Recent advances in surgery and new therapies have greatly improved outcomes for gynecologic cancers, leading to more long-term survivors and a stronger focus on quality of life. Treatments such as surgery, radiation, and chemotherapy often cause iatrogenic menopause, leading to reduced quality of life and long-term health consequences. Hormone replacement therapy is the most effective option for managing menopausal symptoms. However, its use in patients with gynecologic cancer remains controversial because of concerns regarding oncologic safety. We conducted a comprehensive literature review evaluating the safety of hormone replacement therapy in survivors of endometrial, ovarian, cervical, vulvar, and vaginal cancers and uterine sarcomas, as well as in patients with hereditary cancer syndromes. Systemic hormone replacement therapy is safe in women with low-risk, early-stage endometrial cancer, most ovarian cancer sub-types, cervical cancer regardless of histology, and vulvar or vaginal cancers. However, contra-indications exist in specific scenarios such as advanced or non-endometrioid endometrial cancer, uterine sarcomas, and certain ovarian cancer sub-types (granulosa-cell tumors). In these cases, both non-systemic hormonal and non-hormonal alternatives have shown efficacy in managing menopausal symptoms. Hormonal therapies for genitourinary syndrome of menopause, including vaginal estrogens, ospemifene, and vaginal dehydroepiandrosterone, have demonstrated efficacy in relieving symptoms and improving urogenital health. Non-hormonal approaches, such as vaginal moisturizers, lubricants, and vaginal laser therapy, can also provide symptom relief. Non-hormonal therapies proven effective for managing vasomotor symptoms and sleep disturbances include cognitive behavioral therapy, clinical hypnosis, gabapentin, fezolinetant, and selective serotonin or serotonin-norepinephrine re-uptake inhibitors. Personalized treatment decisions should be guided by cancer type, recurrence risk, patient preferences, and quality-of-life considerations. It is essential to balance oncologic safety with symptom relief and long-term health outcomes in this growing population of cancer survivors.
Objective: Older adults with ovarian cancer often receive modified chemotherapy regimens due to concerns about treatment-related toxicity. This retrospective study compares feasibility, efficacy, and safety between a fractionated carboplatin-paclitaxel regimen (carboplatin on day 1 and paclitaxel on days 1 and 8) and the standard every-3-week regimen in patients aged ≥70 years.
Methods: We conducted a single-center retrospective analysis of 102 patients treated with fractionated or standard carboplatin-paclitaxel at Georges Pompidou European Hospital (Paris, France) between 2015 and 2023. The primary end point was treatment feasibility, defined as completion of 6 chemotherapy cycles without premature discontinuation, unplanned hospital admission, significant delay or dose reduction due to toxicity, progression, or death. Secondary end points included progression-free survival, overall survival, and treatment-related adverse events.
Results: Of the 102 patients, 58 received standard and 44 received fractionated carboplatin-paclitaxel. Treatment was feasible in 72% versus 57% of patients receiving the standard or fractionated regimens, respectively (p = .10). Among patients treated in the first-line setting, median progression-free survival was 18 months with the standard regimen and 24 months with the fractionated regimen (p = .36); median overall survival was 71 and 48 months, respectively (p = .36). Overall toxicity rates were similar between groups, but fractionated carboplatin-paclitaxel was associated with a lower rate of grade 2 to 4 sensory neuropathy (16% vs 41%, p = .01) and a higher rate of grade 3 to 4 anemia (26% vs 5%, p = .008).
Conclusions: Both standard and fractionated carboplatin-paclitaxel regimens appear feasible and yield similar survival outcomes in older patients with ovarian cancer. A fractionated regimen may offer reduced neurotoxicity. These findings warrant prospective evaluation of fractionated carboplatin-paclitaxel in older adults and in other tumor types, including cervical, endometrial, and lung cancer, particularly in combination with immune checkpoint inhibitors.
Objective: This study aimed to describe the patterns of adjuvant therapy use within the SUCCOR cohort, a large retrospective analysis comparing disease-free survival following minimally invasive versus open surgery in early-stage cervical cancer. Furthermore, to assess the factors associated with the indication for adjuvant radiotherapy after radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB (≤4cm) cervical cancer.
Methods: A retrospective analysis was performed using the SUCCOR study database. We investigated patients with FIGO 2009 stage IB1, node-negative cervical cancer at final pathology. Univariate and multi-variable logistic regression were performed to determine factors associated with the administration of adjuvant radiation therapy.
Results: The study included a total of 572 patients. Of these, 340 patients (59.4%) did not receive adjuvant radiotherapy, including 45 (13.2%) who met the Sedlis criteria. Conversely, among the 232 patients (40.6%) who received adjuvant radiotherapy, 132 (56.9%) did not meet Sedlis criteria. In the univariate logistic regression, factors associated with adjuvant radiotherapy included tumor size >2 cm (p< .001), lymphovascular space invasion (p < .001) and a tumor grade G3 (vs G1-G2, p .01). Furthermore, the probability of receiving adjuvant radiotherapy was higher for patients with deep stromal invasion (p < .001), and with intermediate stromal invasion (p < .001) in comparison to those with superficial stromal invasion. At multiple logistic regression, open approach (odds ratio [OR] 1.63, p =.01) and G3 tumor grade (OR 1.64, p= .01) were independently associated with the administration of adjuvant radiotherapy. In addition, the presence of Sedlis criteria was associated with a 4 times higher probability of having adjuvant radiotherapy (OR 4.44, p < .001).
Conclusions: While the Sedlis criteria should guide post-operative radiotherapy administration, we observed a significant variation in post-operative adjuvant treatment among institutions involved in the SUCCOR study. A call for a standardized recommendation of adjuvant radiation therapy is needed.
Objective: Gynecologic malignancies remain a leading cause of death among women in low- and middle-income countries. In 2017, the International Gynecologic Cancer Society (IGCS) started the Global Gynecologic Oncology Fellowship Program in countries without existing training. This 2-year structured program allows fellows to train locally with support from international mentors through in-person visits, virtual mentorship, and didactic instruction. Fellows participate in monthly tumor boards, conduct research, complete international observerships, log surgical cases, and complete an oral exam upon graduation. Our objective was to characterize the growth of this program from 2017 to 2024 and determine best practices and areas for improvement.
Methods: Between February and April 2024, 40 IGCS fellowship graduates were invited via email to complete a 38-question survey about their training and post-fellowship experiences. Data were analyzed using descriptive statistics and thematic analysis.
Results: Since 2017, the IGCS fellowship program has expanded from 5 pilot sites to 22 training sites in 18 countries. To date, 52 fellows have graduated and 38 are currently in training. There are 40 international mentors and 53 local supervisors, of whom 15 are previous graduates. Twenty fellows (50%) completed the survey. Nineteen respondents (95.0%) reported practicing as gynecologic oncologists, with an average of 70% of their clinical work focused on this area. However, most reported continuing to provide obstetric and benign gynecology care. Six respondents (30%) reported being the sole gynecologic oncologist at their hospital. Half of respondents never visited their international mentor's site, although 70% reported consistent virtual support. All graduates expressed a need for post-fellowship support, including mentorship, meetings with other graduates, advanced surgical training, and sub-specialty collaboration.
Conclusions: The IGCS fellowship program has significantly expanded gynecologic oncology capacity in low-resource settings. Graduates report valuable training experiences but desire ongoing post-fellowship support, a next step in growth for the IGCS fellowship program.
The collaborative efforts between GOG and LACOG are aimed at advancing clinical oncology research through strategic global partnerships, particularly related to the conduct of clinical trials. Herein, we provide the framework of this relationship addressing key operational components including establishing a shared Publication Policy. In addition, this initiative seeks to standardize contributions, recognize authorship fairly, and ensure compliance with agreed protocols. Emphasis is placed on critical practices like study design, data interpretation, manuscript development, and intellectual review. The Policy considers the roles of individual scientists, institutional sponsors, and contributors while ensuring transparency and authenticity in scientific communication. This collaborative approach underscores the importance of collective expertise in addressing global challenges in oncology and fostering innovation through multi-institutional cooperation. The manuscript outlines the processes for critical review, approval, and publication, ensuring credibility in the dissemination of scientific findings to the community. These frameworks aim to promote inclusivity, equitable representation, and the advancement of oncology knowledge.
Radiation-induced gynecological toxicities are frequently under-recognized, under-diagnosed, and insufficiently managed. These adverse effects negatively impact patients' quality of life and may compromise oncological outcomes by delaying or interrupting cancer treatment. This guideline aims to define best clinical practices for the prevention, identification, and management of both acute and late radiation-induced gynecological toxicities. The French Association for Supportive Care in Cancer (AFSOS) convened a multidisciplinary task force to perform a literature review and apply a consensus methodology to establish these guidelines. External validation was conducted by an independent panel of experts. Optimal management involves a 3-phase approach: before, during, and after radiotherapy. Patients should receive pre-treatment counseling on potential gynecological and sexual side effects, along with preventive hygienic and dietary guidance. During treatment, acute toxicities such as vulvitis, vaginitis, urethritis, and proctitis should be actively managed. Post-radiotherapy care must address vaginal dryness, stenosis, synechiae, premature menopause, lymphedema, and sexual dysfunction, with integration of onco-sexological support as needed. Awareness and proactive management of radiation-induced gynecological toxicities are critical for maintaining quality of life and ensuring treatment continuity. This guideline provides structured recommendations to support clinicians in delivering comprehensive, patient-centered supportive care.
Objective: Low-grade serous ovarian cancer is a rare sub-type characterized by indolent growth, limited therapeutic options, and relative chemoresistance. This study aimed to describe management patterns, survival outcomes, and the efficacy of systemic therapies in a large cohort of patients with low-grade serous ovarian carcinoma treated across 18 French comprehensive cancer centers.
Methods: Using data from the Epidemiological Strategy and Medical Economics ovarian cancer database (NCT03275298), patients with International Federation of Gynecology and Obstetrics (FIGO) stage III to IV low-grade serous ovarian carcinoma diagnosed between 2011 and 2024 were examined. Clinical outcomes, overall survival, and progression-free survival were assessed, along with treatment-related factors affecting survival, including surgical management and bevacizumab administration. Univariable and multi-variable analyses were conducted using Kaplan-Meier estimates and Cox proportional hazards models.
Results: Among 230 patients with low-grade serous ovarian carcinoma (median age 55.5 years [range; 19.8-88.2]), 171 (74.3%) and 59 (25.7%) had FIGO stage III and IV diseases, respectively. Primary debulking surgery was performed in 128 (55.6%), platinum-based chemotherapy was given to 223 (97%), and bevacizumab was administered to 79 (34.3%) patients. The median follow-up period was 73.6 months (95% confidence interval [CI] 69.9 to 80.0). Patients who underwent primary debulking surgery had the longest median progression-free survival (35.2 months, 95% CI 26.5 to 48.1) and overall survival (146 months, 95% CI 110.4 to not reached). Multi-variable analyses identified FIGO stage and primary debulking surgery as key prognostic factors for overall survival, whereas age and bevacizumab use were not significantly associated with outcomes.
Conclusions: This real-world study underscores the prognostic relevance of surgical approach and disease stage in low-grade serous ovarian carcinoma. Continued investigation is warranted to define the optimal integration of emerging systemic therapies and improve outcomes in this rare malignancy.
Endometrioid endometrial cancer especially low-grade expresses estrogen receptors. A sub-group of patients derives significant benefit from hormonal treatment. The presence of activating ESR1 gene mutations is a common mechanism of resistance to hormonal treatment for patients with breast cancer. We evaluated the incidence of ESR1-activating gene mutations in patients with endometrioid endometrial cancer using the American Association of Cancer Research Genomics Evidence of Neoplasia Information Exchange (v18.0) multi-center data set. A total of 2851 patients with endometrioid endometrial cancer were identified. The overall incidence of ESR1 mutations was 4.0% (n = 113). The incidence of ESR1 mutations was higher among patients with metastatic/recurrent disease than those with primary tumors (7.6% vs 3.4%, p < .001). Patients with ESR1-activating mutations also harbored mTOR/PIK3CA pathway genomic alterations: PTEN (75%), PIK3CA (56%), PIK3R1 (42%), AKT1 (12%). Further research to elucidate the clinical impact of ESR1 gene mutations in endometrial cancer are needed. Clinical trials evaluating novel hormonal agents in this patient population are warranted.
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