J Gynecol Oncol.  2008 Dec;19(4):209-217. 10.3802/jgo.2008.19.4.209.

Major clinical research advances in gynecologic cancer 2008

• Kim K
• Choi SC
• Ryu SY
• Kim JW
• Kang SB

• KMID: 2173408
• DOI: http://doi.org/10.3802/jgo.2008.19.4.209

Abstract

In this review, we summarized 14 major clinical advances in gynecology which occurred in 2008. For cervical cancer, clinical impact of HPV vaccine, prognostic value of imaging during radiotherapy, and oncologic/obstetric outcomes of fertility-sparing surgery were chosen. For uterine cancer, optimal method of adjuvant radiotherapy in intermediate-risk patients, extent of lymph node dissection, outcome of robot-assisted staging surgery, new standard chemotherapy regimen for leiomyosarcoma were selected. For ovarian cancer, recent changes in adjuvant therapy, feasibility of neoadjuvant chemotherapy, prediction of optimal secondary cytoreduction, studies on new biomarkers, advances in screening and treatment of women with BRCA mutations were included. For other cancers, the safety of sentinel lymph node dissection in vulvar cancer and chemotherapy regimens for low-risk gestational trophoblastic tumors were reviewed.

Keyword

Gynecology; Urogenital neoplasms; Biomedical research

MeSH Terms

Biomarkers
Female
Gynecology
Humans
Leiomyosarcoma
Lymph Node Excision
Mass Screening
Nitriles
Ovarian Neoplasms
Pyrethrins
Radiotherapy, Adjuvant
Trophoblastic Neoplasms
Urogenital Neoplasms
Uterine Cervical Neoplasms
Uterine Neoplasms
Vulvar Neoplasms
Nitriles
Pyrethrins

Reference

1. Future II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007. 356:1915–1927.

2. Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, et al. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: A randomised controlled trial. Lancet. 2004. 364:1757–1765.

3. Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM, et al. Efficacy of a prophylactic adjuvant bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: An interim analysis of a phase III double-blind, randomised controlled trial. Lancet. 2007. 369:2161–2170.

4. Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: A randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005. 6:271–278.

5. Villa LL, Costa RL, Petta CA, Andrade RP, Paavonen J, Iversen OE, et al. High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer. 2006. 95:1459–1466.

6. Huh WK. Impact of quadrivalent human papillomavirus (HPV) types 6/11/16/18 L1 virus-like particle vaccine on the incidence of abnormal pap tests and cervical procedures [abstract]. Gynecol Oncol. 2008. 108:3 suppl 1. S10.

7. Harry VN, Semple SI, Gilbert FJ, Parkin DE. Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer. Gynecol Oncol. 2008. 111:213–220.

8. Schwarz JK, Lin LL, Siegel BA, Miller TR, Grigsby PW. 18-F-fluorodeoxyglucose-positron emission tomography evaluation of early metabolic response during radiation therapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2008. 72:1502–1507.

9. Harry VN, Semple S, Gilbert FJ, Parkin DE. Novel MRI techniques as biomarkers of rapid response prediction in advanced cervical cancer [abstract]. J Clin Oncol. 2008. 26:15S. Abstract 5569.

10. In : Bjurberg M, Kjellen E, Ohlsson T, Sandell A, Brun E, editors. FDG-PET in early response assessment of locally advanced cervical cancer. 2008. 12th Biennial Meeting International Gynecologic Cancer Society; Oct 25-28; Bangkok. –Abstact 503.

11. Abu-Rustum NR, Sonoda Y, Black D, Levine DA, Chi DS, Barakat RR. Fertility-sparing radical abdominal trachelectomy for cervical carcinoma: Technique and review of the literature. Gynecol Oncol. 2006. 103:807–813.

12. Ramirez PT, Schmeler KM, Soliman PT, Frumovitz M. Fertility preservation in patients with early cervical cancer: Radical trachelectomy. Gynecol Oncol. 2008. 110:3 suppl 1. S25–S28.

13. Shaeffer DT, Randall ME. Adjuvant radiotherapy in endometrial carcinoma. Oncologist. 2005. 10:623–631.

14. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: Multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000. 355:1404–1411.

15. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: A Gynecologic Oncology Group study. Gynecol Oncol. 2004. 92:744–751.

16. Greven K, Winter K, Underhill K, Fontenesci J, Cooper J, Burke T. Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk endometrial cancer. Gynecol Oncol. 2006. 103:155–159.

17. Hogberg T, Rosenberg P, Kristensen G, de Oliveira CF, de Pont Christensen R, Sorbe B, et al. A randomized phase 3 study on adjuvant treatment with radiation (RT) +- chemotherapy (CT) in early-stage high-risk endometrial cancer (NSGO-EC-9501/EORTC 55991) [abstact]. J Clin Oncol. 2007. 25:18S. Abstract 5503.

18. Nout RA, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van de Steen-Banasik EM, et al. Vaginal brachytherapy versus external beam pelvic radiotherapy for high-intermediate risk endometrial cancer: Results of the randomized PORTEC-2 trial [abstact]. J Clin Oncol. 2008. 26:15S. Abstract LBA5503.

19. Creutzberg CL. GOG-99: Ending the controversy regarding pelvic radiotherapy for endometrial carcinoma? Gynecol Oncol. 2004. 92:740–743.

20. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: A paradigm shift in surgical staging. Gynecol Oncol. 2008. 109:11–18.

21. Yokoyama Y, Maruyama H, Sato S, Saito Y. Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers. Gynecol Oncol. 1997. 64:411–417.

22. Gehrig PA, Cantrell LA, Shafer A, Abaid L, Mendivil A, Boggess JF. What is the optimal minimally invasive surgical procedure for endometrial cancer in the obese and morbidly obese women? [abstract]. Gynecol Oncol. 2008. 108:3 suppl 1. S7.

23. Bell MC, Torgerson J. A comparison of robotically assisted hysterectomy with open and laparoscopic hysterectomy in endometrial cancer staging [abstract]. Gynecol Oncol. 2008. 108:3 suppl 1. S26.

24. Hensley ML, Blessing JA, Degeest K, Abulafia O, Rose PG, Homesley HD. Fixed-dose rate gemcitabine plus docetaxel as second-line therapy for metastatic uterine leiomyosarcoma: A Gynecologic Oncology Group phase II study. Gynecol Oncol. 2008. 109:323–328.

25. Hensley ML, Maki R, Venkatraman E, Geller G, Lovegren M, Aghajanian C, et al. Gemcitabine and docetaxel in patients with unresectable leiomyosarcoma: Results of a phase II trial. J Clin Oncol. 2002. 20:2824–2831.

26. Hensley ML, Blessing JA, Mannel R, Rose PG. Fixed-dose rate gemcitabine plus docetaxel as first-line therapy for metastatic uterine leiomyosarcoma: A Gynecologic Oncology Group phase II trial. Gynecol Oncol. 2008. 109:329–334.

27. McGuire WP, Hoskins WJ, Brady MF, Kucera PR, Partridge EE, Look KY, et al. Cyclophosphamide and cisplatin versus paclitaxel and cisplatin: A phase III randomized trial in patients with suboptimal stage III/IV ovarian cancer (from the Gynecologic Oncology Group). Semin Oncol. 1996. 23:40–47.

28. Muggia FM, Braly PS, Brady MF, Sutton G, Niemann TH, Lentz SL, et al. Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: A gynecologic oncology group study. J Clin Oncol. 2000. 18:106–115.

29. Eisenhauer EA, ten Bokkel Huinink WW, Swenerton KD, Gianni L, Myles J, van der Burg ME, et al. European-Canadian randomized trial of paclitaxel in relapsed ovarian cancer: High-dose versus low-dose and long versus short infusion. J Clin Oncol. 1994. 12:2654–2666.

30. Bolis G, Scarfone G, Polverino G, Raspagliesi F, Tateo S, Richiardi G, et al. Paclitaxel 175 or 225 mg per meters squared with carboplatin in advanced ovarian cancer: A randomized trial. J Clin Oncol. 2004. 22:686–690.

31. Isonishi S, Yasuda M, Takahashi F, Katsumata N, Kimura E, Aoki D, et al. Randomized phase 3 trial of conventional paclitaxel and carboplatin (c-TC) versus dose dense weekly paclitaxel and carboplatin (dd-TC) in women with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer: Japanese Gynecologic Oncology [abstract]. J Clin Oncol. 2008. 26:15S. Abstract 5506.

32. Bolis G, Colombo N, Pecorelli S, Torri V, Marsoni S, Bonazzi C, et al. Adjuvant treatment for early epithelial ovarian cancer: Results of two randomised clinical trials comparing cisplatin to no further treatment or chromic phosphate (32P). GICOG: Gruppo Interregionale Collaborativo in Ginecologia Oncologica. Ann Oncol. 1995. 6:887–893.

33. Young RC. Chemotherapy of ovarian cancer: past and present. Semin Oncol. 1975. 2:267–276.

34. Trimbos JB, Vergote I, Bolis G, Vermorken JB, Mangioni C, Madronal C, et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm trial. J Natl Cancer Inst. 2003. 95:113–125.

35. In : Vergote I, Trimbos JBMZ, Coens C, Verleye L, Maneo A, Bolis G, editors. Adjuvant platin-based chemotherapy improves survival in medium risk stage 1 ovarian carcinoma. Long-term follow-up results of the EORTC-ACTION trial. 2008. 12th Biennial Meeting International Gynecologic Cancer Society; Oct 25-28; Bangkok. –Abstact 1519.

36. Hou JY, Kelly MG, Yu H, McAlpine JN, Azodi M, Rutherford TJ, et al. Neoadjuvant chemotherapy lessens surgical morbidity in advanced ovarian cancer and leads to improved survival in stage IV disease. Gynecol Oncol. 2007. 105:211–217.

37. Mazzeo F, Berliere M, Kerger J, Squifflet J, Duck L, D'Hondt V, et al. Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy in patients with primarily unresectable, advanced-stage ovarian cancer. Gynecol Oncol. 2003. 90:163–169.

38. Bristow RE, Chi DS. Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: A meta-analysis. Gynecol Oncol. 2006. 103:1070–1076.

39. In : Vergote I, Trope CG, Amant F, Kristensen GB, Sardi JE, Ehlen T, editors. EORTC-GCG/NCIC-CTG randomized trial comparing primary debulking surgery with neoadjuvant chemotherapy in stage 3C-4 ovarian, fallopian tube and peritoneal cancer (OVCA). 2008. 12th Biennial Meeting International Gynecologic Cancer Society; Oct 25-28; Bangkok.

40. Chi DS, McCaughty K, Diaz JP, Huh J, Schwabenbauer S, Hummer AJ, et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer. 2006. 106:1933–1939.

41. Salani R, Santillan A, Zahurak ML, Giuntoli RL 2nd, Gardner GJ, Armstrong DK, et al. Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer: Analysis of prognostic factors and survival outcome. Cancer. 2007. 109:685–691.

42. Harter P, Bois A, Hahmann M, Hasenburg A, Burges A, Loibl S, et al. Surgery in recurrent ovarian cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006. 13:1702–1710.

43. In : Harter P, Sehouli J, Reuss A, Hasenburg A, Scambia G, Cibula D, editors. Predictive factors for resection in recurrent ovarian cancer (ROC). Intergroup study of AGO KOMMISSION OVAR, AGO-OVAR, AGO AUSTRIA, MITO AND NOGGO. 2008. 12th Biennial Meeting International Gynecologic Cancer Society; Oct 25-28; Bangkok. –Abstact 38.

44. Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol. 1990. 97:922–929.

45. Bailey J, Tailor A, Naik R, Lopes A, Godfrey K, Hatem HM, et al. Risk of malignancy index for referral of ovarian cancer cases to a tertiary center: Does it identify the correct cases? Int J Gynecol Cancer. 2006. 16:16 Suppl 1. 30–34.

46. Moore RG, McMeekin DS, Brown AK, Disilvestro P, Miller MC, Allard WJ. A novel multiple marker bioassay utilizing HE4 and CA125 for the prediction of ovarian cancer in patients with a pelvic mass. Gynecol Oncol. 2008. 10. 11. Epub ahead of print.

47. Hellstrom I, Raycraft J, Hayden-Ledbetter M, Ledbetter JA, Schummer M, McIntosh M, et al. The HE4 (WFDC2) protein is a biomarker for ovarian carcinoma. Cancer Res. 2003. 63:3695–3700.

48. Moore RG, Brown AK, Miller MC, Skates S, Allard WJ, Verch T, et al. The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass. Gynecol Oncol. 2008. 108:402–408.

49. Brown A, Miller C, Robison K, Somers E, Allard J, Granai CO, et al. Differential expression of CA125 and a novel serum tumor marker HE4 in epithelial ovarian cancer [abstract]. J Clin Oncol. 2008. 26:15S. Abstract 5533.

50. Lewin SN, Kemel Y, Kosarin K, Hansen J, Robson ME, Offit K, et al. Utility of ovarian cancer screening in women with BRCA mutations [abstract]. J Clin Oncol. 2008. 15S. Abstract 5531.

51. Fong PC, Boss DS, Carden CP, Roelvink M, De Greve J, Gourley CM, et al. AZD2281 (KU-0059436), a PARP (poly ADP-ribose polymerase) inhibitor with single agent anticancer activity in patients with BRCA deficient ovarian cancer: Results from a phase 1 study [abstract]. J Clin Oncol. 2008. 26:15S. Abstract 5510.

52. Gaarenstroom KN, Kenter GG, Trimbos JB, Agous I, Amant F, Peters AA, et al. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. Int J Gynecol Cancer. 2003. 13:522–527.

53. Stehman FB, Bundy BN, Dvoretsky PM, Creasman WT. Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: A prospective study of the Gynecologic Oncology Group. Obstet Gynecol. 1992. 79:490–497.

54. Hampl M, Hantschmann P, Michels W, Hillemanns P. Validation of the accuracy of the sentinel lymph node procedure in patients with vulvar cancer: Results of a multicenter study in Germany. Gynecol Oncol. 2008. 111:282–288.

55. Van der Zee AG, Oonk MH, De Hullu JA, Ansink AC, Vergote I, Verheijen RH, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008. 26:884–889.

56. Ngan S, Seckl MJ. Gestational trophoblastic neoplasia management: An update. Curr Opin Oncol. 2007. 19:486–491.

57. In : Alazzam M, Tidy J, Hancock B, Osborne R, editors. First line chemotherapy in low risk gestational trophoblastic neoplasia: Cochrane review. 2008. 12th Biennial Meeting International Gynecologic Cancer Society; Oct 25-28; Bangkok.

58. Osborne R, Filiaci V, Schink J, Mannel R, Provencher D, Alvarez-Secord A, et al. A randomized phase 3 trial comparing weekly parenteral methotrexate and "pulsed" dactinomycin as primary management for low-risk gestational trophoblastic neoplasia: A Gynecologic Oncology Group study [abstract]. Gynecol Oncol. 2008. 108:3 suppl 1. S2.