitioned to best supportive care. She died 1 year and 8 months after the MPM diagnosis.</div></div><div><h3>Discussion</h3><div>This case highlights the importance of long-term surveillance following radiotherapy for cervical cancer. Including this case, only four reports exist of MPM developing as a secondary malignancy following pelvic radiotherapy for cervical cancer. In all cases, patients presented with abdominal symptoms and ascites. The case findings underscore the need for clinicians to consider secondary malignancies such as MPM when ascites is detected during follow-up and to pursue a thorough diagnostic workup.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101979"},"PeriodicalIF":1.3,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.gore.2025.101971
Caroline Kernell , Emily MacDuffie , Xiang Lin , Le Gao , Doreen Ramogola-Masire , Surbhi Grover , Erle Robertson
Purpose/Objective(s)
High prevalence of HPV and HIV contribute to the high rate of cervical cancer (CaCx) in Botswana. HPV subtypes in healthy, unvaccinated students (Cohort 1), women with CIN II/III (Cohort 2), and women with invasive CaCx (Cohort 3) were compared.
Materials/Methods
The Ipabalele study in Gaborone, Botswana enrolled patients between 2016–2020. Demographics, clinical characteristics, and HPV cervical swabs were collected. PathoChip quantified prevalence of HPV subtypes.
Results
Overall 414 patients enrolled. Cohort 1: 43; Cohort 2; 212; Cohort 3: 159. Median age was 19, 39, and 46 years. Women living with HIV (WLWH) accounted for 0 %, 76 %, and 72 %. High-risk (HR) HPV prevalence in Cohort 1 increased 34 % to 57 % over 20 months. HPV profiles did not differ by HIV status. The prevalence of all HR HPV subtypes in Cohorts 2 and 3 is increased compared to Cohort 1. The prevalence of HPV HR subtypes except for HPV 53 is increased in Cohort 3 compared to Cohort 2. Among WLWH, Cohort 3 had a higher prevalence of HPV 16, 18, and 34 compared to Cohort 2. Among women without HIV, Cohort 3 had a higher prevalence of HPV 16 and 18 compared to Cohort 2.
Conclusions
Compared to healthy women, HPV subtype representation is higher among women with CIN and CaCx. This suggests the presence of multiple HR HPV strains may impact transformation from pre-cancerous lesions to CaCx, highlighting the importance of CIN detection and primary prevention of HR HPV to decrease the incidence of CaCx in Botswana.
{"title":"HPV profiles in Botswana: An analysis of healthy women, cervical intraepithelial neoplasia, and invasive cervical cancer","authors":"Caroline Kernell , Emily MacDuffie , Xiang Lin , Le Gao , Doreen Ramogola-Masire , Surbhi Grover , Erle Robertson","doi":"10.1016/j.gore.2025.101971","DOIUrl":"10.1016/j.gore.2025.101971","url":null,"abstract":"<div><h3>Purpose/Objective(s)</h3><div>High prevalence of HPV and HIV contribute to the high rate of cervical cancer (CaCx) in Botswana. HPV subtypes in healthy, unvaccinated students (Cohort 1), women with CIN II/III (Cohort 2), and women with invasive CaCx (Cohort 3) were compared.</div></div><div><h3>Materials/Methods</h3><div>The Ipabalele study in Gaborone, Botswana enrolled patients between 2016–2020. Demographics, clinical characteristics, and HPV cervical swabs were collected. PathoChip quantified prevalence of HPV subtypes.</div></div><div><h3>Results</h3><div>Overall 414 patients enrolled. Cohort 1: 43; Cohort 2; 212; Cohort 3: 159. Median age was 19, 39, and 46 years. Women living with HIV (WLWH) accounted for 0 %, 76 %, and 72 %. High-risk (HR) HPV prevalence in Cohort 1 increased 34 % to 57 % over 20 months. HPV profiles did not differ by HIV status. The prevalence of all HR HPV subtypes in Cohorts 2 and 3 is increased compared to Cohort 1. The prevalence of HPV HR subtypes except for HPV 53 is increased in Cohort 3 compared to Cohort 2. Among WLWH, Cohort 3 had a higher prevalence of HPV 16, 18, and 34 compared to Cohort 2. Among women without HIV, Cohort 3 had a higher prevalence of HPV 16 and 18 compared to Cohort 2.</div></div><div><h3>Conclusions</h3><div>Compared to healthy women, HPV subtype representation is higher among women with CIN and CaCx. This suggests the presence of multiple HR HPV strains may impact transformation from pre-cancerous lesions to CaCx, highlighting the importance of CIN detection and primary prevention of HR HPV to decrease the incidence of CaCx in Botswana.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101971"},"PeriodicalIF":1.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.gore.2025.101976
Julia Fromme , Roland Hake , Elmar Armin Joura , Monika Hampl
Background
Giant condyloma acuminata (GCA) is a sexually transmitted disease caused by human papillomavirus (HPV), mostly types 6 and 11. Only a few cases have been reported in children and young patients. Treating these large tumors in adolescent patients is challenging, due to the disfiguring effects of surgery and the high risk of recurrence. Alternative nonsurgical treatments are available such as imiquimod. Imiquimod is a topically active immunomodulatory agent that is formulated as a 5% cream for application by the patient. In immunocompetent patients, imiquimod stimulates the production of interferon-alpha and various other cytokines, and has indirect antiviral activity.
Case presentation
We present a case of successful treatment of an extensive GCA encompassing the entire vulva in a 14-year-old adolescent patient with a history of sexual abuse with imiquimod and three doses of nonavalent HPV vaccination (9vHPV) leading to complete remission of the GCA after 12 weeks of imiquimod application and nearly complete regression of remaining vulvar condylomas after 6 months.
Conclusion
Imiquimod in combination with intramuscular 9vHPV vaccination can be an effective treatment for GCA in young patients, without the disfiguring side effects of surgery and could be considered as an alternative treatment option.
{"title":"Effective treatment of a giant condyloma with imiquimod and HPV vaccination","authors":"Julia Fromme , Roland Hake , Elmar Armin Joura , Monika Hampl","doi":"10.1016/j.gore.2025.101976","DOIUrl":"10.1016/j.gore.2025.101976","url":null,"abstract":"<div><h3>Background</h3><div><span>Giant</span> condyloma acuminata (<span>GCA</span>) is a sexually transmitted disease caused by human papillomavirus (HPV), mostly types 6 and 11. Only a few cases have been reported in children and young patients. Treating these large tumors in adolescent patients is challenging, due to the disfiguring effects of surgery and the high risk of recurrence. Alternative nonsurgical treatments are available such as imiquimod. Imiquimod is a topically active immunomodulatory agent that is formulated as a 5% cream for application by the patient. In immunocompetent patients, imiquimod stimulates the production of interferon-alpha and various other cytokines, and has indirect antiviral activity.</div></div><div><h3>Case presentation</h3><div>We present a case of successful treatment of an extensive GCA encompassing the entire vulva in a 14-year-old adolescent patient with a history of sexual abuse with imiquimod and three doses of nonavalent HPV vaccination (9vHPV) leading to complete remission of the GCA after 12 weeks of imiquimod application and nearly complete regression of remaining vulvar condylomas after 6 months.</div></div><div><h3>Conclusion</h3><div>Imiquimod in combination with intramuscular 9vHPV vaccination can be an effective treatment for GCA in young patients, without the disfiguring side effects of surgery and could be considered as an alternative treatment option.</div></div>","PeriodicalId":12873,"journal":{"name":"Gynecologic Oncology Reports","volume":"62 ","pages":"Article 101976"},"PeriodicalIF":1.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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