Jonathan Peralta

Sentinel lymph node assessment in patients with atypical endometrial hyperplasia: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the rate of sentinel lymph node (SLN) metastases in patients with a pre-operative diagnosis of atypical hyperplasia/endometrial intra-epithelial neoplasia and endometrial cancer in hysterectomy specimens. A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the protocol was registered in PROSPERO (CRD42023416769). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from inception until April 2023. The inclusion criteria were patients with a pre-operative diagnosis of atypical hyperplasia/endometrial intra-epithelial neoplasia undergoing hysterectomy who did or did not undergo SLN assessment. Four studies met the inclusion criteria. All studies were non-randomized studies with a total of 10 217 patients, 1044 in the SLN group and 9173 in the non-nodal assessment group. The unilateral and bilateral detection rate was 89% (I The rate of SLN metastases in patients with pre-operative atypical hyperplasia/endometrial intra-epithelial neoplasia is less than 2%, suggesting that routine SLN evaluation may not be necessary in this population.

Management of invasive cervical carcinoma in three oncology centers in Latin America: A historical cohort study

Abstract Objective To describe clinical and sociodemographic characteristics of patients with invasive cervical cancer treated at three oncology centers in Latin America, as well as their risk factors, and management based on the FIGO stage 2009. Methods This is a descriptive historical cohort study of patients with invasive cervical cancer recruited between January 2010 and June 2016. The study describes demographic characteristics, risk factors, treatments, and oncological outcomes at 1 and 5 years. Results A total of 717 patients were included: 433 (60.39%) from INC Colombia, 174 (24.26%) from INCAN Mexico, and 110 (15.34%) from INEN Peru. Most patients were at FIGO Stage 2009 IIB 213 (29.70%), and the most common histologic subtype was squamous cell carcinoma 550 (76.71%). Concurrent chemo‐radiotherapy was the most frequent approach 334 (46.48%), followed by surgical treatment 261 (36.40%) patients. Regarding oncological outcomes, the 5‐year disease‐free survival (DFS) for all patients was 76.72% (95% CI: 73.34%–80.18%), with worse outcomes observed for Stages III and IV compared to early stages. The 5‐year overall survival (OS) for the general group was 83.76% (95% CI: 81.00%–86.73%), with statistically significant differences showing better outcomes for Stage I, with an OS of 94.52% (95% CI: 91.68–97.44). Conclusion In this descriptive historical cohort, most patients received treatment according to their clinical stage. Survival rates, both overall and disease‐free, were better for early‐stage disease compared to advanced stages.

Gastrointestinal stromal tumor: a rare case of ovarian involvement

Oncological impact of pelvic vessels embolization in patients with locally advanced cervical cancer treated with concomitant chemoradiotherapy

This study aims to address the impact of pelvic vessel embolization on oncological outcomes in patients with locally advanced cervical cancer treated with concomitant chemoradiotherapy. This is a retrospective single-center cohort study including patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics 2018 stages IB3-IVA), treated between January, 2010, and December, 2020. The primary outcome was overall survival, and the secondary outcome was disease-free survival. An inverse probability of treatment weighting was applied to balance baseline characteristics between groups and generate comparable cohorts. A total of 344 patients were included, of whom 8.4% (n = 29) underwent pelvic vessel embolization before the initiation of definitive treatment with concomitant chemoradiotherapy. In the embolized group, most (75.8%, n = 22) were classified as International Federation of Gynecology and Obstetrics 2018 stage III, and 44.8% of them (n = 13) had hemoglobin levels .05). Patients with cervical cancer who underwent pelvic vessel embolization had worse overall survival in this cohort. Further studies are required to confirm this association.

Morbidity of radical surgery and postoperative radiotherapy in cervical cancer

AbstractCervical cancer is among the most common cancers affecting women worldwide. The standard treatment for early‐stage cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] 2018 stages IA1–IB2, IIA1) typically involves a radical or simple hysterectomy with lymph node assessment. Postoperative management may include observation or tailored adjuvant therapy, such as radiotherapy or chemoradiotherapy, depending on individual pathological risk factors. However, these interventions are associated with significant complications: surgical management can lead to urinary and sexual dysfunction, lymphocysts, and lower limb lymphedema, while radiotherapy may cause genitourinary, gastrointestinal, and sexual toxicities. Less‐radical surgery for selected cases could reduce surgical morbidity and advances in radiotherapy techniques, such as intensity‐modulated radiotherapy, volumetric modulated arc therapy, and other three‐dimensional conformal radiation therapies, have the potential to enhance precision and reduce toxicity. Nonetheless, the morbidity associated with combining radical surgery and adjuvant (chemo)radiotherapy remains an area of uncertainty, particularly in light of these emerging technologies. Most current data on this topic derive from retrospective studies involving heterogeneous populations and inconsistent quality‐of‐life assessment methods. Prospective studies employing standardized morbidity assessment tools are essential to determine the true impact of combined treatments compared to single‐modality approaches. Future research should prioritize understanding the long‐term effects of these treatment strategies, aiming to minimize adverse outcomes while maintaining optimal oncological control.

Pelvic lymph node involvement and risk of recurrence in HPV‐associated endocervical adenocarcinoma stage IA2‐IB1 according to Silva's system in two Colombian cancer centers

AbstractObjectiveTo compare the pelvic lymph node involvement and risk of recurrence in patients with human papillomavirus (HPV)‐associated endocervical adenocarcinoma stage IA2‐IB1 undergoing hysterectomy and/or trachelectomy plus lymphadenectomy, according to Silva's classification system.MethodsA retrospective cohort study was performed in two Colombian cancer centers. The cases were classified according to the Silva classification system. Clinical, surgical, and histopathological variables were evaluated. Recurrence risk was analyzed by patterns A, B, or C. A logistic regression model was performed for tumor recurrence. The Kaplan–Meier method was used to estimate overall survival and disease‐free survival (DFS). A weighted kappa was performed to determine the degree of concordance between pathologists.ResultsA total of 100 patients were identified, 33% pattern A, 29% pattern B, and 38% pattern C. The median follow‐up time was 42.5 months. No evidence of lymph node involvement was found in patients classified as A and B, while in the C pattern was observed in 15.8% (n = 6) of cases (P < 0.01). There were 7% of cases with recurrent disease, of which 71.5% corresponded to type C pattern. Patients with Silva pattern B and C had 1.22‐ and 4.46‐fold increased risk of relapse, respectively, compared with pattern A. The 5‐year DFS values by group were 100%, 96.1%, and 80.3% for patterns A, B, and C, respectively.ConclusionFor patients with early‐stage HPV‐associated endocervical adenocarcinoma, the type C pattern presented more lymph node involvement and risk of recurrence compared to the A and B patterns. The concordance in diagnosis of different Silva's patterns by independents pathologists were good.