Journal of Gynecologic Oncology最新文献

Objective: Combining cisplatin and gemcitabine (CG) in the concurrent and adjuvant treatment phase of advanced cervical cancer has improved oncological outcome at the cost of excess toxicity. We aimed to investigate the feasibility and safety of this treatment intensification in the era of modern radiotherapy.

Methods: A retrospective review was performed on patients treated with definitive chemoradiation including CG for advanced cervical cancer. Treatment consisted of chemoradiotherapy (weekly cisplatin 40 mg/m² and gemcitabine 125 mg/m² with volumetric-modulated arc therapy) followed by image-guided adaptive brachytherapy and 2 cycles of adjuvant CG.

Results: Fifty-five patients were included with a median follow-up of 48 months (range, 7-130). Patients with FIGO stage IIIC1 accounted for 49.1% of cases, with an additional 23.6% being stage IIIC2. The median number of concurrent gemcitabine and cisplatin administrations was 4 (range, 1-6), and 5 (range, 2-8), respectively. Forty-four patients (80%) received adjuvant chemotherapy. Hematological severe short-term toxicity (grade ≥3) occurred in 22 patients (43.1%). There was no deviation from planned radiotherapy-schedule. No treatment-related death occurred. Five patients experienced late grade ≥3 adverse events. Local, locoregional and distant control rates at 5 years were 82.0%, 70.5% and 69.3%, respectively. Five-year progression-free survival was 50.9% and overall survival was 70.9%.

Conclusion: Concurrent chemoradiation with CG followed by image-guided adaptive brachytherapy and adjuvant CG is feasible and associated with a lower toxicity profile than previously reported. Further research is needed to refine patient selection for different treatment intensification strategies in advanced cervical cancer.

Objective: To investigate the associations of homologous recombination repair (HRR) gene mutations with clinical prognosis in epithelial ovarian cancer (EOC) patients with various histological subtypes.

Methods: The EOC patients treated at our institute from January 2014 to March 2021 were included. Gene mutations were detected using 24 target HRR genes. The associations between HRR gene mutations and clinical outcomes were analyzed.

Results: A total of 318 patients were evaluated, 37 patients had BRCA, and 21 patients had other HRR gene mutations. EOC patients with HRR gene mutations were associated with platinum sensitivity than wild type (82.8% vs. 68.7%, p=0.033), and it remained significant in patients with advanced stage (79.5% vs. 57.6%, p=0.007), serous carcinoma (89.4% vs. 66.2%, p=0.002) or optimal debulking surgery (97.1% vs. 79.1%, p=0.013). In serous carcinoma, advanced stage (hazard ratio [HR]=2.11; p=0.031), HRR mutation (HR=0.62; p=0.021) and 1st line poly(ADP-ribose) polymerase inhibitor (PARPi, HR=0.28; p<0.001) were significant for cancer recurrence. Suboptimal debulking surgery (HR=1.58; p=0.044) and HRR gene mutation (HR=0.33; p=0.001) were important for cancer-related death. In non-serous carcinoma, mucinous carcinoma (HR=3.91; p=0.023), advanced stage (HR=3.10; p<0.001) and suboptimal debulking surgery (HR=2.63; p=0.001) were significant for cancer recurrence. Mucinous carcinoma (HR=9.17; p=0.001), advanced stage (HR=4.26; p<0.001), and suboptimal debulking surgery (HR=3.80; p<0.001) were important for cancer-related death.

Conclusion: HRR gene mutations were associated with platinum sensitivity, PARPi response and favorable survival in serous EOC patients. In non-serous EOC, HRR gene mutations did not show the same trend, which warrants further investigation.

Objective: Recurrence patterns and survival outcomes in advanced epithelial ovarian cancer (EOC) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remain poorly understood. This post hoc analysis aimed to evaluate patterns of initial recurrence in patients with advanced EOC.

Methods: This analysis of the KOV-HIPEC1 trial included 142 patients with recurrent EOC divided into HIPEC and non-HIPEC groups. Baseline characteristics, recurrence patterns, and post-recurrence survival (PRS) were analyzed.

Results: Among 142 patients with recurrent disease, recurrence patterns were comparable between the HIPEC and non-HIPEC groups, including rates of peritoneal seeding (80.0% vs. 70.1%, p=0.178), lymphatic involvement (47.7% vs. 49.4%, p=0.844), and parenchymal metastases (10.8% vs. 15.6%). In the BRCA-mutated subgroup, peritoneal seeding was significantly more common in the HIPEC group than in the non-HIPEC group (81.8% vs. 33.3%, p=0.036). PRS did not differ significantly between the HIPEC and control groups (p=0.571). Gastrointestinal events at recurrence were less frequent in the HIPEC group, including intestinal obstruction (1.9% vs. 9.3%), ostomy formation (0% vs. 3.1%), intestinal surgery (0% vs. 5.6%) and nasogastric tube placement (1.9% vs. 7.4%).

Conclusion: No significant differences in recurrence pattern or survival outcome were observed between CRS with HIPEC and CRS alone. However, distinct recurrence patterns observed in BRCA-mutated patients suggest potential biological differences that may influence treatment outcomes. A trend toward reduced gastrointestinal morbidity in the HIPEC group, potentially reflecting a more subtle, less invasive recurrence pattern. Further research is warranted to elucidate these observations.

Objective: This phase II study compared the efficacy and safety of lobaplatin versus cisplatin in concurrent chemoradiotherapy (CCRT) for elderly cervical cancer patients.

Methods: Elderly cervical cancer patients aged ≥65 years were randomly assigned (1:1) to lobaplatin-based (2 cycles of lobaplatin 30 mg/m² every 3 weeks) or cisplatin-based (5 cycles of cisplatin 40 mg/m² every week) CCRT. Radiotherapy included external beam radiotherapy (50.4 Gy in 28 fractions) and intracavitary brachytherapy (30 Gy in 5 fractions).

Results: From January 1, 2020, to December 31, 2023, 64 patients were enrolled: 31 were randomly assigned to the lobaplatin group and 33 to the cisplatin group. The lobaplatin group showed higher chemotherapy completion rates compared to the cisplatin group (83.9% vs. 54.5%, p=0.011). The objective response rate and disease control rate were comparable between 2 groups (93.5% vs. 93.9%, 96.8% vs. 97.0%). The 1- and 2-year overall survival rates of the lobaplatin group and the cisplatin group were 96.0% vs. 96.6%, 90.7% vs. 96.6%, respectively (p=0.558). The lobaplatin group had a lower incidence of nephrotoxicity (39.4% vs. 9.7%, p=0.006), and there was also a trend of lower grade 2-3 gastrointestinal toxicity (30.3% vs. 12.9%, p=0.059), although the incidence of grade 3-4 thrombocytopenia was higher (16.1% vs. 6.1%, p=0.295), the difference was not statistically significant.

Conclusion: Lobaplatin-based CCRT demonstrates comparable efficacy to cisplatin in elderly cervical cancer patients, with superior renal safety and improved gastrointestinal tolerability, establishing it as a viable alternative for cisplatin-intolerant populations.

Objective: Cervical intraepithelial neoplasia (CIN) grades 2 and 3 are precancerous lesions requiring timely treatment to prevent progression to invasive cancer. While conization is the standard therapy, it may negatively impact future fertility. This study evaluated the therapeutic efficacy of cervical laser vaporization compared with laser conization.

Methods: This retrospective study included patients with CIN2-3 who underwent laser vaporization or conization at NTT East Sapporo Medical Center between January 2018 and December 2022. Treatment selection was based on colposcopic findings, lesion grade, age, and fertility desire. Human papillomavirus (HPV) testing and cytology were performed before treatment and at 3 months postoperatively. Cytologic follow-up continued biannually for 2 years. The primary outcome was absence of cytologic abnormalities throughout the follow-up period. Patients lost to follow-up were excluded. Fisher's exact test was used for statistical comparisons.

Results: Of 319 patients (93 conization; 226 vaporization), the mean age was 41 in the conization group and 33 in the vaporization group. Despite the age difference, no significant differences were observed in 2-year cytologic cure rates or 3-month HPV clearance in CIN3 cases. HPV16 was the most common genotype, followed by HPV52 and HPV58.

Conclusion: A Laser vaporization showed comparable efficacy to conization in appropriately selected CIN2-3 cases. It may be a fertility-preserving option for younger patients. Strengthening HPV vaccination programs remains essential for reducing high-risk HPV infections.

Objective: This study aimed to retrospectively evaluate and compare the recurrence-free survival (RFS) between abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) while avoiding the use of a uterine manipulator, vaginal washing and clamping before colpotomy, and removal of the uterus with a retrieval bag.

Methods: This study included patients with cervical cancer, classified by the International Federation of Obstetrics and Gynecologists (2018) as preoperative stages IB1, IB2, and IIA1, who underwent radical hysterectomy at our institution between October 2009 and August 2023.

Results: Overall, 103 patients with cervical cancer who underwent radical hysterectomy were included in this study. ARH was performed in 71 patients and LRH in 32. The median follow-up periods were 60 and 50 months for patients who underwent ARH and LRH, respectively. No significant difference was observed in the RFS between the ARH and LRH groups. Furthermore, after adjusting for inverse probability weighting, there was no significant difference in the RFS between the ARH and LRH groups. Similarly, no significant difference in overall survival was observed between the 2 groups.

Conclusion: The RFS after LRH in patients with early-stage cervical cancer did not differ significantly from that in patients who underwent ARH when avoiding the uterine manipulator and tumor isolation method.

Objective: Our previous study demonstrated that training oncologists to provide genetic counselling for ovarian cancer patients in Malaysia, an upper-middle-income Asian country, increased uptake of genetic testing to 80% when the test was free under research. However, in practice, genetic tests are unlikely to be provided for free in low-and-middle-income countries. In this study, we explored the willingness to pay (WTP) for genetic testing among ovarian cancer patients in Malaysia.

Methods: In this multi-center study, ovarian patients without prior genetic counselling were administered questionnaires on WTP (a contingent valuation exercise), facilitators and barriers to genetic counselling, and followed up for at least 6 months. We estimated the WTP value and explored factors associated with being willing to pay using logistic regression.

Results: Of 100 sequential patients recruited, 58% stated WTP for genetic testing at median of MYR1,000 (interquartile range=MYR1,125). Older participants were less likely to be willing to pay (odds ratio=0.95; 95% confidence interval=0.91-0.99). Reasons for being unwilling to pay included affordability (71%), belief that it should be paid by government or insurance (19%) and preference not to know their genetic status (14%). At the end of follow-up (mean 5±17 months), 17% took the test at full price.

Conclusion: In this exploratory study, stated WTP for genetic testing was high but only at a reduced price. At follow-up, only a minority of patients paid the full price. A co-payment framework or subsidy scheme may be needed to reduce the significant cost barriers to genetic testing in Malaysia.

Objective: This multi-center retrospective study aimed to clarify the characteristics, diagnostic accuracy, treatment outcomes, and prognostic factors of uterine serous carcinoma (USC) in Japanese women.

Methods: The medical records of 193 patients who were treated between 2006 and 2008 at 24 participating institutions in the Japanese Clinical Oncology Group were examined, and pathological slides of 188 patients were re-checked through central pathology review (CPR), hematoxylin-eosin staining, and immunohistochemistry.

Results: USC was confirmed in 144 of the 188 (76.6%) patients using CPR, and only 50% were correctly diagnosed preoperatively. Forty-three patients were diagnosed with non-serous carcinoma, whereas one patient had metastasis from another organ. The average age was 65.7 years, and 19% of patients had a history of other cancers. The incidence of stage III-IV disease was 52.8%, and lymph node metastasis was found in 28.5% of patients. Extrauterine spread and distant metastasis occurred in 39% and 14% of patients, respectively. The 2-year overall survival and progression-free survival (PFS) rates were 56% and 42%, respectively. The PFS of patients with stage I and II who underwent complete staging surgery was 92.3%, and that of those without lymph node dissection or omentectomy was 33.3%. Patients with USC had a significantly worse prognosis than 43 patients with non-serous carcinoma.

Conclusion: USC in Japanese women has characteristics different from those of endometrioid carcinoma, worse prognosis, and is difficult to diagnose preoperatively. Complete surgical staging is necessary even for early-stage disease. Additionally, new adjuvant treatment strategies, including molecular targeted therapy, should be explored.

Objective: This systematic review and meta-analysis aimed to assess the impact of postoperative adjuvant chemotherapy on recurrence and mortality in stage IC granulosa cell tumors (GCTs).

Methods: We searched the PubMed, Embase, and Cochrane Library for studies published up to December 1, 2024, comparing the oncological outcomes of adjuvant chemotherapy with observation in stage IC GCTs.

Results: Seventy studies were identified, with 12 included in the meta-analysis. Among 695 patients, 255 (36.7%) received postoperative adjuvant chemotherapy and 440 (63.3%) received observation. The overall recurrence and mortality rates were 18.7% and 7.6%, respectively. No significant differences were observed in survival outcomes between the adjuvant chemotherapy and observation groups, including recurrence rate (odds ratio [OR]=1.32; 95% confidence interval [CI]=0.67-2.58; p=0.424; I²=33%), mortality rate (OR=0.83; 95% CI=0.44-1.57; p=0.560; I²=0%), 5-year disease free survival (OR=0.88; 95% CI=0.18-4.18; p=0.868; I²=54%) and 5-year overall survival (OR=1.28; 95% CI=0.60-2.74; p=0.519; I²=0%). Subgroup analysis revealed no significant difference in recurrence rate between adjuvant chemotherapy and observation for both adult and juvenile GCTs, or between patients who underwent fertility-sparing surgery and those who did not. Additionally, no difference was found in recurrence rate between 'bleomycin, etoposide, and cisplatin' or 'etoposide and cisplatin' and 'paclitaxel combined with carboplatin or cisplatin' regimens.

Conclusion: Postoperative adjuvant chemotherapy did not provide additional benefits in disease recurrence or survival outcomes compared to observation in stage IC GCTs.

Trial registration: PROSPERO Identifier: CRD42024559478.