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Gynecological Cancers: Surgical Treatment and Novel Radiotherapy
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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: 31 December 2024 | Viewed by 4374

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
Special Issues, Collections and Topics in MDPI journals

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

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Published Papers (4 papers)

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Research

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9 pages, 224 KiB  
Article
Robotic versus Mini-Laparoscopic Colposacropexy to Treat Pelvic Organ Prolapse: A Retrospective Observational Cohort Study and a Medicolegal Perspective
by Valentina Billone, Giuseppe Gullo, Girolamo Perino, Erika Catania, Gaspare Cucinella, Silvia Ganduscio, Alessandra Vassiliadis and Simona Zaami
J. Clin. Med. 2024, 13(16), 4802; https://doi.org/10.3390/jcm13164802 - 15 Aug 2024
Viewed by 231
Abstract
Background: POP (pelvic organ prolapse) involves the descent of one or more pelvic organs downwards with or without protrusion from the vaginal opening, caused by the relaxation and weakening of ligaments, connective tissue, and pelvic muscles. Such an outcome negatively impacts the [...] Read more.
Background: POP (pelvic organ prolapse) involves the descent of one or more pelvic organs downwards with or without protrusion from the vaginal opening, caused by the relaxation and weakening of ligaments, connective tissue, and pelvic muscles. Such an outcome negatively impacts the quality of life. The gold standard procedure for repairing apical compartment prolapse is colposacropexy (CS) to secure the anterior and posterior walls of the vagina to the anterior longitudinal sacral ligament, located anteriorly to the sacral promontory, using a mesh. Several surgical approaches are feasible. Laparotomic or minimally invasive methods, including laparoscopic or robotic ones, can restore the horizontal axis of the vagina and typically involve concomitant hysterectomy. Methods: This study is based on 80 patients who underwent CS at Palermo’s Ospedali Riuniti Villa Sofia-Cervello from 2019 to 2023. Women aged 35–85 at the time of surgery were divided into two groups: 40 patients underwent mini-laparoscopic surgery, and 40 patients underwent robotic surgery. The following parameters were accounted for: demographic data (initials of name and surname, age), preoperative clinical diagnosis, date of surgery, surgical procedure performed, estimated intraoperative blood loss, duration of surgical intervention, length of hospital stay, postoperative pain assessed at 24 h using the VAS scale, and any complications occurring in the postoperative period. Mini-laparoscopic CS (Minilap) and robotic CS (Rob) were then compared in terms of outcomes. Results: In the Minilap group, 11 patients out of 40 had a preoperative diagnosis of vaginal vault prolapse. The average age in this group was 61.6. Five of these patients had isolated cystocele, while the rest presented vaginal stump prolapse linked to cystocele, rectocele, or both. The remaining 29 patients in the Minilap group had a preoperative diagnosis of uterovaginal prolapse, also associated with cystocele, rectocele, or both, or isolated in nine cases. In the Rob group (average age: 60.1), 13 patients were diagnosed with vaginal prolapse (isolated or associated with cystocele), while the remaining 27 had a diagnosis of uterovaginal prolapse. In the Minilap group, the average procedure duration was 123.3 min, shorter than the Rob group (160.1 min). Conclusions: The data collected throughout this prospective study point to the mini-laparoscopic approach as being preferable over the robotic one in terms of surgical procedure length, intraoperative blood loss, postoperative pain, and aesthetic outcome. Hospital stay duration and post operative complication rates were similar for both groups. The innovative and ever-progressing nature of such procedures calls for novel standards prioritizing patient care as well as medicolegal viability. Full article
(This article belongs to the Special Issue Gynecological Cancers: Surgical Treatment and Novel Radiotherapy)
9 pages, 832 KiB  
Article
Oncologic Outcomes of Patients with Early-Stage Cervical Cancer after Minimally Invasive Radical Hysterectomy and Sentinel Lymph Node Biopsy
by Tomohito Tanaka, Ruri Nishie, Hikaru Murakami, Hiromitsu Tsuchihashi, Akihiko Toji, Shoko Ueda, Natsuko Morita, Sousuke Hashida, Shinichi Terada, Hiroshi Maruoka, Kohei Taniguchi, Kazumasa Komura and Masahide Ohmichi
J. Clin. Med. 2024, 13(13), 3981; https://doi.org/10.3390/jcm13133981 - 8 Jul 2024
Viewed by 640
Abstract
Background: The sentinel lymph node is the first node that cancer cells reach when migrating from the primary site. However, oncological outcomes after sentinel lymph node biopsy (SNB) have not been reported for cervical cancer. In this study, oncological outcomes were compared [...] Read more.
Background: The sentinel lymph node is the first node that cancer cells reach when migrating from the primary site. However, oncological outcomes after sentinel lymph node biopsy (SNB) have not been reported for cervical cancer. In this study, oncological outcomes were compared between patients receiving SNB and pelvic lymphadenectomy (PLD) for early-stage cervical cancer. Methods: One hundred and four patients with clinical stage 1A2, 1B1, and 2A1 cervical cancer were included in this study. All patients underwent laparoscopic or robot-assisted radical hysterectomy with SNB or PLD. Fifty-two patients with tumors ≤2 cm underwent SNB. Disease-free survival (DFS) and overall survival (OS) were compared between the groups. Results: The median (interquartile range) tumor size was 12 (7–20) mm in the SNB group and 20 (13–25) mm in the PLD group. Lymph node metastasis occurred in one patient in the SNB group and in nine patients in the PLD group. The median follow-up periods were 42 (24–60) and 82 (19–101) months in the SNB group and PLD group, respectively. The 3-year DFS rates were 100% in SNB and 91.5% in PLD. The 3-year OS was 100% in both groups. Conclusions: SNB was sufficient in cervical cancer patients with tumors ≤2 cm, suggesting that PLD might not be necessary for these patients. Full article
(This article belongs to the Special Issue Gynecological Cancers: Surgical Treatment and Novel Radiotherapy)
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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
by Ida Pino, Elisa Gozzini, Davide Radice, Sara Boveri, Anna Daniela Iacobone, Ailyn Mariela Vidal Urbinati, Francesco Multinu, Giuseppe Gullo, Gaspare Cucinella and Dorella Franchi
J. Clin. Med. 2024, 13(2), 496; https://doi.org/10.3390/jcm13020496 - 16 Jan 2024
Cited by 1 | Viewed by 1050
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
by Chrysoula Margioula-Siarkou, Aristarchos Almperis, Giuseppe Gullo, Emmanouela-Aliki Almperi, Georgia Margioula-Siarkou, Eleni Nixarlidou, Konstantina Mponiou, Pavlos Papakotoulas, Chrysanthi Sardeli, Frederic Guyon, Konstantinos Dinas and Stamatios Petousis
J. Clin. Med. 2024, 13(1), 27; https://doi.org/10.3390/jcm13010027 - 20 Dec 2023
Viewed by 1397
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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