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Squamous cervical carcinoma (SCC) requires particular attention in diagnostic and clinical management. New diagnostic tools, such as (positron emission tomography–magnetic resonance imaging) PET–MRI, consent to ameliorate clinical staging accuracy. The availability of new technologies in radiation therapy permits to deliver higher dose lowering toxicities. In this clinical scenario, new surgical concepts could aid in general management. Lastly, new targeted therapies and immunotherapy will have more room in this setting. The aim of this narrative review is to focus both on clinical management and new therapies in the precision radiotherapy era.

In 2024, two randomized controlled trials (RCTs) were published, providing new high-quality evidence on HIPEC in epithelial ovarian cancer (EOC). Updating data on progression-free survival (PFS) and adverse events could offer a clearer understanding of the benefits and risks of HIPEC combined with cytoreductive surgery (CRS), with or without prior neoadjuvant chemotherapy (NACT). An electronic search was conducted using PubMed, Web of Science, EBSCO, and CENTRAL up to 23 November 2024. We only included RCTs reporting PFS and adverse events of interval or secondary CRS, with or without HIPEC, in newly diagnosed or recurrent EOC. The meta-analysis included six RCTs. The addition of HIPEC to surgery significantly improved PFS in patients with newly diagnosed advanced-stage EOC who received NACT (HR 0.59; 95% CI 0.39-0.88; p = 0.01). No significant difference in PFS was observed between secondary CRS plus HIPEC and CRS alone in recurrent ovarian cancer without prior NACT (HR 1.22; 95% CI 0.82-1.83; p = 0.32). Regarding adverse events, a decrease in platelet count of any grade was more frequent in the HIPEC group (p = 0.03). The overall risk of acute kidney failure (AKF) was 10.6%, with a significantly higher incidence compared with CRS alone (p = 0.003). The addition of HIPEC to CRS significantly improved PFS compared with surgery alone in patients with advanced EOC who received NACT. However, the treatment was associated with a higher incidence of AKF, which occurred in 10.6% of patients who underwent HIPEC.

Purpose Uterine carcinosarcomas (UCSs) are aggressive biphasic malignancies, with a carcinomatous/epithelial component and a sarcomatous/mesenchymal counterpart. The aim of this study was to evaluate the impact of the sarcomatous component (homologous vs heterologous) on the overall survival (OS) and progression-free survival (PFS). Methods This is a multicenter observational retrospective study conducted in patients with stage I and II UCSs. Results Ninety-five women with histological diagnosis of early-stage UCSs were retrieved: 60 (63.2%) had tumors with homologous sarcomatous components, and 35 (36.8%) with heterologous. At univariate analysis, a stromal invasion ≥ 50%, the presence of clear cell, serous or undifferentiated carcinomatous component, the heterologous sarcomatous component and FIGO stage IB and II were shown to be variables with a statistically significant negative impact on PFS. Similarly, a depth of invasion ≥ 50%, the heterologous sarcomatous component and FIGO stage IB and II were statistically negative prognostic factors also concerning OS. At multivariate analysis, only the heterologous sarcomatous component was confirmed to be a statistically significant negative prognostic factor both on PFS (HR 2.362, 95% CI 1.207–4.623, p value = 0.012) and on OS (HR 1.950, 95% CI 1.032–3.684, p  = 0.040). Conclusion Carcinomatous and sarcomatous components both played a role in tumor progression and patients’ survival. However, only the sarcomatous component retained a statistical significance at the multivariable model suggesting its preeminent prognostic role in early-stage UCSs.

Introduction/Background*Uterine carcinosarcomas (UCSs) are aggressive biphasic malignancies, with a high grade carcinomatous/epithelial component and a high grade sarcomatous/mesenchymal counterpart. Several studies identified the carcinomatous part as the main factor affecting the aggressive behaviour of UCSs. However, other studies reported that the sarcomatous component, especially the presence of heterologous elements, was associated with a worse prognosis. The prognostic ‘driving force’ is not completely clear for these kind of tumours. For this reason, the aim of our study was to evaluate the impact of the sarcomatous component (Homologous vs Heterologous) on the overall survival (OS) and progression-free survival (PFS).MethodologyThis is a multicenter observational retrospective study conducted in patients with stage I and II UCSs.Result(s)*Ninety-five women with histological diagnosis of early stage UCSs were retrieved: 60 (63.2%) had tumors with homologous sarcomatous components, and 35 (36.8%) with heterologous. Tumors with a sarcomatous heterologous component were significantly larger than the homologous (T ≥ 50 mm: 82.9% vs 51.7%, p-value=0.002) and presented more often lymph-vascular space invasion (62.9% vs 25.9% respectively in patients with heterologous and homologous component, p-value=0.001). At univariate analysis, a stromal invasion ≥ 50%, the presence of clear cell, serous or undifferentiated carcinomatous component, the heterologous sarcomatous component and the FIGO stage IB and II were shown to be variables with a statistically significant negative impact on PFS. Similarly, a depth of invasion ≥ 50%, the heterologous sarcomatous component and the FIGO stage IB and II were statistically negative prognostic factors also concerning OS. At multivariate analysis, only the heterologous sarcomatous component was confirmed to be a statistically significant negative prognostic factor both on PFS (HR 2.362, 95% CI 1.207-4.623, p-value=0.012) and on OS (HR 1.950, 95% CI 1.032-3.684, p=0.040).Conclusion*In conclusion, in our large series of UCSs, both carcinomatous and sarcomatous components played a role in tumor progression and patients’ survival. However, only the sarcomatous component retained a statistical significance at the multivariable model suggesting its preeminent prognostic role in early stage UCSs.

Introduction/BackgroundThe role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer (ROC) is controversial after results of randomized trials.The aim of this study is to evaluate SCS in ROC patients with BRCA ½ (BRCAmut) who received platinum-based chemotherapy followed by olaparib maintenance.MethodologyThis is a case-control study. Patients with recurrent platinum-sensitive high grade serous ovarian cancer admitted to our Gynecologic Oncology Unit between 2014 and 2018 were identified.Main eligibility criteria were positive BRCA 1/2 germline or somatic mutation status and olaparib maintenance at primary recurrence after response to platinum based chemotherapy.Cases were those who received SCS followed by medical treatment (SCS-CT-OLA, group 1), controls were those who received medical treatment alone (CT-OLA, group 2).ResultsOverall, 47 patients were identified; 24 (51%) BRCAmut women undergoing SCS followed by platinum based chemotherapy and olaparib maintenance were matched with 23 (49%) BRCAmut women who received medical treatment alone. Groups were well balanced: no statistical differences were found with regard of age, mutational status, outcomes and treatment’s approach at diagnosis, timing and patterns of disease presentation at recurrence (table 1 and 2). Median time to first subsequent therapy (TFST) was significantly longer in the SCS-CT-OLA than in the CT-OLA group (42 months vs 16 months; p=0.05; figure 1). Furthermore, SCS-CT-OLA patients had the best post-recurrence survival (PRS), with a 3-year PRS of 81% in SCS-CT-OLA group versus 43% in CT-OLA group (p=0.01).ConclusionSCS increases TFST and PRS in ROC patients with BRCAmut candidate for olaparib maintenance after platinum-based chemotherapy. Prospective studies are needed. In the era of personalized medicine, indication to SCS should be individualized.DisclosureNothing to disclose.Abstract P141 Figure 1Time to first subsequent treatment in the SCS-CT-OLA group vs CT-OLA groupAbstract P141 Table 1Distribution of patients‘ clinico-pathological characteristics according with treatment receivedParametersAll ptsSCS-CT-OLA (group 1)CT-OLA (group 2)p value All cases4724 (51%)23 (49%)Age at recurrence (Median and range, years)54 (36–74)54 (36–71)53 (42–74)0.81FIGO Stage II1 (2%)1 (4%)00.25FIGO Stage III45 (96%)23 (96%)22 (96%)FIGO Stage IV1 (2%)01 (4%)PDS32 (68%)17 (71%)15 (65%)0.46NACT15 (32%)7 (29%)8 (35%)RT(mm) 029 (91%)15 (88%)14 (91%)0.58RT(mm) 1–103 (9%)2 (12%)1 (9%)Abstract P141 Table 2Patients characteristic and pattern of recurrent disease according with treatment receivedParametersAll ptsSCS AND OLA n (%)CT AND OLA n (%)p value PFI (Median and range, months)22 (8–56)27 (8–56)24 (13–54)0.45No ascites at recurrence44 (94%)23 (96%)21 (91%)0.48Ascites at recurrence3 (6%)1 (4%)2 (9%)Lymph nodal recurrence32 (68%)16 (67%)16 (70%)0.89Parenchimal (lung, liver, spleen) recurrence11 (23%)7 (29%)4 (17%)0.27Peritoneal recurrence34 (72%)18 (75%)16 (79%)0.46Localized peritoneal disease (up to 3 nodules)10 (21%)7 (29%)3 (13%)0.39Diffused peritoneal disease (more than 3 nodules)24 (51%)11 (48%)13 (56%)

IntroductionNo consensus has yet been reached on the best strategy for treatment of cervical cancer local recurrence. Vaginectomy could be a salvage treatment in selected patients.MethodsThe records of vaginal recurrent cervical cancer patients admitted at Fondazione Policlinico ‘Agostino Gemelli’ IRCCS in Rome from January 2010 to June 2019 were retrospectively analyzed. We reported perioperative and survival outcomes of vaginectomy with respect to a matched series of pelvic exenteration (PE).ResultsFifteen women underwent vaginectomy and 30 patients were submitted to PE. No statistical differences were observed between the two groups at baseline characteristics. The vaginectomy procedures were successfully performed in all women, and no case required conversion to PE. Moreover, a higher rate of major postoperative complications after PE with respect to vaginectomy (p=0.027) were recorded: among them, 3 women required a reoperation within 30 postoperative days, and 4 experienced two or more complications. Twenty-five (55.6%) women experienced recurrence: 8/25 (32.0%) in the vaginectomy group, and 17/25 (68%) in the PE group, with a median progression-free survival of 20 months and 13 months, respectively (p=0.169). In total, 5/15 (33.3%) died of disease in the vaginectomy group and 13/30 (43.3%) in the PE group, with a median overall survival of 39 and 18 months for vaginectomy and PE, respectively (p=0.161).ConclusionsThe vaginectomy seems to allow for salvage treatment, like radiotherapy and/or PE, but with a minimal impact on quality of life in appropriately selected women with local recurrent cervical cancer.

ObjectivesThe aim of this retrospective study was to compare surgical and survival outcome in only patients with early stage uterine carcinosarcomas (UCSs) managed by laparotomic surgery (LPT) versus minimally invasive surgery (MIS).MethodsData were retrospectively collected in 4 Italian different institutions. Inclusion criteria were: UCS diagnosis confirmed by the definitive histological examination, and stage I or II according to the FIGO staging system.ResultsBetween August 2000 and March 2019, the data relative to 150 patients bearing UCSs were collected: of these, 82 were defined as early stage disease (stage I-II) based on the histological report at the primary surgery, and thus were included in this study. Forty patients were managed by LPT, and 42 patients were managed by MIS. The operative time was lower in the MIS group versus the LPT group; the median estimated blood loss was less in the MIS group compared to the median of LPT group (p value <0.0001). The number of days was shorter in the MIS patients (p value <0.0001). Only 1 intra-operative complication was documented in the LPT group. There were 6 (15.0%) post-operative complications; they were more frequent in the LPT group nonetheless there was no statistically significant difference (p value=0.10). There was no difference in the disease free survival (DFS) and overall survival (OS) between the two groups.ConclusionThere was no difference in terms of oncologic outcome between the two approaches, in face of a more favourable peri-operative and post-operative profile in the MIS group.

Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane’s Library and Scopus. The following words and key phrases have been searched: “Two-dimensional vision”, “Three-dimensional vision”, “2D and 3D laparoscopy”, “Trainee surgeons”. This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI − 1.17 to − 0.47;  p  < 0.00001), cutting (MD: − 1.09; 95% CI − 1.50 to − 0.69  p  < 0.00001), suturing (MD: − 0.48; 95% CI − 0.83 to − 0.13  p  = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI − 13.55 to 30.98;  p  = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI − 0.72 to − 4.72; p  = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.