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Background: Bulky or multiple lymph node (LN) metastases are associated with poor prognosis in cervical cancer, and the size or number of LN metastases is not yet reflected in the staging system and therapeutic strategy. Although the therapeutic effects of surgical resection of bulky LNs before standard treatment have been reported in several retrospective studies, well-planned randomized clinical studies are lacking. Therefore, the aim of the Korean Gynecologic Oncology Group (KGOG) 1047/DEBULK trial is to investigate whether the debulking surgery of bulky or multiple LNs prior to concurrent chemoradiation therapy (CCRT) improves the survival rate of patients with cervical cancer IIICr diagnosed by imaging tests. Methods: The KGOG 1047/DEBULK trial is a phase III, multicenter, randomized clinical trial involving patients with bulky or multiple LN metastases in cervical cancer IIICr. This study will include patients with a short-axis diameter of a pelvic or para-aortic LN ≥2 cm or ≥3 LNs with a short-axis diameter ≥1 cm and for whom CCRT is planned. The treatment arms will be randomly allocated in a 1:1 ratio to either receive CCRT (control arm) or undergo surgical debulking of bulky or multiple LNs before CCRT (experimental arm). CCRT consists of extended-field external beam radiotherapy/pelvic radiotherapy, brachytherapy and LN boost, and weekly chemotherapy with cisplatin (40 mg/m2), 4--6 times administered intravenously. The primary endpoint will be 3-year progression-free survival rate. The secondary endpoints will be 3-year overall survival rate, treatment-related complications, and accuracy of radiological diagnosis of bulky or multiple LNs. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the current status of postoperative management of uterine endometrial cancer (EC) in Korea. Methods: A mail survey was administered to members of the Korean Gynecologic Oncology Group and Korean Radiation Oncology Group. A total of 38 gynecologic cancer surgeons (GYNs) and 31 radiation oncologists (RO) in 43 institutions was responded. The questionnaire consisted of general questions for clinical decision and clinical case questions. The GYN and RO responses were compared using chi-square statistics. Results: The 2 expert groups had similar responses for clinical decision based on the results of the Gynecologic Oncology Group (GOG)-249 and Postoperative Radiation Therapy for Endometrial Carcinoma-III trials in the early-stage EC. In contrast, the responses based on GOG-258 results differed, as GYNs most frequently opted for sequential chemotherapy (CTx) and radiotherapy (RT), while ROs preferred concurrent chemoradiotherapy in locally advanced stage (p<0.05). Based on the GOG-258, GYNs preferred CTx alone for adjuvant treatment of serous or clear cell adenocarcinoma histology, whereas ROs advocated for combined CTx and RT (sequential or concurrent). Among the clinical case questions, GYNs were more likely than ROs to choose CTx alone rather than the combination of CTx and RT (sequential or concurrent) as the answers to case questions representing patients with locally advanced stage or unfavorable histology (all p<0.05). Conclusion: The present study showed several different opinions of GYNs and ROs regarding adjuvant treatment for EC, particularly for adjuvant RT in advanced stage or unfavorable histology. [ABSTRACT FROM AUTHOR]

Background: Although recent two phase 3 randomized controlled trials showed survival benefit of secondary cytoreductive surgery in first relapsed ovarian cancer, the patients who received PARP inhibitor (PARPi) as first-line maintenance which is thought as standard treatment nowadays were not included in these trials. Therefore, there is a significant need for optimal strategy including secondary cytoreductive surgery in patients whose cancer progresses while using a PARPi. The aim of SOCCER-P is to find out whether secondary cytoreductive surgery is beneficial in patients who have progressed on PARPi maintenance. Methods: The SOCCER-P is a multicenter, investigator-initiated, randomized phase II trial of secondary cytoreductive surgery in patients with first relapsed ovarian cancer who have progressed on PARPi. This trial included patients with the first recurrence of platinum-sensitive ovarian cancer who had a treatment free interval from last platinum dose (TFIp) 6 months and progressed on PARPi maintenance. Patients who are considered likely to be completely resected according to the international model (AGO or iMODEL) or based on a consensus between the surgeon and designated radiologist are eligible for this study. A total of 124 subjects are randomly assigned to undergo secondary cytoreductive surgery and subsequent platinum-based chemotherapy plus or minus bevacizumab, or to receive platinum-based chemotherapy plus or minus bevacizumab alone. The primary endpoints were progression-free survival. A one-sided log-rank test with an overall sample size of 124 subjects (62 in the control group and 62 in the treatment group) achieves 80.1% power at a 0.100 significance level to detect a hazard ratio of 0.6500. [ABSTRACT FROM AUTHOR]

The sociomedical environment is changing. In the traditional physician-patient relationship, the physician was authoritative and the patient was obedient. The contractual relationship featured patient consent to the physician's decision. Today, the physician must explain fully the planned medical treatment, and any alternative, to the patient, who has the right to choose her treatment after considering the benefits and side-effects. The Korean Society of Gynecologic Oncology (KSGO) thus decided to standardize the surgical consent forms to meet the legal requirements of modern medicine, improve patient understanding of the surgical details, and protect medical staff from legal disputes. To determine the format and content, subcommittees for each cancer type collected and reviewed all relevant articles and the current consent forms of domestic medical institutions. After several meetings, 16 basic items to be included for each type of gynecologic cancer were selected. Also, to help patients understand the surgical details, figures were included. The revised forms were legally reviewed in terms of the appropriateness of the format and content. We also developed English versions to provide adequate information for foreign patients. We hope that these efforts will promote trust between patients and physicians, and contribute to effective treatment by laying a foundation of mutual respect. [ABSTRACT FROM AUTHOR]

Objective: To compare survival outcomes between bevacizumab (BEV) and olaparib (OLA) maintenance therapy in BRCA-mutated, platinum-sensitive relapsed (PSR) high-grade serous ovarian carcinoma (HGSOC). Methods: From 10 institutions, we identified HGSOC patients with germline and/or somatic BRCA1/2 mutations, who experienced platinum-sensitive recurrence between 2013 and 2019, and received second-line platinum-based chemotherapy. Patients were divided into BEV (n=29), OLA (n=83), and non-BEV/non-OLA users (n=36). The OLA and non-BEV/non-OLA users were grouped as the OLA intent group. We conducted 1:2 nearest neighbor-matching between the BEV and OLA intent groups, setting the proportion of OLA users in the OLA intent group from 65% to 100% at 5% intervals, and compared survival outcomes among the matched groups. Results: Overall, OLA users showed significantly better progression-free survival (PFS) than BEV users (median, 23.8 vs. 17.4 months; p=0.004). Before matching, PFS improved in the OLA intent group but marginal statistical significance (p=0.057). After matching, multivariate analyses adjusting confounders identified intention-to-treat OLA as an independent favorable prognostic factor for PFS in the OLA 65P (adjusted hazard ratio [aHR]=0.505; 95% confidence interval [CI]=0.280-0.911; p=0.023) to OLA 100P (aHR=0.348; 95% CI=0.184-0.658; p=0.001) datasets. The aHR of intention-to-treat OLA for recurrence decreased with increasing proportions of OLA users. No differences in overall survival were observed between the BEV and OLA intent groups, and between the BEV and OLA users. Conclusion: Compared to BEV, intention-to-treat OLA and actual use of OLA maintenance therapy were significantly associated with decreased disease recurrence risk in patients with BRCA-mutated, PSR HGSOC. [ABSTRACT FROM AUTHOR]

Best survival strategy for advanced ovary cancer treatment is surgical part and chemotherapy. Surgical debulking is composed of gynecologic and other area depending on surgeon's consultation, but without evident remnant image finding and detailed operation record, it's relatively subjective. Then, evidence based predictive test can be utilized objectively. We report one personally adapted precision treatment for advanced ovary cancer patient. A 69 years old Korean woman with pelvic ascites visited a Samsung Changwon Hospital. Her CA 125 was 10893. Staging operation was done with GS consultation. Surgery date: 2023 February. Staging op including hysterectomy was done with total proctocolectomy with end ileostomy. Pathology: BO (14/13 cm) SB mesentery, spleen, peritoneum, LN (+), right after operation during her recovery, precision test regarding predictive marker is done fully. Results: ER/PR/HER2/PD-L1(+/+/-/<1%) (MSS) NGS (Germline): SUFUBCNS, MDB, basal cell nevus syndrome, medulloblastoma. NGS (Somatic): TP53, MYC - Copy gain, MAPK1 - Copy gain (Wz4002)AURKA-Copy gain, FMO3--PDGFRA RET--PARP11. FoundationOne Liquid CDx: TP53 R2373C, DNMT3A E473fs*175, W306*Myriad HRD: 66 (No BRCA 1,2 somatic mutation). We recommend PAOLA 1 regimen for her. She agreed physician's choice. Her chemotherapy schedule was: 2023 March-July: Taxol-carboplatin #6 (CA 125:1049--91--23- 12-10-8) 2023 June-Present Avastin 15 mg/kg IV q 3weeks (#7) +2023 August-Present Lynparza 600 mg po (CA 125:7--6.7--7.0--7.2--7.2) AP CT (2023 November): CR. There is still uncertainty regarding her future recurrence. It's not easy to apply evidencebased precision medicine for all advanced ovary cancer patient due to available predictive test, insurance and cost. But it's even harder to prohibit one precious patient from approaching evidence treatment in the era of vast open information changing environment. [ABSTRACT FROM AUTHOR]

Objective: Lynch syndrome is a hereditary cancer syndrome that increases the risks of colorectal and gynecologic malignancies such as endometrial and ovarian cancer. Studies have shown that mutations in mismatch repair genes (MSH2, MSH6, and MLH1) are associated with Lynch syndrome. The aim of our study was to estimate the value of MSH2, MSH6, and MLH1 immunohistochemistry based on family history in a Korean sample. Methods: Thirty six women with synchronous gynecologic tumors of endometrial and ovarian cancer were identified among patients being treated at our institution. Among them, 32 patients had tumor blocks (total 62 slides) available for analysis. According to a diagnostic algorithm, we performed immunohistochemistry analyses. Staining was scored based on intensity and proportion (negative or 0: intensity undetectable or minimal, proportion <5%; weak or 1+: intensity mild, proportion 5-30%; strong or 2+: intensity moderate to marked, proportion 30-99%). Results: Among 32 eligible patients, 9 (28%) had a family history of cancer. Six patients (19%) were negative for MLH1; among them, four (4/6) were negative at both sites. Nine patients (28%) were negative for MSH2 or MSH6 at both sites or negative for both MSH2 and MSH6. Among these three patients showed negative staining for both sites. The three patients showing negative staining for MLH1, MSH2, and MSH6 at both sites with family history were considered to be the screening positive groups of Lynch syndrome. Conclusion: In this study, the frequency of Lynch syndrome associated immunohistochemical staining (MLH1, MSH2, and MSH6) group was estimated as 9% (3/32) among Korean women with synchronous gynecologic tumors. [ABSTRACT FROM AUTHOR]