Aim: Assessment of the frequency of lymph node lesions in recurrent ovarian cancer.
Materials and methods: The retrospective analysis included 123 patients who underwent cytoreductive surgery for recurrent ovarian cancer with metastatic lymph node lesion at the N. N. Blokhin National Research Center of Oncology of the Ministry of Health of the Russian Federation from 2005 to 2020. Depending on the location of the recurrence, the patients were divided into 2 groups: 1 – an isolated form of recurrence in the lymph nodes; 2 – a combined form of recurrence in the lymph nodes and other anatomical localizations.
Results: There were no signifi cant differences in the frequency of metastatic lesions in the recurrence of ovarian cancer in different groups of regional and non-regional lymph nodes in both groups. Paraaortic lymph nodes were most commoly localized in lymphogenic progression of ovarian cancer – in 41.5 % of patients. Pelvic lymph nodes and synchronous metastatic lesion of the paraaortic and pelvic lymph nodes were the second and third most common in lymphogenic progression of ovarian cancer – in 22.8 % and 9.8 % of patients, respectively. In other cases, simultaneous lesion of regional and/or non-regional lymph nodes was noted.
Conclusion: Paraaortic and pelvic lymph nodes are a frequent location for lymphogenic progression of ovarian cancer. The absence of peritoneal and parenchymal metastases makes this cohort of patients ideal candidates for achieving complete repeat cytoreductive surgery with a low incidence of clinically signifi cant postoperative complications and associated with a favorable prognosis.
Keywords: ovarian cancer, repeated cytoreductive surgery, isolated recurrence, lymphogenic metastases, paraaortic lymph nodes, pelvic lymph nodes
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Objective: to determine the feasibility of using modulated electrohyperthermia, mEHT (oncothermia), in locally advanced cervical cancer ( LACC) IIb–IVa FIGO patients with massive tumor infi ltration of pelvic tissue.
Materials and Methods: 133 pts. IIb–IVa cervical cancer FIGO were included randomly in 2015–2019 in 2 arms, to undergo 3D-conformal external beam pelvic irradiation (EBRT), in 1.8–2 Gy, to TD EQD2 45–50 Gy with weekly Cisplatin 40 mg/m2 or Carboplatin AUC2, followed by image-guided high dose rate (HDR) 192Ir brachytherapy (IGBT), with or without mEHT addition. Oncothermia (mEHT) sessions (EHY-2000) were proceeded 3 times a week, 60–90 min, energy 110– 130 W, in 68 pts. (ARM 1) as a part of radical chemoradiation, 9–14 sessions per course; 65 pts. (ARM 2) received standard chemoradiation. Clinical target volume of high-risk (HR-CTV) at the beginning of brachytherapy, short- and long-term treatment results, toxic effects, early and late treatment complications were evaluated and compared in two arms.
Results: This schedule of oncothermia during chemoradiation was mostly very well tolerated in all 68 cervical cancer IIb-IVa FIGO patients of Arm 1 and caused a signifi cant increase of complete and subtotal partial (≥ 80 %) response at the beginning of brachytherapy in 17,7±5,3 % and 33,8±4,4 % of them, versus 3,1±2,3 % and 10,8±4,4 % in control Arm 2 respectively (p < 0,01). Signifi cant decrease of HR-CTV volume was achieved in Arm 1; optimal HR-CTV for intracavitary IGBT was reached more frequently in Arm 1 versus Arm 2 (55,9 % vs 13,8 %, p = 0,027), without indications to hybrid brachytherapy technologies.
Oncothermia as a part of standard chemoradiation in LACC IIb–IVa FIGO patients with massive pelvic tissue involvement signifi cantly improved desease-free survival and local control rates in Arm 1 vs Arm 2: the rates of 72,1±6,7 % versus 58,3±6,4 % (p = 0.041) and 92,7±8,7 % versus 78,5±9,4 % (p = 0,048) were achieved at the end of 5-year follow-up respectively. Toxicity during the treatment, early and late complications were compared in 2 arms, no difference in type, frequency and severity was observed in 2 arms, p ≥ 0,05 for all the comparisons.
Conclusion: оncothermia as a part of standard chemoradiation can be considered as an effective and safe additional method to modify the tumor response in LACC IIb-IVa FIGO patients with massive pelvic tissue involvement.
Keywords: cervical cancer, oncothermia, modulated electrohyperthermia, radiation therapy, chemoradiation, radiosensitization, chemosensetization, tumor response
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Objective of the study is to evaluate the results of infertility treatment using their own oocytes in patients who had urogenital tract cancers (endometrial cancer, cervical and ovarian cancer).
Materials and Methods. The paper presents a retrospective review of medical histories of 6 patients who suffered pelvic cancers and sought medical help at the Department of the Center of Innovative Reproductive Technologies named after E. G. Lebedeva of MD GROUP Clinical Hospital for infertility treatment for the period from 2019 to 2024. The structure of patients’ diagnoses included: stage 1C ovarian cancer, T1aNxM0G endometrial cancer, endometrial adenocarcinoma, cervical cancer (T1A1N0M0), borderline tumor of the left ovary with implants in pelvic peritoneum. The average age of the patients was 33,1 years (3 patients were of late reproductive age – over 35 years). In accordance with Orders on assisted reproductive technologies (ART) (803n) and clinical guidelines all patients underwent examination and received medical examination report of oncologists on the possibility of planning pregnancy using assisted reproductive technologies and on the possibility or impossibility of hormone therapy (stimulation of ovarian function as a part of IVF program). Based on the examination results, medical history data, clinical picture and the state of reproductive system at the time they had medical assessment, in accordance with Russian and European clinical guidelines, the patients underwent in vitro fertilization (IVF) with the stimulation of ovulation with gonadotropins and in a natural cycle.
Results. So far, 5 of 6 patients have achieved the desired pregnancy and live births or have their embryos frozen. Follow-up of the patients is ongoing, some of them are planning new pregnancy again.
Conclusion. Current state and advances in gynecologic oncology and novel reproductive technologies in Russia allow to successfully treat infertility and preserve the fertility in patients who have had pelvis cancers, provided that they seek medical help for infertility early and get timely referral to appropriate fertility specialists. Our own experience in the use of assisted reproductive technologies in patients who have had gynecologic cancers, demonstrates the effectiveness and safety of the methods used and encouraging results based on take-home-baby-rate data.
Keywords: fertility preservation, oncofertility, gynecologic oncology, infertility, GnRH antagonist protocol for ovarian stimulation, natural cycle IVF protocol, embryo vitrifi cation, endometrial cancer, endometrial hyperplasia, ovarian cancer
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Objective of the study is to investigate the effectiveness of the use of a vaginal moisturizer Estrogial for the prevention of vulvovaginal atrophy after radiation therapy to the pelvis.
Materials and Methods. 80 patients with locally-advanced cervical cancer who had received a radical course of chemoradiotherapy were included in the study. Group I — an experimental group: for preventing acute vaginal toxicity this group received vaginal moisturizer Estrogial daily, immediately following the termination of radiation therapy, treatment course lasted for 3 months — until the follow-up in outpatient clinics in accordance with follow-up care plan. Group II — a control group, all patients of this group used traditional ointments.
Results. Vulvovaginal atrophy with subsequent forming of vaginal stenosis after pelvic radiation therapy, is a common side effect. Vulvovaginal atrophy reduces the quality of life of women, manifested, in particular, in the development of genitourinary menopausal syndrome, as well as in a decrease of vaginal discharge and lubrication and diffi culties in sexual intercourse. Our experience in the use of a combination of phytoestrogens and hyaluronic acid after pelvic radiation therapy is promising and reaffi rms the necessity of sexual rehabilitation of such patients.
Keywords: vulvovaginal atrophy, vaginal stenosis, pelvic radiation therapy, phytoestrogens, hyaluronic acid
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Objective of the study. To analyze existing scientific studies dedicated to examining the influence of body mass index on outcomes of laparoscopic surgeries in patients with colorectal cancer and gynecological oncological diseases.
Materials and Methods. The review includes both quantitative and qualitative studies, literature reviews, meta-analyses, and clinical guidelines published in scientific journals. Studies published within the last 5 years were considered to ensure the relevance of the data obtained. The following databases were used to collect relevant scientific articles: PubMed, Scopus, Web of Science, and Google Scholar.
Results. The discussion highlights the impact of obesity on laparoscopic surgery in these pathologies, revealing increased operation complexity and higher complication risks in patients with high body mass index. However, despite limitations of existing studies, laparoscopic access remains preferable, necessitating further multicenter research to refine and expand the obtained results.
Conclusion. The study emphasizes the need for preoperative preparation and individualized care for patients with high body mass index, as well as the development of specialized protocols to reduce complication risks. The importance of a multidisciplinary approach to treating obesity in colorectal and gynecological cancer is underscored as a key aspect for improving surgical and oncological outcomes in the future.
Keywords: laparoscopy, laparoscopic surgery, body mass index (BMI), obesity, surgical complications, hysterectomy, colorectal cancer, surgical outcomes
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The article presents a clinical case of obtaining genetic material from a young woman diagnosed with stage IB2 cervical adenocarcinoma after radical hysterectomy with ovarian transposition and radiation therapy. The objective was to retrieve the patient’s oocytes, fertilize them with the spouse’s sperm and transfer the resulting embryo into the uterine cavity of the surrogate mother. Three IVF programs were carried out, ovarian superovulation stimulation was performed in a randomstart protocol, transabdominal access was used for the puncture of the ovaries that had been repositioned. The outcomes of the treatment were pregnancy and delivery via surrogate mother. This clinical case and literature review indicate the need for the interaction between oncologists and reproductive endocrinologists, as well as the relevance of integrating modern techniques of assisted reproductive technologies into oncology.
Keywords: ovarian transposition, in vitro fertilization (IVF), oncofertility, transabdominal ovarian puncture, cervical cancer
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Objective of the study is to carry out a systematic analysis of the data available in current literature on the possibilities of the use of menopausal hormone therapy in survivors after the treatment for cancers of extragenital localization.
Materials and Methods. The review includes the data of foreign and Russian scholarly articles found in PubMed on the subject, published over the past 10 years.
Results. Premature ovarian insuffi ciency is a serious complication of the treatment of most cancers. At the same time, the symptoms of iatrogenic menopause in cancer patients progress in a particularly acute form. In this article we provide the latest data of the world literature from in vitro experiments to clinical investigations regarding the possibilities of the use of menopausal hormone therapy in survivors after the treatment for malignant tumors of extragenital localization assuming oncologic risks.
Conclusion. Based on the evidence collected to date, it might be stated that adequately prescribed menopausal hormone therapy can be benefi cial for certain types of cancer in women and dangerous for hormone-dependent tumors. It is necessary to continue this research, as categorical refusal of menopause hormone therapy is harmful for patients’ health and reduces their life expectancy.
Keywords: menopausal hormone therapy, survivors after the treatment for cancers of extragenital localization
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