IJGC Podcast

SLN in Endometrial Hyperplasia with Andrea Rosati

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Andrea Rosati. Mr. Rosati is a consultant at the Department of Gynecologic Oncology at Fondazione Policlinico Universitario Agostino Gemelli in Rome (Italy). He is currently attending a second level master "Gynecologic Oncology International Master" at the Catholic University of the Sacred Heart (Rome, Italy) accredited as a Subspecialty Fellowship by the European Society of Gynaecological Oncology. His main interest areas are gynecological cancer, surgical anatomy, and gynecologic oncology surgery.
 
Highlights:
This study evaluated the prevalence of concurrent endometrial cancer in patients with pre-operative diagnoses of atypical endometrial hyperplasia undergoing hysterectomy. 
Among 460 patients, 47.2% were found to have concurrent endometrial cancer.
According to ESGO-ESTRO-ESP classification, 71.4%, were low-risk, 9.7% intermediate, 11.1% high to intermediate and 7.8% high-risk tumors.
Positive Lymph node were found in 12 patients, accounting for the 7.6% of concurrent endometrial cancers who underwent SLN biopsy.
SLN biopsy allowed for the adjustment of adjuvant therapy in 12.3% of high to intermediate-risk patients without increasing operative time or complication rates. 
 

ESGO Vulvar Cancer Guidelines 2023 with Maaike Oonk

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Maaike Oonk to discuss the ESGO Vulvar Cancer Guidelines for 2023. Dr. Oonk is a gynaecological oncologist in the University Medical Center Groningen in the Netherlands. Her research focuses on new treatment options for vulvar cancer patients to improve quality of life. She is PI of the GROINSS-V studies and was chair of the 2023 ESGO vulvar cancer guidelines working group.
 
Highlights:
Inguinofemoral radiotherapy is a safe alternative for a lymphadenectomy in patients with micrometastasis in the sentinel node.
In case of unilateral sentinel node involvement, it is probably safe to omit treatment of the contralateral (sentinel node negative) groin.
Studies are ongoing on application of the sentinel node procedure in locally recurrent disease, tumors > 4cm or multifocal tumors: outside these studies, the sentinel node procedure should only be applied in patients with unifocal primary squamous cell vulvar cancer < 4cm.
In advanced disease, both primary chemoradiation and radical surgery are treatment options. The Vulcanize study is investigating the role of neoadjuvant chemotherapy in these patients.
Given the rareness of this disease, treatment of vulvar cancer should be centralized in specialized centers.

IDEAL Framework: Robotics Innovation and Evaluation with Hani Marcus

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Mr. Hani Marcus to discuss the IDEAL Framework. Mr. Marcus is a Consultant Neurosurgeon at the National Hospital for Neurology and Neurosurgery and Honorary Associate Professor at the UCL Queen Square Institute of Neurology.
 
Highlights:
- The development of the next generation of surgical robotics presents unique challenges in evaluation due to their complexity, integration with AI, and potential for system disruption.
- The IDEAL (Idea, Development, Exploration, Assessment, and Long-term monitoring) Robotics colloquium suggests practical recommendations for evaluating surgical robots at different stages: development, comparative study, and clinical monitoring.
- These recommendations are aimed at developers, clinicians, patients, and healthcare systems, considering multiple aspects like economics, training, ethics, and sustainability.

2024 IJGC Special Issue with Christina Fotopoulou, Ane Gerda Z. Eriksson, Glauco Baiocchi, and Oliver Zivanovic

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Christina Fotopoulou, Ane Gerda Z. Eriksson, Glauco Baiocchi, and Oliver Zivanovic to discuss the 2024 Special Issue of IJGC, “Novel Surgical Approaches in Gynecological Oncology”. Dr. Fotopoulou is the Chair of Gynaecological Cancer Surgery at the Department of Surgery and Cancer at Imperial College London, UK. She has served as an elected ESGO council member and Chair of the ESGO and BGCS guidelines committee. Dr. Eriksson is the chair of the endometrial cancer and gyn sarcoma group at the Department of Gynecologic Oncology at the Norwegian Radium Hospital. She is currently an elected ESGO Council member and chair of the ESGO accreditation committee. Dr. Eriksson also serves on the NSGO-CTU Foundation Board.  Dr. Glauco Baiocchi is the head of the Department of Gynecologic Oncology at the AC Camargo Cancer Center. He is also the president of the Brazilian Gynecologic Oncology Group – EVA Group. Oliver Zivanovic MD is a Gynecologic Oncologist and Chairman of the Department of Obstetrics and Gynecology at the Women's Heidelberg University Hospital, Germany. 
 
Highlights:
Surgery is the cornerstone of treatment in gynecologic oncology.
Surgery is being incorporated and adapted to the evolving treatment landscape in gynecologic oncology. 
This special issue highlights the opportunities of tailoring surgical approaches to individual patients both in regard to radically and novel surgical techniques. It brings together out of the box topics such as surgery for lymphedema, uterine transposition, imaging, quality of life, and medico-legal aspects. 
All articles were written by respected and well-known experts on each topic.
Our hope and intention is that this Special Issue will become a significant resource in surgery for gyn oncology and may support and inspire surgeons to deliver better treatment.

The INTERLACE Trial with Mary McCormack

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Mary McCormack to discuss the INTERLACE trial. Dr. McCormack is an Honorary Consultant Clinical Oncologist at University College London Hospitals NHS Trust and an Honorary Associate Clinical Professor at University College London.
 
Highlights:
• INTERLACE first randomised PH3 trial in Locally advanced cervical cancer in more than 2 decades to demonstrate a clinically meaningful and statistically significant improvement in both OS and PFS .
• The IC drugs are widely available and relatively cheap so removing many potential economic barriers to adoption.
• Growth factors -GCSF/Filgrastim should be used as needed to ensure patients complete the chemotherapy (IC & cisplatin)
• Essential to BEGIN the external beam radiation within 7 days of last dose ( #6) of IC.
• Remember OVERALL treatment time for the RADIATION- 96% in trial completed both EXTERNAL BEAM & BRACHYTHERAPY within 56 days.

innovaTV205 with Ignace Vergote

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Professor Em. Ignace Vergote to discuss innovaTV205. Prof. Vergote was Chairman of the Department of Gynaecology and Obstetrics at the Catholic University Leuven from 2003-2020. He published more than 1050 papers on gynecologic cancer in peer-reviewed journals, and his work was cited more than 90,000 times. He served as President of IGCS, ESGO, EORTC-GCG and ENGOT.
 
Highlights:
Tissue factor is almost always highly expressed in cervical carcinoma and can be targeted by tisotumab vedotin (TV), an antibody-drug conjugate.
TV combined with bevacizumab, carboplatin, or pembrolizumab demonstrated manageable safety and encouraging antitumor activity in treatment-naive and previously treated recurrent/metastatic cervical cancer.
The results show that the combination of TV with current treatments may improve outcomes and provide novel treatment options for patients with first or later recurrences and/or primary metastatic cervical cancer.

Trends and Complications after the LACC Trial with Gabriella Schivardi

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Gabriella Schivardi to discuss trends and complications after the LACC Trial. Dr. Schivardi is a first year ESGO fellow at the European Institute of Oncology in Milan and a research collaborator at the Gynecologic Oncology Department at Mayo Clinic, Rochester, United States. In addition, she is a former fellow for the IJGC.
 
Highlights:
The study observed a significant decrease in the use of the minimally invasive approach after the publication of the LACC trial.
Within our population the 30-day major complication, minor complication, and unplanned hospital readmission rates remained stable between the pre- and post-LACC periods.
The study observed an increased rate accross the publication of the LACC trial limited to the intra and post-operative transfusion rate.
The lack of a rise in 30-day complication rates after the LACC trial publication supports the use of laparotomy as the standard of care.

Reviewing the February Issue with Sabrina Piedimonte and Ilaria Capasso

In this episode of the IJGC Podcast, Editorial Fellow Sabrina Piedimonte and Ilaria Capasso discuss the contents of the February issue of IJGC.

ITCs in Low-Risk Endometrial Cancer with Giuseppe Cucinella, Andrea Mariani, and Gretchen E. Glaser

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Giuseppe Cucinella, Andrea Mariani, and Gretchen E. Glaser to discuss ITCs in low-risk endometrial cancer. Giuseppe Cucinella, MD, is a gynecologist working at Istituto Nazionale Tumori IRCSS Fondazione G.Pascale in Naples, Italy (Department of Gynecologic Oncology). During his residency, he worked as a research fellow at Mayo Clinic in Rochester, Minnesota, where he focused on the study of endometrial cancer. He is currently in the second year of the PhD program in "Experimental Oncology and Surgery - Gynecologic Oncology" at the University of Palermo, Palermo (Italy). Dr. Cucinella's clinical research focuses on the diagnosis and treatment of endometrial cancer and minimally invasive surgery in gynecologic oncology. Dr. Andrea Mariani is a Full Professor in the Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, at Mayo Clinic in Rochester, Minnesota.  Dr. Mariani is the Gynecologic Oncology Division Chair in the Department of Obstetrics and Gynecology.  Dr. Mariani’s research interest is endometrial cancer with a special interest in robotic surgery. He is internationally recognized for his contributions in the advancement of surgical and postoperative treatment of endometrial cancer. Gretchen E. Glaser, MD is a Gynecologic Oncologist at Mayo Clinic specializing in complex surgery for malignant and benign conditions, including minimally invasive and open approaches. In addition to her clinical work, Dr. Glaser focuses her clinical research in endometrial cancer diagnosis, treatment, and outcomes as well as quality improvement of surgical care using enhanced recovery after surgery techniques. She also serves as the Vice Chair and Practice Chair for Obstetrics and Gynecology and has a special interested in patient and physician wellness.
 
Highlights:
• The aim of our study was to evaluate the prognostic value of SLNs-isolated tumor cells in patients with low-risk endometrial cancer who underwent SLN biopsy and did not receive adjuvant therapy. Outcomes were compared with node negative patients.
• Our study shows that recurrence free survival among patients with low-risk endometrial cancer and no adjuvant treatment was significantly worse in patients with SLNs–isolated tumor cells compared with negative nodes. However, we did not observe any significant difference in overall survival.
• The presence of SLNs-isolated tumor cells, lymphovascular space invasion, and International Federation of Obstetrics and Gynecology (FIGO) grade 2 were significant risk factors for recurrence (any recurrence and non-vaginal recurrence).
• Our group has designed a prospective multicenter cohort study called ENDO-ITC with the aim of definitively establishing the prognostic role of ITC in an otherwise low-risk population who undergo SLN biopsy. In addition, we will evaluate a standardized follow-up plan for these patients.

Immunotherapy in Vulvar Melanoma with Dimitrios Nasioudis

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Dimitrios Nasioudis to discuss immunotherapy in vulvar melanoma. Dr. Nasioudis is from the Division of Gynecologic Oncology at the Abramson Cancer Center of the University of Pennsylvania. His current research focuses on translational therapeutics and population-based research with an emphasis on rare gynecologic tumors.
 
Highlights:
• Prognosis of patients with vulvar melanoma and inguinal lymph node metastasis is poor.
• In our study using real-world data approximately 1 in 4 patients received adjuvant immunotherapy with no clear overall survival benefit.           
• Further research to identify biomarkers to select patients who may benefit from immunotherapy is needed.