Gynecologic oncology最新文献

{"title":"Hormonal biomarkers remain prognostically relevant within the molecular subgroups in endometrial cancer","authors":"Stephanie W. Vrede ,&nbsp;Willem Jan Van Weelden ,&nbsp;Johan Bulten ,&nbsp;C. Blake Gilks ,&nbsp;Steven Teerenstra ,&nbsp;Jutta Huvila ,&nbsp;Xavier Matias-Guiu ,&nbsp;Antonio Gil-Moreno ,&nbsp;Jasmin Asberger ,&nbsp;Sanne Sweegers ,&nbsp;Louis J.M. van der Putten ,&nbsp;Heidi V.N. Küsters-Vandevelde ,&nbsp;Casper Reijnen ,&nbsp;Eva Colas ,&nbsp;Jitka Hausnerová ,&nbsp;Vit Weinberger ,&nbsp;Marc P.L.M. Snijders ,&nbsp;Petra Vinklerova ,&nbsp;Antonella Ravaggi ,&nbsp;Franco Odicino ,&nbsp;Johanna M.A. Pijnenborg","doi":"10.1016/j.ygyno.2024.10.028","DOIUrl":"10.1016/j.ygyno.2024.10.028","url":null,"abstract":"<div><h3>Objective</h3><div>The prognostic relevance of hormonal biomarkers in endometrial cancer (EC) has been well-established. A refined three-tiered risk model for estrogen receptor (ER)/progesterone receptor (PR) expression was shown to improve prognostication. This has not been evaluated in relation to the molecular subgroups. This study aimed to evaluate the ER/PR expression within the molecular subgroups in EC.</div></div><div><h3>Methods</h3><div>A retrospective multicenter cohort study was performed and data from the European Network for Individualized Treatment centers and Vancouver, Canada were used. ER/PR immunohistochemical expression was grouped as: ER/PR 0–10 %, 20–80 % or 90–100 %. Molecular subgroups were determined with full next-generation sequencing or combined with immunohistochemistry: <em>POLE</em>mut, mismatch repair deficient (MMRd), p53mut and no-specific molecular profile (NSMP).</div></div><div><h3>Results</h3><div>A total of 739 patients were included (median follow-up 5.0 years). Tumors were classified as <em>POLE</em>mut in 9.1 %(<em>N</em> = 67), MMRd in 27.6 %(<em>N</em> = 204), p53mut in 20.8 %(<em>N</em> = 154) and NSMP in 42.5 %(<em>N</em> = 314). Among all molecular subgroups, patients with ER/PR 90–100 % expression revealed the best disease-specific survival (DSS). Within p53mut, PR 90–100 % expression showed a 5-year DSS of 100.0 %. ER expression is prognostic more relevant in MMRd and NSMP tumors while PR expression in p53mut and NSMP tumors. Across all molecular subgroups, PR 0–10 %, p53mut, lympho-vascular space invasion and FIGO stage III-IV remained independently prognostic for reduced DSS Whereas PR 90–100 % and <em>POLE</em>mut remained independently prognostic for improved DSS.</div></div><div><h3>Conclusion</h3><div>We demonstrated that ER/PR expression remain prognostically relevant within the molecular subgroups, and that a three-tiered cutoff refines prognostication. These data support incorporating routine evaluation of ER/PR expression in clinical practice.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"192 ","pages":"Pages 15-23"},"PeriodicalIF":4.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603315","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":"Evolutionary pathways in early-stage, non-myoinvasive endometrioid endometrial cancers of no specific molecular profile","authors":"Sara Moufarrij ,&nbsp;Yulia Lakhman ,&nbsp;Carol Aghajanian ,&nbsp;Nadeem R. Abu-Rustum ,&nbsp;Lora H. Ellenson ,&nbsp;Britta Weigelt ,&nbsp;Amir Momeni-Boroujeni","doi":"10.1016/j.ygyno.2024.10.029","DOIUrl":"10.1016/j.ygyno.2024.10.029","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the genomic landscape of FIGO 2009 stage IA, non-myometrial invasive endometrioid endometrial cancers (ECs) of no specific molecular profile (NSMP) and define the earliest driver genetic alterations and subsequent tumor evolution.</div></div><div><h3>Methods</h3><div>Early-stage (FIGO 2009 stage IA), non-myoinvasive endometrioid NSMP ECs subjected to clinical tumor-normal targeted sequencing between 2014 and 2022 were identified. ECs were dichotomized into low- and high-volume disease based on gross and histologic measurement using a cutoff of 1.8 cm³. Cancer cell fractions (CCF) of somatic mutations were determined.</div></div><div><h3>Results</h3><div>A total of 171 noninvasive, FIGO 2009 stage I endometrioid ECs of NSMP subtype were identified, of which the majority (<em>n</em> = 139; 81 %) were FIGO grade 1. The median calculated volume of disease was 1.8 cm³ at diagnosis. The ECs had on average 6 pathogenic mutations, affecting known EC cancer-related genes, including <em>PTEN</em> (80 %), <em>ARID1A</em> (52 %), <em>PIK3CA</em> (52 %), <em>CTNNB1</em> (39 %), <em>PIK3R1</em> (37 %), and <em>KRAS</em> (29 %). Genomic alterations did not correlate with tumor volume. <em>PTEN</em> mutations had the highest CCFs. Unsupervised hierarchical clustering based on CCF revealed 4 main groups characterized by: 1. clonal alterations in <em>PTEN</em> accompanied by <em>PIK3CA, PIK3R1,</em> or <em>ARID1A</em> alterations, 2. mutations in <em>PIK3CA</em> co-occurring with <em>ARID1A</em> alterations, 3. <em>KRAS</em> mutations, particularly associated with 1q high-level gain, or 4. <em>AKT1</em> mutations, which uniquely occurred without concurrent <em>PTEN</em>, <em>PIK3CA</em>, or <em>PIK3R1</em> alterations.</div></div><div><h3>Conclusion</h3><div>Stage IA non-myoinvasive NSMP ECs show genomic heterogeneity suggestive of multiple evolutionary pathways. Further studies are warranted to define whether this is a sign of early genomic drift.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"192 ","pages":"Pages 8-14"},"PeriodicalIF":4.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593098","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): Impact of risk-reducing salpingo-oophorectomy on depressive and anxiety symptoms at 24 months","authors":"Martha Hickey ,&nbsp;Tuong L. Nguyen ,&nbsp;Efrosinia O. Krejany ,&nbsp;Susan M. Domchek ,&nbsp;Alison Brand ,&nbsp;John L. Hopper ,&nbsp;Hadine Joffe","doi":"10.1016/j.ygyno.2024.10.031","DOIUrl":"10.1016/j.ygyno.2024.10.031","url":null,"abstract":"<div><h3>Objective</h3><div>For women with pathogenic variants in <em>BRCA1</em> and <em>BRCA2,</em> risk-reducing salpingo-oophorectomy (RRSO) at the recommended age causes surgical menopause. We previously reported elevated depressive symptoms at 6 and 12 months and elevated anxiety symptoms at 6 months after RRSO. We now report these outcomes at 24 months, their baseline and 12-month predictors and the effect of Menopausal Hormone Therapy (MHT).</div></div><div><h3>Methods</h3><div>Prospective controlled study of 59 premenopausal women planning RRSO and 91 comparisons who retained their ovaries. Depressive (CES<img>D) and anxiety symptoms (GAD-7) were measured at baseline (before RRSO) and at 12 and 24 months. We used ordinary and logistic multivariable regression to estimate differences between and within groups at 24 months, before and after conditioning on baseline and 12 month measures.</div></div><div><h3>Results</h3><div>Overall, depressive and anxiety symptoms were not elevated above baseline at 24 months and did not differ between RRSO and comparisons, before or after adjusting for previous measures (<em>P</em> &gt; 0.05). Elevated depressive symptoms at 12 months (OR = 24, <em>P</em> &lt; 0.001), and elevated anxiety symptoms at 12 months (OR = 13, <em>P</em> &lt; 0.001), strongly predicted 24 month measures. Elevated depressive symptoms at baseline no longer predicted 24 month symptoms once 12 month symptoms were considered, but elevated baseline anxiety still predicted anxiety at 24 months, even when 12 month anxiety was considered. No association between MHT use and depressive or anxiety symptoms was observed.</div></div><div><h3>Conclusions</h3><div>Depressive and anxiety symptoms are not elevated 24 months after RRSO. However, depressive symptoms at 12 months after RRSO are likely to persist at 24 months.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"192 ","pages":"Pages 1-7"},"PeriodicalIF":4.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590165","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":"KRAS mutations in endometrial cancers: Possible prognostic and treatment implications","authors":"Karolina A. Kilowski ,&nbsp;Martin F. Dietrich ,&nbsp;Joanne Xiu ,&nbsp;Yasmine Baca ,&nbsp;Andrew Hinton ,&nbsp;Sarfraz Ahmad ,&nbsp;Thomas J. Herzog ,&nbsp;Premal Thaker ,&nbsp;Robert W. Holloway","doi":"10.1016/j.ygyno.2024.10.026","DOIUrl":"10.1016/j.ygyno.2024.10.026","url":null,"abstract":"<div><h3>Background/Objectives</h3><div>Patients with recurrent or metastatic endometrial cancer (EC) have poor prognoses with limited therapeutic options following immunotherapy or immunochemotherapy treatments. Inhibitors of KRAS mutations (KRAS-mut) have shown efficacy in early solid tumor studies, but data in EC are lacking. This study describes the frequency of KRAS-mut relative to other oncogenic alterations in EC to identify genomic characteristics of KRAS-mut tumors that could lead to novel therapeutic options.</div></div><div><h3>Methods</h3><div>A molecular database of 7870 ECs was queried for presence of oncogenic mutations and immunotherapy biomarkers. Comparisons were performed using Fisher-Exact/ChiSquare (<em>p</em>-values) and adjusted for multiple tests by Benjamini-Hochberg (q) and pairwise nonparametric analysis using Wilcoxon Method.</div></div><div><h3>Results</h3><div><em>KRAS-</em>mut is a relatively frequent genotype in EC, detected in 16% of cases. Codon 12 was most frequently mutated, with G12D (31%) and G12V (27%) the most common subtypes. Biomarkers of immunotherapy response co-occur with <em>KRAS-</em>mut. Microsatellite instability-high and tumor mutational burden-high status were observed in 34.1% and 36.5% in <em>KRAS-</em>mut compared to 19.8% and 16.9% in <em>KRAS-</em>WT, respectively (<em>p</em> &lt; 0.05). PD-L1 &gt;1% was detected in 8.4% vs 6.4% of KRAS-mut vs KRAS-WT (<em>p</em> &lt; 0.05). <em>BRCA1/2</em> mutations were detected with similar low frequency (5.9% vs 4.9%) among <em>KRAS-</em>mut and <em>KRAS-</em>WT ECs (<em>p</em> &gt; 0.05). KRAS-mut was inversely associated with Her-2 overexpression (1.8% KRAS-mut vs 13% KRAS-WT. (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div><em>KRAS-</em>mut represents a genotypically distinct group of ECs. Overlap exists with genomic predictors (TMB-high, MSI-high) of immunotherapy response, suggesting a possible biomarker-driven combination option with immunotherapy. Clinical trials to evaluate these strategies should be developed.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 299-306"},"PeriodicalIF":4.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582371","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":"Disparities in ovarian cancer survival among ethnic Asian American populations, 2006–2020","authors":"Alice W. Lee ,&nbsp;Valerie Poynor ,&nbsp;Sannia Siddiqui","doi":"10.1016/j.ygyno.2024.10.017","DOIUrl":"10.1016/j.ygyno.2024.10.017","url":null,"abstract":"<div><h3>Background</h3><div>Asian Americans have the highest ovarian cancer survival across the major racial groups although it is unclear whether this survival advantage is observed when each Asian ethnic subgroup is examined separately. Disaggregated survival analyses of this heterogeneous population is needed to ensure ethnic-specific disparities are not overlooked.</div></div><div><h3>Methods</h3><div>Data on ovarian cancer cases diagnosed from 2006 through 2020 from the Surveillance, Epidemiology, and End Results (SEER) Program were analyzed. Age-standardized five-year cause-specific survival was calculated for Non-Hispanic Whites and seven Asian ethnic subgroups in the U.S. (Asian Indian/Pakistani, Chinese, Filipino, Hawaiian/Pacific Islander, Japanese, Korean, Vietnamese) by stage and histotype. Multivariable Cox regression analyses using a weighted approach were conducted to calculate average hazard ratios (AHRs) and 95 % confidence intervals (CIs) to quantify the risk of ovarian cancer death comparing each Asian ethnic subgroup to Non-Hispanic Whites.</div></div><div><h3>Results</h3><div>Hawaiian/Pacific Islanders were the only Asian subgroup to show lower five-year cause-specific survival than Non-Hispanic Whites (44.99 % versus 47.90 %, respectively); Asian Indian/Pakistanis showed the highest survival (56.12 %). After adjusting for sociodemographic, tumor, and treatment characteristics, Asian Indian/Pakistani ovarian cancer patients were 17 % less likely to die from their disease whereas Hawaiian/Pacific Islander patients were 28 % more likely to die when compared to Non-Hispanic Whites (AHR = 0.83, 95 % CI 0.75–0.92 and AHR = 1.28, 95 % CI 1.07–1.53, respectively).</div></div><div><h3>Conclusions</h3><div>There are clear ethnic-specific survival disparities among Asian American ovarian cancer patients that are missed when the population is examined as a single group, further highlighting the need for data disaggregation in future ovarian cancer research.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 292-298"},"PeriodicalIF":4.5,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567829","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":"Too much of a good thing? Projecting the need for gynecologic oncologists over the next 20 years","authors":"Teresa K.L. Boitano ,&nbsp;Stephanie V. Blank ,&nbsp;Laura J. Havrilesky ,&nbsp;Warner K. Huh ,&nbsp;Evan R. Myers","doi":"10.1016/j.ygyno.2024.10.027","DOIUrl":"10.1016/j.ygyno.2024.10.027","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the effect of growth in gynecologic oncology fellowships in the United States on surgical volume for trainees and practicing gynecologic oncologists over the next 20 years.</div></div><div><h3>Methods</h3><div>Using 2010–2019 age-specific gynecologic cancer incidence estimates from US Cancer Statistics, significant changes in incidence were identified with Joinpoint software. Statistically significant changes in annual rates were projected forward five years, and these estimates were used to generate projections of cancer cases in the population from the U.S. The number of practicing gynecologic oncologists was projected through 2045 based on current fellowship enrollment. For sensitivity analysis, we varied the number of new fellows and fellowships based on data trends from the last five years.</div></div><div><h3>Results</h3><div>Over the next 20 years, cancer cases will increase by 14 % with the majority being endometrial. With current trainee numbers, the average annual number of new surgical cancer patients per practicing gynecologic oncologist will decrease from 73 to 51 (30 % decrease). An increase of one fellow per year nationally to the total number of trainees will further decrease new surgical cancer cases to 43 cases/gynecologic oncologist annually (41 % decrease). When accounting for one additionally trainee nationally per year over the next 20 years, the average number of oncologic surgical cases per fellow/year will decrease from 208 to 160 (23 % decrease). Under the assumption of no additional fellowship positions, surgical cases will increase from 208 to 226 per fellow/year (9 % increase).</div></div><div><h3>Conclusion</h3><div>The gynecologic cancer caseload of practicing gynecologic oncologists is estimated to decrease by nearly 41 % and trainee case volume will drop by 23 % over the next 20 years with minimal continued addition of training positions. Careful consideration should be given to creating an appropriate balance between the number of practicing gynecologic oncologists, potential dilution of programs' case volume per trainee, and the effects on the needs of future patients.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 287-291"},"PeriodicalIF":4.5,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567752","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":"Efficacy and safety of minimally invasive surgery versus open laparotomy for epithelial ovarian cancer: A systematic review and meta-analysis.","authors":"Akira Yokoi, Hiroko Machida, Muneaki Shimada, Koji Matsuo, Shogo Shigeta, Shigenori Furukawa, Nobumichi Nishikawa, Hiroyuki Nomura, Kensuke Hori, Hideki Tokunaga, Tadahiro Shoji, Tsukasa Baba, Satoru Nagase","doi":"10.1016/j.ygyno.2024.08.011","DOIUrl":"10.1016/j.ygyno.2024.08.011","url":null,"abstract":"<p><strong>Objective: </strong>To examine the efficacy and safety of minimally invasive surgery (MIS) and conventional abdominal surgery for epithelial ovarian cancer (EOC), stratified by treatment type.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Ovarian Cancer Committee. Several academic databases, including PubMed/MEDLINE, Cochrane Database, and Ichushi were searched by the Japan Medical Library Association on November 11, 2023, using the keywords \"epithelial ovarian cancer\", \"minimally invasive surgery\", \"laparoscopic\", and \"robot-assisted\". Articles describing MIS treatment for EOC compared with conventional abdominal surgery were independently assessed by two authors. The primary outcomes were survival and perioperative adverse events.</p><p><strong>Results: </strong>After screening 1114 studies, 35 articles were identified, including primary staging surgery (PSS) for early-stage EOC EOC (n = 20) and neoadjuvant chemotherapy following interval debulking surgery (NACT-IDS; n = 10) and upfront primary debulking surgery (PDS; n = 5) for advanced-stage EOC. These studies included 29,888 patients (7661 undergoing MIS and 22,227 undergoing abdominal surgery). Patients receiving MIS and abdominal surgery had similar overall survival (PSS: odds ratio [OR] 1.02, 95% confidence interval [CI] 0.75-1.37; NACT-IDS: OR 0.93, 95%CI 0.25-3.44 and PDS: OR 0.66, 95%CI 0.36-1.22, all P > 0.05). MIS showed perioperative complication rates comparable to those of abdominal surgery (intraoperative and postoperative, all treatment types P ≥ 0.05). However, the rate of lymph node dissection in early-stage EOC (PSS: OR 0.49, 95%CI0.26-0.91) and multivisceral resections in advanced-stage EOC (NACT-IDS: OR 0.27 95%CI 0.16-0.44 and PDS: OR 0.27, 95%CI 0.16-0.44) was lower in MIS than in abdominal surgery (all P < 0.05).</p><p><strong>Conclusion: </strong>MIS did not negatively impact the survival and perioperative complications of patients with EOC compared to abdominal surgery. While MIS is a viable option, varied case selection and surgical procedures suggest potential bias, requiring further validation studies.</p>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"190 ","pages":"42-52"},"PeriodicalIF":4.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982126","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":"Hormonal maintenance therapy for advance low grade serous ovarian carcinoma appears to be of benefit – That's a relief!","authors":"Jubilee Brown M.D.","doi":"10.1016/j.ygyno.2024.10.025","DOIUrl":"10.1016/j.ygyno.2024.10.025","url":null,"abstract":"","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"190 ","pages":"Pages A1-A2"},"PeriodicalIF":4.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618755","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":"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}