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Advances in Gynecological Oncology: From Pathogenesis to Therapy: 2nd Edition

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Dear Colleagues,

This collection is the second edition of the Special Issue “Advances in Gynecological Oncology: From Pathogenesis to Therapy ” (https://www.mdpi.com/journal/cancers/special_issues/Advances_Gynecological_Oncology_Pathogenesis_Therapy).

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. Biomarkers and molecular alterations are increasingly being used to choose the best systemic treatment. It is also now evident that molecular characteristics affect the biological behavior and chemo-sensitivity of ovarian carcinomas. Advanced cervical cancer and recurrences respond poorly to chemotherapy. The HPV vaccine plays a crucial role in preventing this disease, and its coverage should be implemented worldwide.

There is a further need to identify better biomarkers that allow for personalized therapy and combined therapeutic regimens, including immunotherapy, radiation therapy and chemotherapy, and personalized fertility-sparing treatment in young women should be considered when feasible.

In several gynecological cancers, sentinel lymph node use showed decreased morbidity, high sensitivity and a high negative predictive value. Many surgeons reserve its use for intermediate/high-risk patients, but further evidence is needed in this area.

This Special Issue aims to gather reviews and original contributions in one collection to illustrate recent advances in gynecological cancers and the future directions of clinical and basic research.

Dr. Andrea Ciavattini
Guest Editor

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19 pages, 1719 KiB

Open AccessArticle

Predictors of Clinical Hematological Toxicities under Radiotherapy in Patients with Cervical Cancer—A Risk Analysis

by Șerban Andrei Marinescu, Radu-Valeriu Toma, Oana Gabriela Trifănescu, Laurenția Nicoleta Galeș, Antonia Ruxandra Folea, Adrian Sima, Liviu Bîlteanu and Rodica Anghel

Cancers 2024, 16(17), 3032; https://doi.org/10.3390/cancers16173032 - 30 Aug 2024

Viewed by 340

Abstract

Background: Cervical cancer ranks third in frequency among female cancers globally and causes high mortality worldwide. Concurrent chemoradiotherapy improves the overall survival in cervical cancer patients by 6% but it can cause significant acute and late toxicities affecting patient quality of life. Whole pelvis radiotherapy doses of 10–20 Gy can lead to myelosuppression and to subsequent hematological toxicities since pelvic bones contain half of bone marrow tissue. Methods: A total of 69 patients with IB-IVB-staged cervical cancer have been included in this retrospective cohort study. We analyzed clinical adverse events and changes in blood cell counts (hemoglobin, neutrophils, leukocytes, and platelets) during radiation or chemoradiotherapy received at the Oncological Institute of Bucharest from 2018 to 2021. Results: Decreases in hemoglobin levels of over 2.30 g/dL during treatment were associated with BMI > 23.2 kg/m² (OR = 8.68, 95%CI = [1.01, 75.01]), age over 53 years (OR = 4.60 95%CI = [1.10, 19.22]), with conformational 3D irradiation (OR = 4.78, 95%CI = [1.31, 17.40]) and with total EQD2 of over 66.1 Gy (OR = 3.67, 95%CI = [1.02, 13.14]). The hemoglobin decrease rate of 0.07 g/dL/day was related to 95% isodose volume (OR = 18.00). Neutropenia is associated frequently with gastrointestinal side effects and with the bowel and rectal V45 isodoses (OR = 16.5 and OR = 18.0, respectively). Associations of total external and internal radiation dose with the time durations calculated from the initiation of treatment to the onset of hematological adverse reactions were also obtained. The maximum drop in leukocytes was observed before day 35 from the RT initiation in patients who underwent treatment with 3D conformal radiotherapy (OR = 4.44, 95%CI = [1.25, 15.82]). Neutrophil levels under 2.2 × 10³/μL and thrombocyte levels under 131 × 10³/μL during the follow-up period were associated with a total planned dose of 54 Gy to the pelvic region volume (OR = 6.82 and OR = 6.67, respectively). Conclusions: This study shows the existence of clinical and blood predictors of hematological adverse reactions in cervical cancer patients. Thus, patients who are in a precarious clinical situation, with low hematological values (but not yet abnormal), should be monitored during days 29–35 after the initiation of RT, especially if they are obese or over 53 years of age. Full article

(This article belongs to the Special Issue Advances in Gynecological Oncology: From Pathogenesis to Therapy: 2nd Edition)

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