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BackgroundEndometrial cancer (EC) is the most common gynecologic malignancy. We examined factors affecting overall prognosis and survival among different racial groups diagnosed with high-grade EC.MethodsWe utilized the California Cancer Registry database (CCR) to identify women with high-grade II EC from 1998 to 2009. Using the Kaplan-Meier method, we described disease-specific survival. Survival by stage, race, and time to treatment category was compared using the log-rank test. The associations of race with disease-specific survival were modeled using Cox proportional hazards regression. Covariates were selected a priori.ResultsA total of 10 647 patients met study eligibility criteria. The majority of patients in this cohort of high-grade EC were non-Hispanic (NH) white (64.1%), followed by Hispanic (15.7%), Asian (10.4%), and NH black (9.8%). NH black women had higher incidence of certain aggressive histologic subtypes in comparison with NH whites, including serous carcinomas and carcinosarcoma. Non-Hispanic black patients had a worse 5-year disease-specific survival (DSS) when compared to other racial groups. The five-year DSS for NH black women was 54% (51%-57%), compared to NH white women 66% (65%-67%), Hispanic 67% (64%-69%), and Asians 69% (67%-72%) (P

Surgical training experience in obstetrics-gynecology (OB-GYN) residency and fellowship training, particularly in open abdominal surgeries has declined over the last 2 decades. This is due, in part, due to a universal trend toward non-invasive treatments for gynecologic conditions once treated surgically. Management of placenta accreta spectrum (PAS) often requires complex surgical skills, including, but not limited to highly complex hysterectomy. The decline in surgical case numbers has fallen as the incidence of PAS has risen, which we anticipate will lead to a gap in critical skills needed for graduating obstetrician-gynecologists to able to safely care for people with PAS. [ABSTRACT FROM AUTHOR]

The surgical management of placenta accreta spectrum (PAS) is often challenging. There are a variety of techniques and management options described in the literature ranging from uterine sparing to cesarean hysterectomy. Following the inaugural meeting of the Pan-American Society for Placenta Accreta Spectrum a multidisciplinary group collaborated to describe collective recommendations for the surgical management of PAS. In this manuscript, we outline individual components of the procedure and provide suggested direction at key points of a cesarean hysterectomy in the setting of PAS. Key Points The surgical management of PAS requires careful planning and expertise. Multidisciplinary team care for pregnancies complicated by PAS can decrease morbidity and mortality. Careful surgical techniques can minimize risk of significant hemorrhage by avoiding pitfalls. [ABSTRACT FROM AUTHOR]

Patients with metastatic uterine leiomyosarcoma (uLMS) have poor prognosis due to limited treatment options, especially when disease progresses on doxorubicin and gemcitabine-docetaxel regimens. Here we report a patient whose metastatic uLMS contains a BRCA2 deep deletion as well as TP53 and PTEN deep deletion. The patient responded rapidly to olaparib, a poly (ADPribose) polymerase inhibitor, after progressing on gemcitabinedocetaxel, doxorubicin, and temozolomide regimens. This case report shall be helpful to the treatment of other patients with metastatic uLMS that harbors a BRCA2 mutation or deletion. [ABSTRACT FROM AUTHOR]

Purpose: We report the effect of antiangiogenic therapy on the biodistribution of F-FPPRGD (a surrogate biomarker of integrin αβ expression), and the potential of F-FPPRGD to predict the prognosis in patients with cervical cancer and ovarian cancer in this clinical scenario. Methods: Data from six women, age range 30 - 59 years (mean ± SD 44.0 ± 12.5 years), who had undergone a F-FPPRGD PET/CT scan and bevacizumab-containing therapy were prospectively collected and analyzed. We compared baseline F-FPPRGD and F-FDG uptake in the lesions and tumor-to-background (T/B) ratios. The maximum and mean F-FPPRGD standardized uptake values (SUV and SUV) were recorded for 13 normal organs, as well as in all the identified malignant lesions on the pretreatment scan and the 1-week post-treatment scan. We also measured changes in F-FPPRGD uptake from before to 1 week after treatment and compared them to the changes in F-FDG uptake from before to 6 weeks after treatment. Treatment outcomes were correlated with these changes. Results: The uptake in lesions and T/B ratio of F-FPPRGD were lower than those of F-FDG (SUV 3.7 ± 1.3 vs. 6.0 ± 1.8, P < 0.001; SUV 2.6 ± 0.7 vs. 4.2 ± 1.3, P < 0.001; T/B ratio based on SUV 2.4 ± 1.0 vs. 2.6 ± 1.0, P < 0.04; T/B ratio based on SUV 1.9 ± 0.6 vs. 2.4 ± 1.0, P < 0.003). One patient did not return for the follow-up scan and in another patient no lesions were identified on the pretreatment scan. F-FPPRGD uptake in lesions in the remaining four patients had significantly changed 1 week after treatment (SUV 3.3 ± 1.0 vs. 2.7 ± 1.0, P < 0.001), while uptake in all normal tissues analyzed was not affected by treatment. One patient with clinical disease progression had a decrease in lesional F-FPPRGD SUV of 1.6 % and in F-FDG SUV of 9.4 %. Two patients with a clinical complete response to treatment had decreases in lesional F-FPPRGD SUV of 25.2 % and 25.0 % and in F-FDG SUV of 6.1 % and 71.8 %. One patient with a clinical partial response had a decrease in lesional F-FPPRGD SUV of 7.9 % and in F-FDG SUV of 76.4 %. Conclusion: This pilot study showed that F-FPPRGD and F-FDG provide independent information about the biology of ovarian and cervical cancers. Bevacizumab-containing therapy does not affect F-FPPRGD uptake in normal organs, but does result in statistically significant changes in lesions. In addition, F-FPPRGD may have potential for early prediction of response to such treatments. These preliminary findings have to be confirmed in larger studies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The role of risk-reducing surgery in hereditary breast and ovarian cancer," by Lynn C. Hartmann and Noralane M. Lindor in the February 4, 2016 issue.

Cancer outcomes are largely measured in terms of disease-free survival or overall survival, which is highly dependent on timely diagnosis and access to treatment methods available within the country's existing health care system. Although cancer survival rates have markedly led in the past few decades, any improvement in the 5-year survival of gynecologic cancers has been modest, as in the case of ovarian and cervical cancers, or has declined, as in the case of endometrial cancer. The lack of effective screening options contributes to many women presenting with advanced-stage disease and the need for radical approaches to treatment. Although treatment for early-stage disease can lead to a cure, advanced-stage disease is fraught with a high potential for morbidity and mortality, and recent clinical trials have aimed to assess the noninferiority of minimally invasive options versus aggressive surgical approaches. Of particular interest is fertility-sparing treatments for endometrial and cervical cancers, which have recently been on the rise among younger women. Balancing morbidity with the risk of mortality, and loss of fertility and quality of life requires a targeted patient-centered approach to treatment. This is an ongoing area of intense research and sometimes may challenge current treatment paradigms. In this two-part review, we present an overview of current approaches to gynecologic cancer treatment and the need to de-escalate radical surgical approaches and preserve fertility. We also review the intricacies of ovarian and advanced endometrial cancer treatment, exploring the nuances in surgical debulking timing and its impact on outcomes.