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Human papillomavirus (HPV) is causatively associated with cervical cancer (CC), the fourth most common malignant disease of women worldwide. The introduction of first generation prophylactic HPV vaccines in several national vaccination programmes has substantially decreased the global incidence of HPV cervical infections. Despite the success obtained, the two-licenced bivalent and quadrivalent L1 (the major HPV capsid protein) virus-like particle (VLP)-based vaccines (2vHPV and 4vHPV) present some limitations, such as a virus-type restricted protection, the high cost of the manufacture, and an absence of therapeutic activity on the established lesions. The second-generation prophylactic HPV vaccines, constituted by alternative viral components (such as capsomere or minor capsid HPV L2 protein) or made by more cost-effective strategies of production, are undergoing an intense clinical evaluation. This review aims to offer the reader a complete and updated overview on the HPV vaccination. The authors describe the effectiveness and the limitations of the approved HPV vaccines, and highlight the main characteristics of the new generation vaccines. IMPACT STATEMENT What is already known on this subject? CC is the fourth most common cancer of women in the world. HPV is the etiologic cause of almost all CCs. After being approved by the FDA, the first prophylactic 2vHPV and 4vHPV have been implemented into a routine vaccination schedule around the world, substantially decreasing the incidence of HPV and related-diseases in countries with high coverage rates. Currently, research is focusing on finding innovative and alternative systems to produce and deliver new HPV vaccines, overcoming all of the limitations that have partly restricted the potential benefit of previous vaccines on public health. What do the results of this study add? This narrative review was performed to find all the published studies reporting the efficacy and limitations of 2vHPV and 4vHPV, and evaluating the new HPV vaccines under pre- and clinical investigation. What are the implications of these findings for clinical practice and/or further research? Next generation of HPV vaccines will address many, if not all, of the limitations associated with current vaccines and will represent a step forward in the fight against CC. [ABSTRACT FROM AUTHOR]

The role of adopting PET/CT and its cost-effectiveness in the context of sentinel node mapping have to be further validated into prospective trials. As observed for CT scan [[8]], in high-risk patients PET/CT would be useful in identify gross intra-abdominal disease and suspected nodes, thus tailoring surgical plans. Accumulating data suggested that sentinel node mapping improves detection rate of positive nodes in comparison to lymphadenectomy, thanks to the application of ultrastaging on sentinel nodes harvested. [Extracted from the article]

Then, minimally invasive nerve-sparing radical hysterectomy improves both peri-operative outcomes and pelvic floor dysfunctions, thus representing a win-win scenario for cervical cancer patients [[8]]. Although minimally invasive nerve sparing radical hysterectomy is associated with improved preoperative outcomes in comparison with open surgery, the potential detrimental oncologic results related to the execution of a minimally invasive procedure limited the adoption of laparoscopic and robotic assisted procedures in this setting. [Extracted from the article]