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Objectives: To assess the long-term oncological safety of laparoscopic fertility-sparing surgery (FSS) in borderline ovarian tumors and the impact of laparoscopic surgical factors on recurrences. Primary outcomes were the recurrence rate and time to recurrence after laparoscopic FSS. Secondary outcomes were to evaluate the recurrence rate after a second laparoscopic surgery and to assess factors associated with the risk of relapse. Methods: This is a retrospective single-center observational study in a tertiary university-affiliated hospital. Thirty-four patients diagnosed with borderline ovarian tumors who underwent laparoscopic FSS were recruited. Patients were categorized into two groups: the adnexectomy group, including patients who underwent unilateral adnexectomy, and the cystectomy group, which included patients who underwent unilateral cystectomy, bilateral cystectomy, and unilateral adnexectomy with contralateral cystectomy. Results: Eleven relapses (32.3%) were observed during a median follow-up period of 116.1 [62.5–185.4] months. The recurrence rate was similar for patients who underwent cystectomy (6/19, 31.6%) and adnexectomy (5/15, 33.3%). Cystectomy led to a shorter time to first recurrence (36-month progression-free survival rates of 66% vs. 85%) and higher rates of capsular rupture (71.4% vs. 20%, p = 0.04) compared to adnexectomy. No deaths due to progression of disease were reported. Conclusions: Laparoscopic FSS for borderline ovarian tumors is a safe, long-term oncological option. Although the recurrence rate was similar in patients undergoing adnexectomy or cystectomy, the time to recurrence was shorter in cases treated with cystectomy. Further research is needed to identify eventual laparoscopic risk factors more strongly correlated with recurrence. [ABSTRACT FROM AUTHOR]

Background: Salvage surgery is considered an option for isolated recurrences of retroperitoneal and pelvic tumors, in patients who have undergone previous radiotherapy. In order to increase local control intra operative electron radiation therapy (IOERT) can be used in these patients to administer additional radiation dose. We evaluated the outcomes and adverse effects in patients with retroperitoneal sarcoma and gynecologic tumors after salvage surgery and IOERT. Materials and Methods: Twenty patients were retrospectively analyzed. Twenty-three IOERT treatments were performed after surgery. six (30%) were sarcoma and 14 (70%) were gynecological carcinoma. Administered dose depended on previous dose received with external beam radiotherapy (EBRT) and proximity to critical structures. The toxicities were scored using the Common Terminology Criteria for Adverse events version 4.0. Results: The median age of the patients was 51 years (range 34-70). After a median follow-up of 32 months (range 1-68), in the sarcoma group the local control rate was 66.6%; while in the gynecological group the local control rate was 64.3%. In relation to late toxicity, one patient had a Grade 2 vesicovaginal fistula, and one patient presented Grade 4 enterocolitis and enteric intestinal fistula. conclusions: IOERT could have a role in the treatment of retroperitoneal sarcomas in primary tumors after EBRT, as it may suggest a benefit in local control or recurrences after surgical resection in those at high risk of microscopic residual disease. The addition of IOERT to salvage resection for isolated recurrence of gynecologic cancers suggest favorable local control in cases with concern for residual microscopic disease. [ABSTRACT FROM AUTHOR]

Objectives : Accurate assessment of disease extent is required to select the best primary treatment for advanced epithelial ovarian cancer patients. Estimation of tumour burden is challenging and it is usually performed by means of a surgical procedure. Imaging techniques and tumour markers can help to estimate tumour burden non-invasively. 2-[18F]FDG PET/CT allows the evaluation of the whole-body disease. This study aimed to correlate HE4 and CA125 serum concentrations with tumour burden evaluated by volumetric 2-[18F]FDG PET/CT parameters in advanced high-grade epithelial ovarian cancer. Methods: We included 66 patients who underwent 2-[18F]FDG PET/CT and serum tumour markers determination before primary treatment. Volumes of interest were delimited in every pathological uptake. Whole-body metabolic tumour volume (wb_MTV) and total lesion glycolysis (wb_TLG) were calculated summing up every VOI's MTV value. SUVmax thresholds were set at 40% (MTV40 and TLG40) and 50% (MTV50 and TLG50). In addition, four VOI subgroups were defined: peritoneal carcinomatosis, retroperitoneal nodes, supradiaphragmatic nodes, and distant metastases. MTV and TLG were calculated for each group by adding up the corresponding MTV values. TLG was calculated likewise. Results: wb_MTV and wb_TLG were found to be significantly correlated with serum CA125 and HE4 concentrations. The strongest correlation was observed between HE4 and wb_MTV40 (r = 0.62, p < 0.001). Pearson's correlation coefficients between peritoneal carcinomatosis MTV40 and tumour markers were 0.61 (p < 0.0001) and 0.29 (p = 0.02) for HE4 and CA125 respectively. None of these tumour markers showed a positive correlation with tumour load outside the abdominal cavity assessed by volumetric parameters. Conclusion: HE4 performs better than CA125 to predict metabolic tumour burden in high-grade epithelial ovarian cancer before primary treatment. 2-[18F]FDG PET/CT volumetric parameters arise as feasible tools for the objective assessment of tumour load and its anatomical distribution. These results support the usefulness of HE4 and PET/CT to improve the stratification of these patients in clinical practice. Key Points: • In patients with high-grade advanced ovarian epithelial carcinoma, both CA125 and HE4 correlate to whole-body tumour burden assessed by PET/CT before primary treatment. • HE4 estimates peritoneal disease much better than CA125. • PET/CT volumetric parameters arise as feasible tools for the objective assessment of tumour load and its anatomical distribution. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the accuracy of sentinel lymph node (SLN) mapping with transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) to detect lymph node (LN) metastases, in patients with intermediate and high-risk endometrial cancer (EC), focusing on its performance to detect paraaortic involvement. Methods: Prospective study including women with preoperative intermediate or high-risk EC, according to ESMO-ESGO-ESTRO consensus, who underwent SLN mapping using the TUMIR approach. SLNs were preoperatively localized by planar and single photon emission computed tomography/computed tomography images, and intraoperatively by gamma-probe. Immediately after SLN excision, all women underwent systematic pelvic and paraaortic lymphadenectomy by laparoscopy. Results: The study included 102 patients. The intraoperative SLN detection rate was 79.4% (81/102). Pelvic and paraaortic drainage was observed in 92.6% (75/81) and 45.7% (37/81) women, respectively, being exclusively paraaortic in 7.4% (6/81). After systematic lymphadenectomy, LN metastases were identified in 19.6% (20/102) patients, with 45.0% (9/20) showing paraaortic involvement, which was exclusive in 15.0% (3/20). The overall sensitivity and negative predictive value (NPV) of SLNs by the TUMIR approach to detect lymphatic involvement were 87.5% and 97.0%, respectively; and 83.3% and 96.9%, for paraaortic metastases. After applying the MSKCC SLN mapping algorithm, the sensitivity and NPV were 93.8% and 98.5%, respectively. Conclusion: The TUMIR method provides valuable information of endometrial drainage in patients at higher risk of paraaortic LN involvement. The TUMIR approach showed a detection rate of paraaortic SLNs greater than 45% and a high sensitivity and NPV for paraaortic metastases in women with intermediate and high-risk EC. [ABSTRACT FROM AUTHOR]

Introduction Germ cell tumors (GCT) represent less than 3% of all ovarian malignancies. They occur predominantly at young ages. The immature ovarian teratoma is the third commonest of the GCT, accounting for less than 1% of ovarian cancer cases worldwide. Growing teratoma syndrome (GTS) is a clinical entity characterized by a rapidly enlarging benign tumor mass, that arises during or after adjuvant chemotherapy for malignant ovarian GCT in presence of normal tumor markers. Its incidence has been reported to be from 2.5% to 19% of immature teratomas. We report an unusual case of GTS in a patient previously treated for recurrent stage IA immature teratoma of the ovary. Patients and results A 32-year-old nulligravida woman underwent right laparoscopic salpingo-oophorectomy because of suspected teratoma. Preoperative transvaginal ultrasound had identified a 12 cm complex cystic ovarian mass, with thin wall, a central solid component of 7 cm in size and two septa. Computed tomography (CT) did not show carcinomatosis nor other signs of disseminated disease. Serum tumor markers were normal except from α-fetoprotein (AFP)=156ng/ml. Removal of specimen was performed within an endobag. Intraoperatory histological examination informed benign teratoma. Final pathology revealed the presence of isolated foci of neuroepithelial immature tissue in one low magnification field of only one histological preparation, prompting the diagnosis of grade- 1 stage IA immature teratoma. The cytologic examination of peritoneal washing did not detect malignant cells. Tumor board decided to perform follow-up and this was agreed with the patient. Three months after surgery the patient consulted again for abdominal pain. Transvaginal ultrasound revealed the presence of a 15 cm complex solid mass in the right adnexal fossa. CT described a vast 20cm pelvic mass, a 7 cm left iliac fossa tumor, two Douglas pouch implants (2 and 2.5 cm), one 1.5 cm subhepatic implant and a 2 cm right iliac fossa implant. Elevated serum tumor markers were: CA-125=250U/ml, CA-19.9=97U/ml, TAG-72=19.8U/ml and AFP=3054ng/ml). Optimal citorreductive open surgery was performed, removing the pelvic tumor, cecal appendix, greater omentum and implants in Douglas pouch, uterine serosa, left ovarian surface, pelvic peritoneum and sigmoid colon serosa. Final pathology revealed a grade-3 immature teratoma in all resected lesions. The patient underwent adjuvant chemotherapy postoperatively with cisplatin, etoposide, and bleomycin (BEP x 4 cycles). Five months after surgery, a control CT scan was performed showing multiple 3 to 5 cm implants in the abdominal cavity. All tumor markers were normal. Another complete citorreduction that required a right hemicolectomy was achieved. Final pathology informed 39 implants, all of them presenting mature teratoma histology. Close follow-up was agreed. Conclusion Immature teratoma is an aggressive tumor that usually shows a good response to chemotherapy. Its aggressiveness remains on the proportion of tissue containing immature neural elements found. The occurrence of GTS should be bared in mind when dealing with immature teratoma. Surgical treatment with no residual disease is fundamental and should be always attempted. Long-term close follow-up is always needed. [ABSTRACT FROM AUTHOR]