International Journal of Gynecological Cancer最新文献

Objective: This study aimed to clarify the role of levonorgestrel-releasing intra-uterine device as a stand-alone therapy in managing patients with endometrial atypical hyperplasia/endometrial cancer who are not suitable for surgery, through the evaluation of cause-specific survival and the control of vaginal bleeding.

Methods: This is a retrospective, multi-center study conducted in 9 referral gynecologic centers in Italy. Data regarding the clinical and oncological outcomes of patients with endometrial atypical hyperplasia/endometrial cancer (International Federation of Gynecology and Obstetrics Stage I) were analyzed. Patients were judged unsuitable for surgery due to an American Society of Anesthesiologists score ≥3 and the presence of multiple severe co-morbidities and, therefore, triaged to receive levonorgestrel-releasing intra-uterine device alone.

Results: A total of 78 women were enrolled. Fifteen patients (19.2%) had a diagnosis of endometrial atypical hyperplasia, whereas the other 63 (80.8%) had endometrial cancer. The baseline hemoglobin levels averaged 11.6 (range; 6-16), increasing to 12.1 (range; 7.8-14.9) during follow-up after levonorgestrel-releasing intra-uterine device insertion (p = .003). No patient experienced any side effects, and bleeding control was rated as excellent in most patients. Median disease-free survival was 43 months (range; 5-120) and median overall survival was 45 months (range; 5-120).

Conclusions: Levonorgestrel-releasing intra-uterine device alone is a safe and effective approach, showing no side effects, and a promising oncological outcome in women with early-stage endometrial atypical hyperplasia/endometrial cancer unfit for surgery. Future prospective studies are required to clarify how to select patient candidates for this therapy and how to predict response to levonorgestrel-releasing intra-uterine device.

Objective: Secondary cytoreductive surgery is considered for selected patients with recurrent ovarian cancer. Although evidence supports its impact on progression-free survival, its effect on overall survival remains controversial. This study aims to identify patient sub-groups that benefit most from secondary cytoreductive surgery.

Methods: A systematic review and trial-level meta-analysis of randomized controlled trials published through March 2025 was conducted. The primary end points were pooled hazard ratio (HR) for overall survival and progression-free survival comparing secondary cytoreductive surgery plus chemotherapy versus chemotherapy alone. Sub-group analyses were performed based on histology, platinum-free interval, number of recurrent lesions, individualized model or Arbeitsgemeinschaft Gynäkologische Onkologie score, and residual disease status.

Results: Three randomized controlled trials involving 1249 patients were included in this meta-analysis. Patients with favorable validated selection scores (positive Arbeitsgemeinschaft Gynäkologische Onkologie or individualized model ≤4.7) showed significantly improved overall survival (HR 0.79, 95% confidence interval [CI] 0.66 to 0.96). Complete resection was associated with significantly better overall survival (HR 0.53, 95% CI 0.43 to 0.64) and progression-free survival (HR 0.51, 95% CI 0.42 to 0.61) than patients who had residual disease. A progression-free survival benefit was also observed in the non-high-grade serous histology (HR 0.52, 95% CI 0.38 to 0.72). In patients with a platinum-free interval of 6 to 12 months (SOC-1, 6-16 months), there was a significant trend toward improved overall survival (HR 0.70, 95% CI 0.55 to 0.91).

Conclusions: Secondary cytoreductive surgery significantly improves progression-free survival and provides an overall survival benefit in carefully selected patients, particularly, those with a high likelihood of complete resection, favorable surgical selection scores, and a shorter platinum-free interval (<16 months). These findings highlight the critical role of patient selection and surgical completeness in optimizing outcomes for recurrent ovarian cancer.

Objective: This study aimed to explore the prognostic impact of different post-operative radiotherapy patterns in cervical cancer and identify an optimal treatment strategy using a multi-center database.

Methods: This cohort was derived from the Standardized Cervical Cancer-Specific Database, and enrolled patients with clinical International Federation of Gynecology and Obstetrics stage IB1 to IIA2 undergoing radical hysterectomy and adjuvant radiation therapy, concurrent chemoradiation, or sequential chemoradiotherapy between 2019 and 2023. Patients were stratified into high-risk and intermediate-risk groups. Kaplan-Meier curves and Cox proportional hazards model regression analyses were performed to identify potential prognostic factors. Propensity score matching was subsequently applied to balance relevant covariates.

Results: A total of 1436 patients were identified (radiation therapy: 308; concurrent chemoradiation: 950; sequential chemoradiotherapy: 178) with a median follow-up of 32 months (range; 10.3-72.9). Among high-risk patients, concurrent chemoradiation showed superior 3-year progression-free survival (94.1%) versus sequential chemoradiotherapy (87.4%) or radiation therapy (83.4%, p = .014), but no significant overall survival difference was observed (concurrent chemoradiation: 88.5%; sequential chemoradiotherapy: 82.0%; radiation therapy: 77.3%, p = .07). For intermediate-risk patients, radiation therapy and concurrent chemoradiation exhibited better 3-year progression-free survival than sequential chemoradiotherapy (radiation therapy: 97.9%; concurrent chemoradiation: 96.3%; sequential chemoradiotherapy: 90.8%, p = .0019), with comparable overall survival (radiation therapy: 96.9%; concurrent chemoradiation: 95.3%; sequential chemoradiotherapy: 89.1%, p = .37). Post-matching, concurrent chemoradiation retained progression-free survival superiority in high-risk patients compared with sequential chemoradiotherapy (96.1% vs 88.9%, p = .044), whereas no progression-free survival (radiation therapy: 97.5%; concurrent chemoradiation: 94.3%, p = .22) or overall survival (radiation therapy: 96.3%; concurrent chemoradiation: 96.4%, p = .52) differences emerged between radiation therapy and concurrent chemoradiation in intermediate-risk patients.

Conclusions: This cohort study demonstrates that concurrent chemoradiation may be considered a preferred approach for high-risk populations, whereas adding chemotherapy to radiation therapy could not improve prognosis for intermediate-risk patients.

Recommended therapy for cervical and other pelvic cancers relies on external beam radiation therapy with brachytherapy. The total biologically equivalent dose in 2 Gy fractions delivered to the tumor ranges from 60 to 90 Gy. The addition of brachytherapy boosts tumor dose and substantially improves 5-year survival, but unavoidable radiation exposure of surrounding vaginal tissue often induces fibrotic scarring which constricts the vaginal vault and can result in complete occlusion. This condition is termed vaginal stenosis, a serious, chronic syndrome which leads to sexual dysfunction and may obstruct gynecological surveillance for cancer recurrence. Clinical management consists of self-administered vaginal dilation with hard plastic rods, an approach that is effective when applied consistently. However, many women are reluctant to use these dilators because the underlying rationale and the methodology are often inadequately presented, and dilator use can be painful and even injurious. Additional challenges with clinically managing vaginal stenosis include incompletely characterized radiation dosimetry, the absence of widely standardized diagnostic and assessment criteria, and an absence of innovative new therapeutics that are both well tolerated and efficacious. Accordingly, in the present review we begin by describing the pathogenesis of vaginal stenosis and focus on risk factors including irradiation modalities and methods and nonadherence to dilator use. Subsequently, in this context we address the key importance of standardized stenosis assessment and identify current inconsistencies in clinical reporting. Finally, within the above landscape we highlight potential innovations for protecting vaginal tissue and promoting vaginal recovery in pelvic radiotherapy patients.

Objective: Concurrent chemoradiotherapy remains the standard of care for locally advanced cervical cancer. Alternative strategies, such as induction chemotherapy followed by concurrent chemoradiotherapy and the addition of immune checkpoint inhibitors, show promise but lack consensus. Other approaches, including adjuvant chemotherapy and surgery, have also been explored. This network meta-analysis compared the efficacy of these approaches.

Methods: A systematic review identified randomized controlled trials evaluating treatments for International Federation of Gynecology and Obstetrics stage IB2 to IVA locally advanced cervical cancer. Interventions included concurrent chemoradiotherapy, induction chemotherapy, neoadjuvant or adjuvant chemotherapy, radiotherapy alone, concurrent chemoradiotherapy with immune checkpoint inhibitors, surgery, or their combinations. Progression-free and overall survival were assessed. HRs were extracted or reconstructed using individual patient data from Kaplan-Meier curves. A Bayesian network meta-analysis with random-effects models was conducted, with treatment rankings based on surface under the cumulative ranking curve and superiority probabilities.

Results: Forty-seven trials (14,155 patients; 89% with squamous histology) were included. For overall survival (41 trials, 12,241 patients), no significant differences were observed among treatments, but concurrent chemoradiotherapy showed a trend toward superiority over radiotherapy alone (HR 0.84, 95% credible interval; 0.67-1.06; superiority probability = 93.1%). For progression-free survival (39 trials, 11,825 patients), concurrent chemoradiotherapy outperformed radiotherapy and induction chemotherapy followed by radiotherapy but showed similar efficacy to immune checkpoint inhibitor combinations, adjuvant chemotherapy, or induction chemotherapy. Concurrent chemoradiotherapy with immune checkpoint inhibitors ranked highest for both outcomes.

Conclusions: Concurrent chemoradiotherapy remains more effective than radiotherapy alone or surgery and comparable to other combination strategies. These findings support it as the cornerstone of treatment for locally advanced cervical cancer while highlighting the promise of immune checkpoint inhibitor-based approaches.

Objective: This study aimed to estimate the incidence of intra-operative, structural, and functional post-operative urologic complications associated with abdominal radical hysterectomy for cervical cancer.

Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted in PubMed, EMBASE, CINAHL, and Web of Science up to July 2025. Inclusion criteria were randomized trials including women with cervical cancer undergoing abdominal radical hysterectomy and reporting urologic complications. Data extraction and risk of bias assessment were independently performed by 2 reviewers. Urologic morbidities were classified as intra-operative, structural, and functional. Meta-analyses were conducted using random- or common-effects models, depending on heterogeneity.

Results: A total of 10 studies comprising 1247 patients were included. For intra-operative complications, the incidence of bladder injury was 0.2% (95% CI 0% to 1.2%) and of ureteral injury 0.3% (95% CI 0% to 1.1%), with low heterogeneity. In contrast, the rates of structural post-operative complications, such as genitourinary fistulas (0.3% to 5.7%) and ureteral obstruction or hydronephrosis (8.2% to 11%), and functional complications, including urinary retention or bladder atony (6.7% to 12.3%), and urinary incontinence (1.7% to 11%), were drawn from heterogeneous studies with variable definitions and assessments. Because of this substantial heterogeneity, these values should be interpreted only as descriptive ranges rather than precise pooled estimates. Accordingly, a meta-analysis was not performed for structural and functional complications.

Conclusions: Abdominal radical hysterectomy is associated with a low incidence of intra-operative urologic injuries but a notable risk of structural and functional complications, particularly, in patients receiving adjuvant radiotherapy. These findings highlight the need for patient counseling, standardized outcome reporting, and strategies to minimize long-term genitourinary morbidity.

Review registration: CRD420250484975.