Gynecologic oncology最新文献

{"title":"Weight-loss therapy in patients with obesity with endometrial intraepithelial neoplasia and uterine cancer.","authors":"Yukio Suzuki, Ling Chen, Koji Matsuo, Jennifer S Ferris, Elena B Elkin, Alexander Melamed, Chung Yin Kong, Nina Bickell, Evan R Myers, Laura J Havrilesky, Xiao Xu, Stephanie V Blank, William D Hazelton, Dawn L Hershman, Jason D Wright","doi":"10.1016/j.ygyno.2024.08.003","DOIUrl":"10.1016/j.ygyno.2024.08.003","url":null,"abstract":"<p><strong>Objective: </strong>Although obesity is an important risk factor for endometrial intraepithelial neoplasia (EIN) and uterine cancer, little is known about the trends in use of weight-loss therapy for patients with obesity with EIN and uterine cancer. We examined the use of weight-loss therapy among patients with obesity with EIN and uterine cancer.</p><p><strong>Methods: </strong>The Merative MarketScan Database was used to identify patients aged 18-70 years who were obese and diagnosed with EIN or uterine cancer. The primary treatment for EIN or uterine cancer was categorized as either primary hysterectomy or hormonal therapy. Nutrition counseling, bariatric surgeries, and weight-management medications were identified as weight-loss therapy. We analyzed trends in the use of any weight-loss therapies with Cochran-Armitage tests. A multivariable logistic regression model was developed to examine factors associated with weight-loss therapy use.</p><p><strong>Results: </strong>Overall, 15,374 patients were identified, including 5561 (36.2%) patients with EIN and obesity, and 9813 (63.8%) patients with uterine cancer and obesity. Weight-loss therapy was utilized within 1 year after diagnosis in 480 (8.6%) patients with EIN and in 802 (8.2%) patients with uterine cancer. Use of any weight-loss therapy after diagnosis of EIN increased from 4.1% in 2009 to 12.6% in 2020 (P < .001), and the use of any weight-loss therapy after diagnosis of uterine cancer increased from 4.9% in 2009 to 11.4% in 2020 (P < .001). In a multivariable regression model, younger age and patients with high comorbidity score were associated with a higher likelihood of using any weight-loss therapy.</p><p><strong>Conclusions: </strong>Use of weight-loss therapy has increased, however there is still a significant underuse of this adjunctive therapy in patients with obesity with EIN or uterine cancer.</p>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"190 ","pages":"78-83"},"PeriodicalIF":4.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brachytherapy in vaginal cancer for organ preservation: Clinical outcome and safety from a single center experience.","authors":"Ricarda Merten, Vratislav Strnad, Andre Karius, Michael Lotter, Stephan Kreppner, Claudia Schweizer, Rainer Fietkau, Philipp Schubert","doi":"10.1016/j.ygyno.2024.07.683","DOIUrl":"10.1016/j.ygyno.2024.07.683","url":null,"abstract":"<p><strong>Background: </strong>Interstitial and/or intracavitary brachytherapy is an integral part of the treatment of vaginal cancer Brachytherapy (BT) has shown to improve local control, overall survival (OS) and disease-free survival (DFS). The aim of our study was to analyze the efficacy and safety of brachytherapy in patients with vaginal cancer.</p><p><strong>Materials and methods: </strong>Between 2000 and 2023, 27 patients with vaginal cancer in stage FIGO I-III were treated with brachytherapy with or without external beam radiotherapy (EBRT) and simultaneous chemotherapy. Brachytherapy has been performed either as PDR-brachytherapy alone with a median cumulative dose up to 62.5 Gy (EQD2 = 63.9 Gy) or with PDR-BT boost with median dose of 30.9 Gy (EQD2 = 30.4 Gy). HDR-BT was administered solely as boost with a median dose of 25.5 Gy (EQD2 = 47.8 Gy). The median dose of EBRT was 48.7 Gy and 49.4 Gy for primary and for pelvic lymph nodes.</p><p><strong>Results: </strong>Median follow-up was 39 months (2-120). 5/27 patients developed local recurrences and the 5-year cumulative local recurrence rate for whole patient population was 18.5%. 5-year OS and DFS was 90% and 68%. 5-year DFS for Stage I-II was 72% and for Stage III 65% (p = 0.933). Grade 3 late side effects of brachytherapy were documented in 3/22 patients (13.6%), one patient experienced Grade 4 toxicity (4.5%).</p><p><strong>Conclusion: </strong>Brachytherapy with or without EBRT and concomitant chemotherapy for vaginal cancer is a safe and effective treatment option with excellent local control and overall survival and acceptable toxicity.</p>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"190 ","pages":"35-41"},"PeriodicalIF":4.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standard of care treatment for stage IVB cervical cancer: A systematic review and meta-analysis","authors":"Kyra S. Hunsberger ,&nbsp;Krishnansu S. Tewari ,&nbsp;Bradley J. Monk ,&nbsp;Dana M. Chase","doi":"10.1016/j.ygyno.2024.10.023","DOIUrl":"10.1016/j.ygyno.2024.10.023","url":null,"abstract":"<div><h3>Objective</h3><div>Our aim was to perform a systematic review and meta-analysis evaluating the efficacy of standard treatment for stage IVB cervical cancer.</div></div><div><h3>Method</h3><div>Databases were searched for Phase III trials evaluating stage IVB CC patients according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Systematic review included Phase III trials evaluating first-line treatment of stage IVB cervical cancer (CC). A meta-analysis was pursued for Phase III trials establishing standard of care treatment that included independent analyses of stage IVB, persistent, and recurrent CC.</div></div><div><h3>Results</h3><div>For the systematic review, 8 studies met inclusion criteria, with a total of 3,161 CC patients analyzed. Of these studies, three met criteria and included suitable data for meta-analysis – GOG 240, KEYNOTE-826, and BEATcc. Of the 1,479 women included in the meta-analysis, 289 (19.5 %) had stage IVB and 1,190 (80.5 %) had persistent or recurrent CC. HR of OS was 0.64 (95 % confidence interval (CI): 0.55–0.75) and 0.85 (95 % CI: 0.64–1.14) for persistent/recurrent and stage IVB CC, respectively. In the test of group differences, <em>p</em>-value was insignificant at 0.098.</div></div><div><h3>Conclusion</h3><div>While trials have assessed outcomes in stage IVB, persistent, and recurrent CC, new treatments demonstrate poorer PFS and OS for stage IVB compared to persistent and recurrent CC. The exact benefit for current standard of care for stage IVB CC could be better defined. Given that stage IVB CC has a different clinical course and treatment history compared to persistent and recurrent disease, stage IVB CC should be analyzed independently in future clinical trials.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 259-264"},"PeriodicalIF":4.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biobehavioral predictors of mood, pain, fatigue, and insomnia in endometrial cancer survivors","authors":"Elizabeth S. Ver Hoeve ,&nbsp;Meredith E. Rumble ,&nbsp;Jessica S. Gorzelitz ,&nbsp;Stephen L. Rose ,&nbsp;Ashley M. Nelson ,&nbsp;Keayra E. Morris ,&nbsp;Erin S. Costanzo","doi":"10.1016/j.ygyno.2024.10.024","DOIUrl":"10.1016/j.ygyno.2024.10.024","url":null,"abstract":"<div><h3>Objective</h3><div>Endometrial cancer survivors experience persistent health-related quality of life concerns, including pain, fatigue, and disrupted emotional and social functioning. The purpose of this longitudinal study was to evaluate associations between biobehavioral factors, including daytime physical activity, nighttime sleep, and 24-h circadian rest-activity rhythms, with psychological and physical symptoms following endometrial cancer surgery.</div></div><div><h3>Methods</h3><div>This study included 69 adult female patients undergoing surgery for endometrial cancer. At each of three assessment points (1, 4, and 16 weeks post-surgery), participants wore a wrist actigraph for 3 days and completed a sleep log and self-report measures of depression and anxiety (Inventory of Depression and Anxiety Symptoms), pain (Brief Pain Inventory), fatigue (Fatigue Symptom Inventory), and insomnia (Insomnia Severity Index). Physical activity, sleep, and 24-h rest-activity indices were derived from actigraphy. Mixed- and fixed-effects linear regression models were utilized to evaluate relationships between actigraphy indices and patient-reported outcomes.</div></div><div><h3>Results</h3><div>Clinically elevated fatigue persisted for a majority of participants (64 %), while a sizeable minority continued to report clinically elevated insomnia (41 %) and pain (19 %) at 16-weeks post-surgery. Participants who recorded less daytime activity, more disrupted sleep, and less consistent 24-h rest-activity rhythms by actigraphy reported more depression and anxiety symptoms and greater pain and fatigue. Within individual participants, at time points when activity was lowest, sleep most disrupted, and 24-h rest-activity rhythms least consistent, participants experienced more psychological and physical symptoms.</div></div><div><h3>Conclusions</h3><div>Findings suggest that disruptions in daytime physical activity, nighttime sleep, and 24-h rest-activity patterns contribute to patient-reported outcomes in the weeks and months after endometrial cancer treatment. Findings support modifiable intervention targets to address co-occurring physical and psychological symptoms and optimize health and recovery after endometrial cancer surgery.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 265-274"},"PeriodicalIF":4.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular classification in fertility-sparing treatment of early-stage endometrial cancer: A potential tool for optimizing patient selection","authors":"Shiyi Peng ,&nbsp;Ying Zheng ,&nbsp;Jianhong Liu ,&nbsp;Sijing Chen ,&nbsp;Kaixuan Yang ,&nbsp;Wei Wang ,&nbsp;Gang Ning ,&nbsp;Xiao Tang ,&nbsp;Lei Li ,&nbsp;Zhijun Ye ,&nbsp;Yunwei Ouyang ,&nbsp;Zhongying Huang ,&nbsp;Qianhong Ma ,&nbsp;Fan Yang ,&nbsp;Aiyun Xing ,&nbsp;Yuedong He ,&nbsp;Ping Wang ,&nbsp;Xiaoyun Yang ,&nbsp;Zhilan Peng","doi":"10.1016/j.ygyno.2024.10.012","DOIUrl":"10.1016/j.ygyno.2024.10.012","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the prognostic significance of molecular classification on treatment outcomes of fertility-sparing treatment (FST) in early-stage endometrial cancer (EC), and its potential in optimizing fertility-sparing management.</div></div><div><h3>Methods</h3><div>Patients with early-stage EC who received FST with ProMisE classification were investigated. Oncological and reproductive outcomes were compared across four molecular subtypes. Factors influencing complete response (CR) were analyzed.</div></div><div><h3>Results</h3><div>Among 116 molecularly classified patients, 80 were evaluated for therapeutic effects, including 64 (80.0 %) p53wt, 7 (8.7 %) MMR-D, 5 (6.3 %) POLE EDM, and 4 (5.0 %) p53abn. Overall CR rates were comparable across four molecular subtypes, with 92.2 % of p53wt, 71.4 % of MMR-D, 100.0 % of POLE EDM, and 75.0 % of p53abn (<em>P</em> = 0.145). MMR-D patients needed the longest median treatment time to achieve CR (7.9 months, range 3.5–15.9), while POLE EDM required the shortest (3.0 months, range 2.8–6.4), followed by p53abn (3.5 months, range 3.0–3.7) and p53wt (3.7 months, range 2.2–22.8) (<em>P</em> <em>=</em> 0.049). Among 14 p53wt patients with superficial myometrial invasion (MI) or G2 histology, 13 (92.9 %) achieved CR, and of 8 who attempted to conceive,4 delivered. Multivariable analysis identified MMR-D, superficial MI and insulin resistance negatively predicted CR, while POLE EDM was a positive factor.</div></div><div><h3>Conclusions</h3><div>Molecular classification of EC may serve as a tool for predicting response to FST and assist in identifying candidates for FST. POLE EDM patients tended to obtain promising outcomes. MMR-D cases should be cautiously administrated for FST with close surveillance. Patients with p53wt demonstrated favorable outcomes, including those with superficial MI or G2 EC. Patients with endometrium-confined p53abn tumors may benefit from FST. However, given the small sample sizes of certain subtypes, further investigation is necessary to validate these findings.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 240-248"},"PeriodicalIF":4.5,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and tolerability of mirvetuximab soravtansine monotherapy for folate receptor alpha–expressing recurrent ovarian cancer: An integrated safety summary","authors":"Kathleen N. Moore ,&nbsp;Domenica Lorusso ,&nbsp;Ana Oaknin ,&nbsp;Amit Oza ,&nbsp;Nicoletta Colombo ,&nbsp;Toon Van Gorp ,&nbsp;David M. O'Malley ,&nbsp;Susana Banerjee ,&nbsp;Conleth G. Murphy ,&nbsp;Philipp Harter ,&nbsp;Gottfried E. Konecny ,&nbsp;Patricia Pautier ,&nbsp;Michael Method ,&nbsp;Yuemei Wang ,&nbsp;Robert L. Coleman ,&nbsp;Michael Birrer ,&nbsp;Ursula A. Matulonis","doi":"10.1016/j.ygyno.2024.10.013","DOIUrl":"10.1016/j.ygyno.2024.10.013","url":null,"abstract":"<div><h3>Objective</h3><div>Mirvetuximab soravtansine-gynx (MIRV) is a novel antibody-drug conjugate targeting folate receptor alpha (FRα), which is overexpressed in epithelial ovarian cancer (EOC), with limited expression on normal tissues. This integrated safety summary sought to characterize the safety profile of MIRV monotherapy in participants with FRα-expressing recurrent EOC.</div></div><div><h3>Methods</h3><div>Safety data were retrospectively analyzed from 4 clinical studies (phase 1 trial [<span><span>NCT01609556</span><svg><path></path></svg></span>], phase 3 FORWARD I [<span><span>NCT02631876</span><svg><path></path></svg></span>], phase 2 SORAYA [<span><span>NCT04296890</span><svg><path></path></svg></span>], phase 3 MIRASOL [<span><span>NCT04209855</span><svg><path></path></svg></span>]) that evaluated participants with FRα-expressing recurrent EOC who received ≥1 dose of MIRV 6 mg/kg adjusted ideal body weight every 3 weeks.</div></div><div><h3>Results</h3><div>In this analysis of 682 participants, 94 % had platinum-resistant ovarian cancer (PROC). Blurred vision (43 %), nausea (41 %), diarrhea (39 %), and fatigue (35 %) were the most common treatment-emergent adverse events (TEAEs) and were primarily grade 1–2 in severity. Grade ≥ 3 TEAEs occurred in 48 % of participants, with the most common being keratopathy and blurred vision (5 % each). Most TEAEs were managed with supportive care and dose modifications, and only 12 % of participants experienced a TEAE leading to discontinuation (1 % due to ocular events). No corneal ulcerations or perforations have been reported. Median time to onset of blurred vision and keratopathy was 5.9 and 6.7 weeks, respectively. Most blurred vision events and keratopathy events resolved completely (71 % and 66 %, respectively) or partially (15 % and 14 %, respectively).</div></div><div><h3>Conclusions</h3><div>As demonstrated among 682 participants, the safety profile of MIRV is well tolerated and consists primarily of low-grade gastrointestinal, fatigue, headache, peripheral neuropathy, and resolvable ocular adverse events.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 249-258"},"PeriodicalIF":4.5,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase II clinical trial assessing the efficacy of enzalutamide in advanced non-resectable granulosa cell ovarian tumors: The GREKO III study (GETHI2016–01)","authors":"Jesus García-Donas ,&nbsp;Andres Redondo ,&nbsp;Ana Santaballa ,&nbsp;Laia Garrigos ,&nbsp;Mª. Jesus Rubio ,&nbsp;Nuria Lainez ,&nbsp;María Iglesias González ,&nbsp;Juan Fernando Cueva ,&nbsp;Arantzazu Barquin ,&nbsp;Tatiana P. Grazioso ,&nbsp;Alicia Hurtado ,&nbsp;Elena Sevillano ,&nbsp;Enrique Grande ,&nbsp;Juan Francisco Rodriguez-Moreno ,&nbsp;Paloma Navarro","doi":"10.1016/j.ygyno.2024.10.019","DOIUrl":"10.1016/j.ygyno.2024.10.019","url":null,"abstract":"<div><h3>Background</h3><div>Granulosa cell ovarian tumors (GCT) are orphan disease with limited treatments. Hormone therapy is a potential treatment, due to the overexpression of hormone receptors in most tumors. This study explores the activity of the antiandrogen, enzalutamide, in metastatic cases.</div></div><div><h3>Methods</h3><div>We designed a phase II clinical trial under the Spanish Collaborative Group for Transversal Oncology and Rare and Orphan Tumors (GETTHI). Eligible participants were adult women with advanced GCT. Primary endpoint was objective response rate. Secondary endpoints included clinical benefit rate, progression-free survival, overall survival, and safety profile. Patients received enzalutamide 160 mg once daily.</div></div><div><h3>Results</h3><div>From April 2018 to March 2020, eighteen patients were screened, and sixteen were included across nine institutions. Median age was 56.4 years (range 45–71), and most were Caucasian (14 cases), one Arabian and one Latin. ECOG performance status was zero in 13 cases (81 %) and one in three (19 %). Six patients (38 %) had previously received hormone therapy as adjuvant treatment or for advanced disease, and 15 (94 %) chemotherapy. Median time from metastasis to study entry was 96 months (range 4.5–198).</div><div>No objective response was observed, but the clinical benefit rate reached 68.8 % (95 % CI [46 %–91.5 %]). Median progression-free survival was 3.8 months (95 % CI [1.36–6.14]). Median overall survival was not reached, with a median follow-up of 6 months (range 2.2–19).</div><div>At the time of database closure, 14 patients had discontinued treatment, 13 due to disease progression and one by personal choice. Two deaths attributed to disease progression were recorded.</div><div>Five grade 3 adverse events were reported, with only one (asthenia) deemed related to the therapy.</div></div><div><h3>Conclusions</h3><div>Although enzalutamide demonstrated modest activity in GCT, durable stabilization was observed in some cases.</div><div><em>Trial Registration:</em> <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT03464201</span><svg><path></path></svg></span></div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 233-239"},"PeriodicalIF":4.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in brachytherapy in utilization for vaginal cancer in the United States from 2004 to 2021","authors":"Darien Colson-Fearon,&nbsp;Akila N. Viswanathan","doi":"10.1016/j.ygyno.2024.10.014","DOIUrl":"10.1016/j.ygyno.2024.10.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy (BT) is recommended for vaginal cancer treatment, particularly cases of bulky and/or recurrent disease. However, previous studies noted a decline in utilization rates. This study examines recent trends in BT utilization to assess for reversal in trends.</div></div><div><h3>Material and methods</h3><div>This study analyzed the National Cancer Database (NCDB) of patients with FIGO stage I to IVA vaginal cancer treated between 2004 and 2021. A log binomial regression with robust variance was used to estimate incidence rate ratios (IRRs) of BT utilization over time and identify potential factors associated with receipt.</div></div><div><h3>Results</h3><div>Brachytherapy use increased from 48.0 % in 2004 to 63.3 % in 2021. Factors associated with increased brachytherapy use included, receiving care at an academic/research program (IRR: 1.35 95 % CI: 1.18–1.55), integrated cancer program (1.22 [1.06–1.41]), and diagnosis after 2018 (1.31 [1.21–1.42]). Factors associated with decreased use included American Indian or Alaskan Native race (0.55 [0.31–0.97]) when compared to white race, age over 70 (≥ 70–79 years: 0.91 [0.83–0.99]; ≥ 80 years: 0.68 [0.61–0.76]) when compared to age less than 50, and stage II (0.91 [0.86–0.96]), III (0.71 [0.67–0.75]), or IVA (0.43 [0.37–0.50]) disease when compared to stage I. Finally, geographic differences were also observed in BT use.</div></div><div><h3>Conclusions</h3><div>In patients with stage I – IVA vaginal cancer from 2004 to 2021, brachytherapy utilization has significantly increased. These results indicate a recent start of the reversal of previously identified declining use of brachytherapy. However, more work is needed to ensure equitable use across demographic strata.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 228-232"},"PeriodicalIF":4.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant therapy de-escalation for stage I uterine leiomyosarcoma: A systematic review and meta-analysis","authors":"Yoshikazu Nagase ,&nbsp;Koji Matsuo ,&nbsp;Yumi Nakao ,&nbsp;Tsuyoshi Hisa ,&nbsp;Shoji Kamiura ,&nbsp;Takeshi Yokoi ,&nbsp;Lynda D. Roman ,&nbsp;Jason D. Wright ,&nbsp;Shinya Matsuzaki","doi":"10.1016/j.ygyno.2024.10.018","DOIUrl":"10.1016/j.ygyno.2024.10.018","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between adjuvant chemotherapy and survival outcomes in patients with stage I uterine leiomyosarcoma (uLMS).</div></div><div><h3>Methods</h3><div>This comprehensive systematic review and meta-analysis through December 31, 2023 (PROSPERO registration number: CRD42024504776) investigated studies that examined survival outcomes in patients with stage I uLMS using 4 public search engines (PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials). Two investigators searched the studies independently, and survival outcomes (overall survival [OS] and disease-free survival [DFS]) were compared between the adjuvant chemotherapy and observation groups. Utilization rate of adjuvant chemotherapy and the regimens used were also assessed. Kaplan-Meier survival curves in the two treatment groups were evaluated using ImageJ software.</div></div><div><h3>Results</h3><div>From 1988 to 2022, 16 eligible studies including a total of 5690 patients met the inclusion criteria and evaluated the effect of adjuvant chemotherapy on survival outcomes in patients with stage I uLMS. Adjuvant chemotherapy was utilized in 38.5 % of patients (range, 14.8 % to 70.0 %). Eight studies from 2017 to 2022 compared the survival outcomes between adjuvant chemotherapy and observation. OS was comparable between the two groups in both unadjusted (<em>n</em> = 6, hazard ratio [HR] 1.02, 95 % confidence interval [CI] 0.77–1.35, <em>P =</em> 0.88) and adjusted (<em>n</em> = 4, HR 0.90, 95 %CI 0.56–1.43, <em>P =</em> 0.65) pooled analyses. DFS was also similar between adjuvant chemotherapy and observation in both unadjusted (<em>n</em> = 4, HR 0.78, 95 %CI 0.53–1.13, <em>P =</em> 0.18) and adjusted (<em>n</em> = 2, HR 1.14, 95 %CI 0.67–1.94, <em>P =</em> 0.64) pooled analyses. Adjuvant chemotherapy regimens utilized included doxorubicin, ifosfamide, cisplatin, gemcitabine, and docetaxel as monotherapies or combination therapies.</div></div><div><h3>Conclusions</h3><div>In this contemporaneous systematic review and meta-analysis, less than 40 % of patients received adjuvant chemotherapy for stage I uLMS and adjuvant chemotherapy which was not associated with improved survival. These results support the current National Comprehensive Cancer Network clinical practice guidelines that recommends de-escalating adjuvant chemotherapy in stage I uLMS after complete resection.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 219-227"},"PeriodicalIF":4.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What happens after menopause? (WHAM): A prospective controlled study of vasomotor symptoms and menopause-related quality of life 24 months after premenopausal risk-reducing salpingo-oophorectomy (RRSO)","authors":"Martha Hickey ,&nbsp;Alison H. Trainer ,&nbsp;Efrosinia O. Krejany ,&nbsp;Alison Brand ,&nbsp;Susan M. Domchek ,&nbsp;Vanessa Pac Soo ,&nbsp;Sabine Braat ,&nbsp;Gita D. Mishra","doi":"10.1016/j.ygyno.2024.10.007","DOIUrl":"10.1016/j.ygyno.2024.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>To measure vasomotor symptoms and menopause-related quality of life up to 24 months after RRSO, and the effects of Menopausal Hormone Therapy (MHT).</div></div><div><h3>Methods</h3><div>Prospective observational study of 104 premenopausal women at elevated risk of ovarian cancer planning RRSO and age-matched comparators (<em>n</em> = 102) who retained their ovaries. Vasomotor symptoms and quality of life were measured using the Menopause-specific QoL Intervention (MENQOL-I) scale. Changes in QoL were examined using a population-averaged linear regression model. The study was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12615000082505.</div></div><div><h3>Results</h3><div>At 24 months after RRSO the prevalence of vasomotor symptoms had increased from 6 % at baseline to 59 % and night sweats from 21 % to 39 %. There was a clinically and statistically significant difference of 1.14 points in MENQOL score (95 % CI 0.71, 1.57, <em>p</em> &lt; 0.001) in the change from baseline to 24 months in vasomotor symptoms between the RRSO vs comparison group. Following RRSO, 61 % started MHT, most (79 %) within 3 months. At 24 months, 54 % of MHT users reported vasomotor symptoms of which around half (52 %) categorized these as “mild”. Amongst non-MHT users, 88 % reported vasomotor symptoms at 24 months of which 72 % categorized these as “mild”. Menopause-related QoL decreased after RRSO but was stable in comparators. Menopause related quality of life was higher in MHT users vs non-users.</div></div><div><h3>Conclusions</h3><div>Vasomotor symptoms peak by 3 months after RRSO and are stable over 24 months. MHT mitigates but does not fully resolve vasomotor symptoms and improves menopause-related QoL.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 201-211"},"PeriodicalIF":4.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}