International Journal of Gynecological Cancer最新文献

{"title":"From genetic testing to prevention: an integrated clinical pathway for hereditary risk assessment in tubo-ovarian cancer.","authors":"David Viveros-Carreño, Nathalia Mora-Soto, Isabel Beshar, Nuria Agustí, Lucía Martínez-Cruz, Andreina Fernandes, Alessandro Buda, Alejandro Rauh-Hain, René Pareja","doi":"10.1016/j.ijgc.2026.104898","DOIUrl":"10.1016/j.ijgc.2026.104898","url":null,"abstract":"<p><p>Hereditary tubo-ovarian cancer risk assessment has evolved from a BRCA1/2-centered consultation to an integrated prevention pathway that begins at diagnosis and extends to unaffected relatives. Germline testing is now justified for patients with epithelial tubo-ovarian cancer because actionable pathogenic variants are common enough that family-history-only referral misses many carriers. The central clinical challenge is no longer whether testing matters, but whether testing is interpreted and implemented in a way that prevents cancer. BRCA1 and BRCA2 remain the highest-impact tubo-ovarian cancer predisposition genes, but Lynch syndrome genes, BRIP1, RAD51C, RAD51D, PALB2, and selected rare histology-directed syndromes require distinct counseling. Gene-specific penetrance, age-specific risk, family history, comorbidities, reproductive plans, and menopause consequences should shape the timing of risk-reducing surgery. Tumor testing improves therapeutic selection and can identify possible hereditary variants, but tumor-only testing does not replace germline testing when hereditary evaluation is indicated. Cascade testing should be measured and resourced as part of tubo-ovarian cancer care rather than treated as a passive family responsibility. Mainstream testing, traceback programs, and navigation-supported cascade testing offer pragmatic implementation models, but access gaps remain. For gynecologic oncology clinicians, modern hereditary risk assessment should be understood as a multi-disciplinary prevention intervention: testing is the entry point, not the endpoint. This narrative review synthesizes gene-specific counseling, tumor-germline interpretation, and implementation strategies into a clinically oriented pathway from diagnosis to prevention for patients and relatives.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104898"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792899","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":"FIGO/IGCS Statement on the efficacy of topical treatments for high-risk human papillomavirus in preventing CIN 3+ lesions.","authors":"René Pareja, Fernando Heredia, Emmanuel Sánchez-Díaz, Mauricio A Cuello, Silvia de Sanjosé, José Jerónimo, Suzanne M Garland, Marta Del Pino, Angélica Fletcher, Aureli Torné, Gabriel Levin, Lisa Flowers, Munachiso Iheme Ndukwe, Lina María Trujillo, Sarikapan Wilailak, Neerja Bhatla, Christina Fotopoulou, Barbara Schmalfeldt, Gloria Inés Sánchez, Maria Kyrgiou, Patrick Petignat, Nadeem Abu-Rustum","doi":"10.1016/j.ijgc.2026.104946","DOIUrl":"10.1016/j.ijgc.2026.104946","url":null,"abstract":"<p><p>Cervical cancer is caused by persistent high-risk human papillomavirus (HR-HPV) infection and remains a major global health burden despite available preventive strategies. Most HR-HPV infections and associated low-grade squamous intraepithelial lesions (LSIL) regress spontaneously, yet increasing commercial promotion of topical therapies targeting HPV clearance has emerged in clinical practice. This FIGO/International Gynecologic Cancer Society (IGCS) Position Statement critically appraises the available evidence on topical treatments for HR-HPV infection and LSIL, and provides evidence-based recommendations for clinical practice and future research. No randomized controlled trial has been adequately designed or powered to evaluate the effect of topical therapies on the prevention of histologically confirmed high-grade squamous intraepithelial lesions (HSIL/CIN3+). Available studies are characterized by small sample sizes, short follow-up periods, heterogeneous populations, inadequate comparators, and reliance on surrogate endpoints of uncertain clinical relevance, including cytological regression, HPV nondetection, and immunohistochemical markers such as p16/Ki-67. Published meta-analyses reporting statistically significant improvements in virological and cytological surrogates are limited by substantial heterogeneity, publication bias, and follow-up periods under 1 year. Product-specific appraisal of Coriolus versicolor-based and silicon dioxide/selenite-based vaginal gels reveal additional methodological concerns, including retrospective trial registration, industry funding, and misinterpretation of findings consistent with the spin phenomenon. In the absence of high-quality evidence demonstrating clinically meaningful benefit, FIGO and IGCS do not endorse the routine clinical use of any currently available topical agent for HR-HPV infection or LSIL. Evidence-based surveillance remains the standard of care. Future research should prioritize rigorous trial design with histologically confirmed HSIL/CIN3+ as the primary endpoint, adequate follow-up of at least 3 years, and appropriate comparators. Clinical management should center on informed shared decision-making and evidence-based counseling, rather than on interventions lacking proven clinical benefit.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104946"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874045","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":"Cadonilimab for recurrent small cell neuroendocrine carcinoma of the cervix: a phase 2 study.","authors":"Helen D Clark, Michael Frumovitz, Kelly M Rangel, Zhouxuan Li, Ying Yuan, Shannon N Westin, Amir A Jazaeri, Larissa A Meyer, Travis T Sims","doi":"10.1016/j.ijgc.2026.104860","DOIUrl":"10.1016/j.ijgc.2026.104860","url":null,"abstract":"<p><strong>Objective: </strong>Small cell neuroendocrine carcinoma is a rare, aggressive histologic sub-type of cervical cancer. Although a standard frontline regimen exists, no standard highly active agent is available for recurrent disease. Single-agent anti-programmed cell death 1 therapy has also failed to demonstrate efficacy in this population; however, dual immune checkpoint blockade of programmed cell death 1 and cytotoxic T-lymphocyte-associated protein 4 has shown promising activity in high-grade neuroendocrine neoplasms. Data specific to recurrent small cell neuroendocrine cervical cancer remain sparse. We examined the safety and efficacy of cadonilimab, a bispecific antibody targeting programmed cell death 1 and cytotoxic T-lymphocyte-associated protein 4, in recurrent or metastatic small cell neuroendocrine cervical cancer.</p><p><strong>Methods: </strong>This was a phase 2, open-label, single-arm study of cadonilimab monotherapy in patients with recurrent or metastatic high-grade small cell neuroendocrine cervical cancer. Eligible patients received 6 mg/kg of cadonilimab on days 1 and 15 of each 28-day treatment cycle for up to 24 months. The primary objective was to estimate the 6-month progression-free survival probability using Kaplan-Meier analysis. Progression-free survival was defined as the time from treatment initiation to disease progression or death from any cause.</p><p><strong>Results: </strong>Among 9 patients who initiated treatment, 8 were evaluable for efficacy. One patient remained progression-free at 6 months (probability 0.125, 95% confidence interval 0.02 to 0.78). The median progression-free survival for the efficacy cohort was 2.19 months (95% confidence interval 1.84 to not available). The objective response rate was 0% (95% confidence interval 0% to 37%). Two patients experienced stable disease lasting 9.4 and 16.2 weeks, resulting in a disease control rate of 25% (2/8; 95% confidence interval 3% to 65%). One patient (1/9, 11%) experienced grade 3 fatigue. No grade 4 or 5 adverse events occurred.</p><p><strong>Conclusions: </strong>Cadonilimab monotherapy for recurrent or metastatic small cell neuroendocrine cervical cancer was safe; however, no objective responses were observed.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104860"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591037","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":"Management of medically inoperable low-grade endometrial cancer: patterns of care and outcomes with radiation, brachytherapy, and hormonal therapy.","authors":"Kevin Tam, Leslie D Peralta, Glenn P Boyles, Meredith A Newton, Kimberly Dessources, Shivani Sud, Olivia D Lara, Benjamin B Albright","doi":"10.1016/j.ijgc.2026.104496","DOIUrl":"10.1016/j.ijgc.2026.104496","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore treatment patterns and outcomes for medically inoperable patients with stage I low-grade endometrial cancer undergoing primary non-surgical treatment with radiation or hormonal therapy.</p><p><strong>Methods: </strong>From the 2004-2021 National Cancer Database files, we identified patients aged > 50 years with clinical stage I grade 1 to 2 endometrioid endometrial adenocarcinoma undergoing primary radiation or hormonal therapy without surgery. We described trends and explored factors associated with treatment choice with logistic regression and survival with Kaplan-Meier curves and Cox regression.</p><p><strong>Results: </strong>Among 3842 patients, 70.6% were treated with radiation, 34.9% with hormonal therapy, and 5.6% with both. Among those undergoing radiation, 45.0% received brachytherapy. Comparing 2004-2008 with 2017-2021, the use of hormonal therapy increased (16.4% to 45.8%), whereas radiation declined (86.4% to 61.2%). Patients with grade 2 tumors had higher odds of receiving radiation. Otherwise, the use of hormonal therapy and brachytherapy were strongly associated with facility characteristics (region, academic affiliation, volume). Patients treated with radiation had longer median overall survival versus hormonal therapy alone (53.8 vs 46.6 months; p = .004), with the survival longest in patients receiving brachytherapy (median 66.2 months). After adjustment, hormonal therapy was associated with increased hazard of death (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.15 to 1.41), with a greater estimated hazard for grade 2 (HR 1.47, 95% CI 1.21 to 1.81) versus grade 1 disease (HR 1.22, 95% CI 1.09 to 1.38). Similar hazards were identified comparing treatment lacking brachytherapy versus those with brachytherapy (HR 1.37, 95% CI 1.24 to 1.51).</p><p><strong>Conclusions: </strong>Despite limited data on comparative efficacy, the use of hormonal therapy is increasing over time, with treatment choice strongly associated with facility type, region, and volume. Patients undergoing radiation, particularly, brachytherapy, had longer survival.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104496"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776349","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":"Metastatic intra-placental choriocarcinoma presenting with third-trimester hemorrhage: diagnostic challenges and multi-disciplinary management.","authors":"Reyes Oliver-Pérez, Sara Barba, Mario Martinez-Lopez, Alberto Martínez-Arnaiz, Ainhoa Madariaga","doi":"10.1016/j.ijgc.2026.104643","DOIUrl":"10.1016/j.ijgc.2026.104643","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104643"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672996","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":"Diffuse uterine leiomyomatosis: diagnostic challenges of a rare condition.","authors":"Samantha G Walczak, Ramya P Masand","doi":"10.1016/j.ijgc.2026.104696","DOIUrl":"10.1016/j.ijgc.2026.104696","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"104696"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837618","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":"Beyond MEK inhibition: exploring MAPK pathway dependency in low-grade serous ovarian carcinoma.","authors":"Júlia Chain Martins, Ana Carolina Sousa Soares, Mariana Scaranti","doi":"10.1016/j.ijgc.2026.104799","DOIUrl":"10.1016/j.ijgc.2026.104799","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104799"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360710","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":"Updated pocket guide for integrated risk stratification in endometrial carcinoma: a practical tool based on European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology 2025 guidelines.","authors":"Reyes Oliver-Perez, Manon Daix, Jorge García-Ibañez, Alejandra Martinez, Martina Aida Angeles","doi":"10.1016/j.ijgc.2026.104785","DOIUrl":"10.1016/j.ijgc.2026.104785","url":null,"abstract":"","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104785"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360623","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":"Age-related distribution of homologous recombination deficiency in advanced ovarian carcinoma: a large real-world French cohort.","authors":"Witold Gertych, Alexis Trecourt, Faustine Morineau, Pauline Beacco, Astrid Brasselet, Marion Carnet, Angélique Chevriaux, Sandy Chevrier, Morgane Dupasquier, Anne Gibeaud, Juliette Albuisson, Anthony Comte, Valentin Derangère, Vincent Goussot, Laurent Arnould, Anthony Bergeron, Françoise Beltjens, Céline Charon-Barra, Charles Vinson, Romain Boidot","doi":"10.1016/j.ijgc.2026.104821","DOIUrl":"10.1016/j.ijgc.2026.104821","url":null,"abstract":"<p><strong>Objective: </strong>Tumor genetic testing for BRCA and homologous recombination repair is essential for guiding maintenance therapy in high-grade non-mucinous ovarian carcinomas. While clinical trials (PAOLA-1, PRIMA, ATHENA-MONO, PRIME) have reported homologous recombination deficiency rates of 44% to 67% in cohorts with a median age of 61, real-world data suggest age-related variations. We aimed to evaluate homologous recombination deficiency prevalence in a large French population and hypothesized a distribution pattern similar to the recent German findings published in 2022, in which older age correlated with lower homologous recombination deficiency rates.</p><p><strong>Methods: </strong>We retrospectively analyzed advanced ovarian carcinoma cases referred to the Dijon Cancer Center from 191 care centers between 2022 and 2024 for Myriad MyChoice homologous recombination deficiency testing. Data collected included age, histologic type, homologous recombination deficiency status, homologous recombination proficiency status, and genomic instability scores. We compared the distribution of homologous recombination deficiency and HRP tumors in women <60 and ≥60 years using the χ² test.</p><p><strong>Results: </strong>In 1322 advanced ovarian carcinoma cases with a median age of 70.1 years, the overall rates were 35.3% homologous recombination deficiency and 64.7% homologous recombination proficiency. A sub-analysis of 1226 high-grade cases (median age 70.4; including high-grade serous carcinoma, clear-cell carcinoma, undifferentiated carcinomas, and carcinosarcoma) showed 36.5% homologous recombination deficiency and 63.5% homologous recombination proficiency. Notably, patients aged ≥60 years had a significantly higher likelihood of presenting with a homologous recombination proficiency tumor compared with those aged <60 years (65.8% vs 53.2%, p < .001). Among 42 clear-cell carcinoma cases, 97.6% exhibited homologous recombination proficiency status.</p><p><strong>Conclusions: </strong>In this large real-world cohort of advanced ovarian carcinoma, we observed a notably higher prevalence of homologous recombination proficiency tumors compared to the 4 clinical trials reported in the literature, with homologous recombination proficiency incidence increasing significantly with age. Given that older patients predominantly present with homologous recombination proficiency tumors, which are associated with poorer survival, treatment strategies should be adjusted to better address the specific needs of this demographic.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104821"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470536","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":"From vaginal morbidity to sexual health: rethinking sexual rehabilitation after gynecological cancer through a survivor-informed patient expert perspective.","authors":"Icó Tóth, Richárd Tóth, Kathrin Kirchheiner","doi":"10.1016/j.ijgc.2026.104833","DOIUrl":"10.1016/j.ijgc.2026.104833","url":null,"abstract":"<p><p>Sexual health is a core component of quality of life in gynecologic cancer survivorship, yet it remains not fully integrated into routine oncologic care. Advances in treatment have improved survival, shifting attention toward long-term outcomes, including sexual function, identity, and relational well-being. Vaginal morbidity represents a common and clinically accessible entry point for interventions. However, the relationship between tissue changes and sexual experience is non-linear, as psychological, behavioral, and relational factors critically modulate outcomes. Evidence from cognitive-behavioral models suggests that repeated pain experiences may reinforce maladaptive avoidance patterns, whereas positive experiential learning and gradual exposure may restore adaptive sexual functioning. Current clinical guidelines appropriately emphasize prevention and management of vaginal morbidity through lubricants, local estrogen therapy, and vaginal dilation. Nonetheless, these approaches often implicitly prioritize penetrative intercourse as the primary marker of sexual health, potentially overlooking broader dimensions of sexuality. Alternative tools, such as vibrators, may provide comparable mechanical benefits to dilators while additionally enhancing arousal, reducing pelvic floor tension, and supporting patient agency. Furthermore, re-centering sexual pleasure as a legitimate therapeutic goal and addressing relational dynamics are essential for meaningful recovery. Ultimately, successful sexual rehabilitation should not be defined by anatomical restoration alone but by alignment with individual preferences, restoration of bodily trust, and the capacity for intimacy and pleasure. Integrating multidisciplinary, patient-centered sexual health care into survivorship pathways is critical to achieving comprehensive oncologic outcomes.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":"36 9","pages":"104833"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148602670","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}