Gynecological Cancers: Surgical Treatment and Novel Radiotherapy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 27 March 2024 | Viewed by 1887

Special Issue Editor

Dr. Gaspare Cucinella
E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital IVF UNIT, University of Palermo, 90146 Palermo, Italy
Interests: obstetrics and gynecology; endoscopy; cancer; laparoscopy; fertility preservation; medical therapies; genital prolapse; urinary incontinence; endometriosis; oncological gynecology
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Special Issue Information

Dear Colleagues,

Recent decades have witnessed significant advancements in surgical techniques for the treatment of gynecological cancers, resulting in shorter hospital stays, less blood loss, and lower morbidity levels due to the minimally invasive approach. It is now known that the histological categories of some gynecological tumors do not accurately differentiate the clinical course and response to therapy. Currently, a molecular profile study is being carried out to improve the risk stratification and targeted therapy for endometrial cancer.

Radiotherapy has an important place in the management of gynecological tumors, either as an upfront treatment or as an adjuvant in patients treated with surgery and harboring risk factors for locoregional relapse (e.g., endometrial cancer, early-stage cervical cancer, etc.).

Surgery is the mainstay of the treatment of endometrial cancer. The major evolution in surgical strategy has occurred in lymph node staging. The standard surgical staging includes pelvic and paraaortic lymph node dissection to the level of the left renal vein. Sentinel lymph node dissection has been validated as a less morbid alternative to systematic lymphadenectomy, indicated in patients with low and intermediate risk of lymph node involvement.

In particular, in ovarian cancer treatment, testing for the BRCA and HRD status is expected to further improve the prognosis by combining molecularly targeted agents with different mechanisms of action.

This Special Issue aims to collect original research studies and review articles that add to the current knowledge and showcase the potential future approaches of novel agents for gynecologic cancers.

Dr. Gaspare Cucinella
Guest Editor

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Keywords

  • gynecological cancers
  • uterine cancer
  • cervical cancer
  • vulvar cancer
  • biomarkers
  • fertility preservation
  • sentinel lymph node evaluation
  • fertility-sparing treatment
  • novel treatment strategies

Published Papers (2 papers)

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Research

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16 pages, 2370 KiB  
Article
Advancing Tailored Treatments: A Predictive Nomogram, Based on Ultrasound and Laboratory Data, for Assessing Nodal Involvement in Endometrial Cancer Patients
J. Clin. Med. 2024, 13(2), 496; https://doi.org/10.3390/jcm13020496 - 16 Jan 2024
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Abstract
Assessing lymph node metastasis is crucial in determining the optimal therapeutic approach for endometrial cancer (EC). Considering the impact of lymphadenectomy, there is an urgent need for a cost-effective and easily applicable method to evaluate the risk of lymph node metastasis in cases [...] Read more.
Assessing lymph node metastasis is crucial in determining the optimal therapeutic approach for endometrial cancer (EC). Considering the impact of lymphadenectomy, there is an urgent need for a cost-effective and easily applicable method to evaluate the risk of lymph node metastasis in cases of sentinel lymph node (SLN) biopsy failure. This retrospective monocentric study enrolled EC patients, who underwent surgical staging with nodal assessment. Data concerning demographic, clinicopathological, ultrasound, and surgical characteristics were collected from medical records. Ultrasound examinations were conducted in accordance with the IETA statement. We identified 425 patients, and, after applying exclusion criteria, the analysis included 313 women. Parameters incorporated into the nomogram were selected via univariate and multivariable analyses, including platelet count, myometrial infiltration, minimal tumor-free margin, and CA 125. The nomogram exhibited good accuracy in predicting lymph node involvement, with an AUC of 0.88. Using a cutoff of 10% likelihood of nodal involvement, the nomogram displayed a low false-negative rate of 0.04 (95% CI 0.00–0.19) in the training set. The adaptability of this straightforward model renders it suitable for implementation across diverse clinical settings, aiding gynecological oncologists in preoperative patient evaluations and facilitating the design of personalized treatments. However, external validation is mandatory for confirming diagnostic accuracy. Full article
(This article belongs to the Special Issue Gynecological Cancers: Surgical Treatment and Novel Radiotherapy)
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Review

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10 pages, 233 KiB  
Review
Sentinel Lymph Node Staging in Early-Stage Cervical Cancer: A Comprehensive Review
J. Clin. Med. 2024, 13(1), 27; https://doi.org/10.3390/jcm13010027 - 20 Dec 2023
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Abstract
Cervical cancer (CC) continues to be a significant global public health concern, even with preventive measures in place. In women with early-stage CC, the status of lymph nodes is of paramount importance, not only for the final prognosis but also for determining the [...] Read more.
Cervical cancer (CC) continues to be a significant global public health concern, even with preventive measures in place. In women with early-stage CC, the status of lymph nodes is of paramount importance, not only for the final prognosis but also for determining the best therapeutic strategy. According to main international guidelines, pelvic full lymphadenectomy (PLND) is recommended for lymph node staging. However, in these early stages of CC, sentinel lymph node biopsy (SLNB) has emerged as a precise technique for evaluating lymph node involvement, improving its morbidity profile. We performed a literature review through PubMed articles about progress on the application of SLNB in women with early-stage CC focusing on the comparison with PET/CT and PLND in terms of oncological outcomes and diagnostic accuracy. While the superiority of SLNB is clear compared to radiologic modalities, it demonstrates no clear oncologic inferiority over PLND, given the higher detection rate of positive lymph nodes and predominance of no lymph node recurrences. However, due to a lack of prospective evidence, particularly concerning long-term oncological safety, SLNB is not the current gold standard. With careful patient selection and adherence to straightforward protocols, a low false-negative rate can be ensured. The aim of the ongoing prospective trials is to address these issues. Full article
(This article belongs to the Special Issue Gynecological Cancers: Surgical Treatment and Novel Radiotherapy)
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