1.Fertility-sparing surgery for women with stage I cervical cancer of 4 cm or larger: a systematic review
Violante Di DONATO ; Giuseppe CARUSO ; Carolina Maria SASSU ; Giusi SANTANGELO ; Giorgio BOGANI ; Francesco PLOTTI ; Flavia SORBI ; Giorgia PERNIOLA ; Innocenza PALAIA ; Gianluca TERRIN ; Roberto ANGIOLI ; Pierluigi Benedetti PANICI ; Ludovico MUZII
Journal of Gynecologic Oncology 2021;32(6):e83-
Objective:
To investigate current evidence on oncological, fertility and obstetric outcomes of patients with stage I cervical cancer of 4 cm or larger undergoing fertility-sparing surgery (FSS).
Methods:
Systematic review of studies including women affected by stage I cervical cancer ≥4 cm who underwent FSS. Main outcome measures: disease-free survival (DFS), overall survival (OS), pregnancy rate, live birth rate, premature delivery rate.
Results:
Fifteen studies met all eligibility criteria for this systematic review, involving 48 patients affected by cervical cancer ≥4 cm who completed FSS. Three patients (6.3%) experienced a recurrence and one of them (2.1%) died of disease. The 5-year DFS rate was 92.4%. The 5-year OS rate was 97.6%. A significantly shorter 5-year DFS was reported for high-risk patients (G3, non-squamous histotype, diameter ≥5 cm) compared with low-risk (74.7% vs. 100%; log-rank test, p=0.024). Data about fertility outcomes were available for 12 patients. Five patients out of 12 (41.7%) attempted to conceive with an estimated pregnancy rate of 80%, a live birth rate of 83.3% and a premature delivery rate of 20%.
Conclusion
Women with high tumor grade, aggressive histology and tumor size ≥5 cm have a higher risk of recurrence. Oncologic outcomes are encouraging among low-risk patients; however, the lack of high-quality studies makes it difficult to draw any firm conclusions. Prospective multicentric clinical trials with a proper selection of inclusion/exclusion criteria should be conducted in women with low-risk factors, strong desire to preserve their fertility and high likelihood to conceive.
2.Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis
Giuseppe CARUSO ; Innocenza PALAIA ; Giorgio BOGANI ; Federica TOMAO ; Giorgia PERNIOLA ; Pierluigi Benedetti PANICI ; Ludovico MUZII ; Violante Di DONATO
Journal of Gynecologic Oncology 2022;33(5):e69-
Objective:
To evaluate the efficacy and safety of systematic lymph node dissection (SyLND) at the time of interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC).
Methods:
Systematic literature review of studies including AEOC patients undergoing SyLND versus selective lymph node dissection (SeLND) or no lymph node dissection (NoLND) after neoadjuvant chemotherapy (NACT). Primary endpoints included progression-free survival (PFS) and overall survival (OS). Secondary endpoints included severe postoperative complications, lymphocele, lymphedema, blood loss, blood transfusions, operative time, and hospital stay.
Results:
Nine retrospective studies met the eligibility criteria, involving a total of 1,660 patients: 827 (49.8%) SyLND, 490 (29.5%) SeLND, and 343 (20.7%) NoLND. The pooled estimated hazard ratios (HR) for PFS and OS were, respectively, 0.88 (95% confidence interval [CI]=0.65–1.20; p=0.43) and 0.80 (95% CI=0.50–1.30; p=0.37). The pooled estimated odds ratios (ORs) for severe postoperative complications, lymphocele, lymphedema, and blood transfusions were, respectively, 1.83 (95% CI=1.19–2.82; p=0.006), 3.38 (95% CI=1.71–6.70; p<0.001), 7.23 (95% CI=3.40–15.36; p<0.0001), and 1.22 (95% CI=0.50–2.96; p=0.67).
Conclusion
Despite the heterogeneity in the study designs, SyLND after NACT failed to demonstrate a significant improvement in PFS and OS and resulted in a higher risk of severe postoperative complications.
3.Hormone replacement therapy in gynecological cancer survivors and BRCA mutation carriers: a MITO group survey
Innocenza PALAIA ; Giuseppe CARUSO ; Violante Di DONATO ; Camilla TURETTA ; Antonella SAVARESE ; Giorgia PERNIOLA ; Roberta GALLO ; Andrea GIANNINI ; Vanda SALUTARI ; Giorgio BOGANI ; Federica TOMAO ; Diana GIANNARELLI ; Gabriella GENTILE ; Angela MUSELLA ; Ludovico MUZII ; Sandro PIGNATA ; On behalf of the MITO group
Journal of Gynecologic Oncology 2024;35(3):e70-
Objective:
Early iatrogenic menopause in gynecological cancer survivors and BRCA mutation (BRCAm) carriers undergoing risk-reducing salpingo-oophorectomy (RRSO) is a major health concern. Hormone replacement therapy (HRT) is the most effective remedy, but remains underused in clinical practice. The Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group promoted a national survey to investigate the knowledge and attitudes of healthcare professionals regarding the prescription of HRT.
Methods:
The survey consisted of a self-administered, multiple-choice 45-item questionnaire, available online to all MITO members for 2 months starting from January 2022.
Results:
A total of 61 participants completed the questionnaire (47 out of 180 MITO centers;compliance: 26.1%). Most respondents were female (73.8%), younger than 50 years (65.6%), and gynecologic oncologists (55.7%), working in public general hospitals (49.2%). An 84.4% of specialists actively discuss HRT with patients and 51.0% of patients ask the specialist for an opinion on HRT. The rate of specialists globally in favor of prescribing HRT was 22.9% for ovarian cancer, 49.1% for cervical cancer, and 8.2% for endometrial cancer patients. Most respondents (70.5%) believe HRT is safe for BRCA-mutated patients after RRSO. Nearly 70% of physicians prescribe systemic HRT, while 23.8% prefer local HRT. Most specialists recommend HRT for as long as there is a benefit and generally for up to 5 years.
Conclusion
Real-world data suggest that many healthcare professionals still do not easily prescribe HRT for gynecological cancer survivors and BRCA mutation carriers after RRSO.Further efforts are required to implement the use of HRT in clinical practice and to support both clinicians in recommending HRT and patients in accepting it.
4.Hormone replacement therapy in gynecological cancer survivors and BRCA mutation carriers: a MITO group survey
Innocenza PALAIA ; Giuseppe CARUSO ; Violante Di DONATO ; Camilla TURETTA ; Antonella SAVARESE ; Giorgia PERNIOLA ; Roberta GALLO ; Andrea GIANNINI ; Vanda SALUTARI ; Giorgio BOGANI ; Federica TOMAO ; Diana GIANNARELLI ; Gabriella GENTILE ; Angela MUSELLA ; Ludovico MUZII ; Sandro PIGNATA ; On behalf of the MITO group
Journal of Gynecologic Oncology 2024;35(3):e70-
Objective:
Early iatrogenic menopause in gynecological cancer survivors and BRCA mutation (BRCAm) carriers undergoing risk-reducing salpingo-oophorectomy (RRSO) is a major health concern. Hormone replacement therapy (HRT) is the most effective remedy, but remains underused in clinical practice. The Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group promoted a national survey to investigate the knowledge and attitudes of healthcare professionals regarding the prescription of HRT.
Methods:
The survey consisted of a self-administered, multiple-choice 45-item questionnaire, available online to all MITO members for 2 months starting from January 2022.
Results:
A total of 61 participants completed the questionnaire (47 out of 180 MITO centers;compliance: 26.1%). Most respondents were female (73.8%), younger than 50 years (65.6%), and gynecologic oncologists (55.7%), working in public general hospitals (49.2%). An 84.4% of specialists actively discuss HRT with patients and 51.0% of patients ask the specialist for an opinion on HRT. The rate of specialists globally in favor of prescribing HRT was 22.9% for ovarian cancer, 49.1% for cervical cancer, and 8.2% for endometrial cancer patients. Most respondents (70.5%) believe HRT is safe for BRCA-mutated patients after RRSO. Nearly 70% of physicians prescribe systemic HRT, while 23.8% prefer local HRT. Most specialists recommend HRT for as long as there is a benefit and generally for up to 5 years.
Conclusion
Real-world data suggest that many healthcare professionals still do not easily prescribe HRT for gynecological cancer survivors and BRCA mutation carriers after RRSO.Further efforts are required to implement the use of HRT in clinical practice and to support both clinicians in recommending HRT and patients in accepting it.
5.Hormone replacement therapy in gynecological cancer survivors and BRCA mutation carriers: a MITO group survey
Innocenza PALAIA ; Giuseppe CARUSO ; Violante Di DONATO ; Camilla TURETTA ; Antonella SAVARESE ; Giorgia PERNIOLA ; Roberta GALLO ; Andrea GIANNINI ; Vanda SALUTARI ; Giorgio BOGANI ; Federica TOMAO ; Diana GIANNARELLI ; Gabriella GENTILE ; Angela MUSELLA ; Ludovico MUZII ; Sandro PIGNATA ; On behalf of the MITO group
Journal of Gynecologic Oncology 2024;35(3):e70-
Objective:
Early iatrogenic menopause in gynecological cancer survivors and BRCA mutation (BRCAm) carriers undergoing risk-reducing salpingo-oophorectomy (RRSO) is a major health concern. Hormone replacement therapy (HRT) is the most effective remedy, but remains underused in clinical practice. The Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group promoted a national survey to investigate the knowledge and attitudes of healthcare professionals regarding the prescription of HRT.
Methods:
The survey consisted of a self-administered, multiple-choice 45-item questionnaire, available online to all MITO members for 2 months starting from January 2022.
Results:
A total of 61 participants completed the questionnaire (47 out of 180 MITO centers;compliance: 26.1%). Most respondents were female (73.8%), younger than 50 years (65.6%), and gynecologic oncologists (55.7%), working in public general hospitals (49.2%). An 84.4% of specialists actively discuss HRT with patients and 51.0% of patients ask the specialist for an opinion on HRT. The rate of specialists globally in favor of prescribing HRT was 22.9% for ovarian cancer, 49.1% for cervical cancer, and 8.2% for endometrial cancer patients. Most respondents (70.5%) believe HRT is safe for BRCA-mutated patients after RRSO. Nearly 70% of physicians prescribe systemic HRT, while 23.8% prefer local HRT. Most specialists recommend HRT for as long as there is a benefit and generally for up to 5 years.
Conclusion
Real-world data suggest that many healthcare professionals still do not easily prescribe HRT for gynecological cancer survivors and BRCA mutation carriers after RRSO.Further efforts are required to implement the use of HRT in clinical practice and to support both clinicians in recommending HRT and patients in accepting it.